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Time for Health Ministry to provide perks
Published on: Sunday, July 30, 2017

By Datuk Dr S. H. Lee
IT was recently reported that up to 500 clinics have been forced to close in the peninsular due to poor business.

It is an early warning sign of the future of medical care in our country – heading into an unsustainable situation of increasing cost and deteriorating standard of care.

Over-regulation of the GPs in the absence of regulating the other parties, in fact, is the root cause of the GPs’ problems.

Healthcare provision and financing have changed in the last 30 years, from a focus on availability to accessibility, equity and quality. Data collected over the last 30 years in high and middle-income countries clearly demonstrate that unregulated health systems contribute little to equity and social justice, and failed to get the best health outcomes for money.

The World Health Organization (WHO) observatory data clearly demonstrated that effective primary care directed at public needs and demand is the single most important factor to reduce healthcare cost and enhance performance.

When Dr Margaret Chan took office as Director-General of WHO in 2007, she reiterated the Alma-Ata declaration of “health for all” and the WHO 2008 annual report was titled Primary Health Care: Now More Than Ever.

Four areas of reform were identified, all of which necessitated an efficient high quality primary service.

One of the major barriers to healthcare reform in this report was “health systems where a hands-off or laissez-faire approach to governance has allowed unregulated commercialisation of health to flourish”, to the detriment of overall care.

Commercialisation of healthcare delivery created the infamous “medical-industrial complex” (Arnold Relman, N Engl J Med. 1980, 303:963-970) and resulted in the most expensive and relatively inefficient healthcare of the world in the United States.

With commercialisation came the large number of industries, stockholders, investors, business giants, private insurers, managed care organisations, lawyers and hundreds of thousands of non-medical personnel, all of whom demand a much larger portion of the USS$2.2tril dollar pie.

Soon, non-medical supporting services became the masters of the game and frontline workers were forced to comply, or perish.

Garrett Hardin (1968) coined the term “The Tragedy of the Commons” (Science 162 (3859), p1243-1248.

Garrett Hardin, Dec 13, 1968) in his discussion on population control. He provided the example of farmers allowing their cattle to graze on a common pasture. As each farmer, to their own benefit, increases the number of cattle, the land exceeds its carrying capacity and leads to the “ruin” of all, resulting in the “tragedy of the commons”.

The total resources available that any society can devote to medical care may be viewed as analogous to the grazing area on Hardin’s commons. Ultra-regulation of the sheep soon leads to explosive growth of the dinosaurs.

The quality of the commons then deteriorates and eventually we risk reaching a point where marginal gains to individuals threaten the welfare of the whole.

“Ruin,” concluded Hardin, “is the destination towards which all men rush, each pursuing his own best interest in a society that believes in the freedom of the commons. Freedom in commons brings ruin to all.”

Unregulated commercialisation of healthcare will eventually lead to either a general fall of standard and quality of care; or unaffordable care to a large proportion of the population for whom the entire system was originally set out to serve.

Hardin’s solution to this problem was “mutual coercion”, which in Malaysian terms may be translated as mutual give-way and cooperation to achieve the goal of our people.

There is thus an urgent need for the Health Ministry to incentivise providers to give high-quality, effective treatment while promoting a rational allocation of resources and, more importantly, to create a meaningful platform of communication of all stakeholders for the needs of the public.

Datuk Dr S. H. Lee

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