I’ve been snooping around talking to experts in the insurance industry on the possibilities of 1Care Malaysia’s proposed modus operandi. Whether what I have learnt is the actual modus operandi to legally rob taxpayers is anybody’s guess now as the Barisan Nasional (BN) government has refused to release details of its plan and intentions.
Experts say the government is expected to initially set up a National Healthcare Financing Authority (NHFA) for approval submission. Upon approval, it will be structured into a government-linked company (GLC), owned by BN cronies.
Little birds say the NHFA will be controlled by some big fellas with nominees. It is also believed that a relative of one of those eyeing the multi-billion-ringgit gravy train had planned and structured the 1Care proposal.
The scheme will likely be underwritten by more than one local insurance company.
These companies will partially reinsure (maybe up to as much as 70%) with an overseas reinsurance company, through another “agent” who could be based in Labuan.
Commission allowable from local insurance companies (to NHFA) can be anything from 10% to 25% of premium depending on negotiations. Commission allowable from reinsurance company to the “agent” is normally 3% to 5% and payable outside Malaysia into the “agent’s” account.
Health Ministry deputy director for the National Health Financing unit Dr Rozita Halina Hussein, amidst what the government terms as speculations and twisted facts, told the media yesterday (Feb 9, 2012) that 1Care would have to be made mandatory.
That is what we already know (or what the government accused us of speculation). However, what they are not telling is the quantum and limited benefits while Malaysian taxpayers pay through their noses.
They are also not telling who will benefit from the billions of ringgit, year in and year out!
Based on available information, every household will be made to pay up to 9.4% of gross household income for social health insurance. The payers will be the individual, the employer and the government via taxes, the exact proportion still being worked out.
There shall be no choice. Everyone has to pay. There is no opting out. We have to pay upfront. It will no longer be fee-for-service; it is fee-before-service. There has been no information on exactly how this payment will have to be made or how the government will collect from self-employed people.
The government will be expected to contribute to the insurance premiums of government pensioners, civil servants and five dependents. But the problem is: 1Care does not cover all your medical expenses; only for a prescribed basic list of what “you can have” healthcare items.
Anything more than basic you will have to pay your own. Your long-serving independent family doctor will have to join the system or will not be allowed to see you under the 1Care scheme. The robust, cost-effective independent clinics serving the country will be replaced by 1Care clinics.
You cannot pick your own doctor. 1Care will allocate a doctor to you. If you want to see a doctor of your choice, you’ll need to pay for that from your own pocket. Your allocated doctor will decide when and which specialist you can see if the need arises (a process called gate-keeping). The NHFA will pay GPs RM60 (present proposal) for each patient as consultation fees. It does not include medicine.
Compare this with presently, for cough and cold visit, the GP would charge RM20 to RM30 for consultation and medicine. With 1Care: Consultation for GP visit is RM60 and this does not include medicine.
You cannot see your doctor as and when you feel the need arises. There will be a rationing system in place as well. There will also be rationing for specialist care with the GP as the gate-keeper. Likewise if you wish to see the specialist of your choice or go to a hospital of your choice, unless referred by your allocated doctor, you will also have to pay out of your pocket.
Even if you only see the doctor once in a year, you will not get a refund from 1Care. Your medical costs are prepaid in advance irrespective of whether you become sick or not.
You are also expected to make an additional co-payment for your visit. This is to discourage you from seeing doctors too often.
You will be prescribed only medicines from a standardised list of not-the-original medicines in keeping with the WHO list of essential medications. This will save cost for 1Care and maximise profit for the insurance companies. Insurance companies will have a major say in the price and the range of this standardised medicine list. It will likely to be the cheapest medicine.
The doctor will only give you injections. You’ll need to get all other medicines from a pharmacist, even if it means hauling three sick children with high fever along a hot, dusty busy street looking for the nearest pharmacy.
If you do not like what is given to you, you can get alternative care by paying out of your own pocket. For such a crappy deal, taxpayers would fork out about RM45 billion a year! So Malaysians, do you get the big picture now how the BN government loves to care for you!
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