Two-tier system in general hospitals would undermine community solidarity

The proposal to extend the controversial “full-paying patients” scheme to more general hospitals has raised concern.

Jan 06, 2017

By Anil Netto
The proposal to extend the controversial “full-paying patients” scheme to more general hospitals has raised concern.

Under this scheme, patients in government hospitals who are able to pay more can opt to jump queues to receive faster treatment from government specialists of their choice. They would also be able to enjoy “additional facilities, subject to availability of existing resources, field of specialty and services” and stay in “first-class” and “executive” wards.

The government specialists under this scheme would, in turn, be able to earn more — the idea being that they would then be less inclined to quit and move to the more lucrative private sector.

On paper it may look good. But there are fundamental and ethical problems with this scheme.

With this scheme, the more experienced specialists will be much in demand, devoting more time to patients who are able to pay more, including after their regular working hours.

These specialists could succumb to the all-too-human tendency of spending more of their time and energy where they can earn more money — ie with the patients who can afford the higher rates under the scheme.

The result of the long hours could be that these specialists end up less energetic and enthusiastic in their treatment of patients who are not in the scheme. In short, chances are the scheme could give rise to a bias in favour of patients who can pay more.

At present, the pilot project for this scheme has been implemented in Selayang and Putrajaya general hospitals. In Putrajaya Hospital, for instance, the daily bed charges under the scheme range from RM80/day (first class ward, four beds) to RM400/day (for critical/intensive/coronary care). Consultation charges for inpatients range from RM60 to RM180 (for intensive care).

Now, the plan is to extend the scheme to general hospitals in Kota Bharu, Kuala Trengganu, Kuantan, Temerloh, Ipoh, Kuala Lumpur, Klang and Seremban.
This could result in patients who can’t afford these rates being handled mainly by less esperienced specialists.

The result would be a two-tier system within the general hospitals in the country — to add to the existing two-tier system of public and private hospitals.
The problem is that some 80 per cent of specialists, with over 10 years of experience, are already working in the private sector.

But 70 per cent of inpatients in Malaysia are in government hospitals. That means the 20 per cent of experienced specialists in Malaysia will have to handle a large majority of Malaysian inpatients.

With this scheme, this 20 per cent of specialists will then be distracted from giving their full attention to these inpatients, many of them from the lower-income group.

The full-paying patients scheme thus undermines community solidarity in the financing of our public hospitals, especially for those who have no other alternative but to rely on government hospitals.

Community solidarity is one of the bedrock principles of Catholic Social Teaching.

We pay taxes to the government so that it can provide essential services to the people — water supply, education and healthcare at nominal rates that even the poor can afford. In a progressive taxation system, the wealthy are in effect subsidising (through their taxes) the vulnerable and the marginalised who are unable to afford quality essential services.

Unfortunately, only about 2 per cent of our GDP goes to our public healthcare system, which would mean it is underfunded. Rather than extracting higher fees from patients (including low-income foreigners) who seek treatment in government hospitals through the full-paying patients scheme, the government should increase its budget allocations for public healthcare.

We need to build up community solidarity through a properly funded public healthcare system. Aneurin Bevan, who was instrumental in setting up Britain’s National Health Service, spoke some eternal truths, when he said: “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community.

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

To create a two-tier system within our government hospitals would further undermine our community solidarity.

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