Health Minister Chua Jui Meng prior to last year's general election announced that the government had decided to shelve its privatisation policy of hospitals. His announcement was universally lauded as there was extreme disquiet over a policy which was seen to be wasteful and particularly disadvantageous to the lower income groups in Malaysia.

It is instructive to note that there has been an average increase of about 250 percent in cost since 1996 when the Health Ministry privatised the five hospital support services - cleaning, laundry, clinical waste, maintenance of biomedical equipment, and emergency power supply.

Among the crony companies given these contracts without any serious tender were Faber (a Renong subsidiary) and Tongkah Holdings (owned by Mokhzani Mahathir). At a public seminar last year, where members of the Economic Planning Unit (EPU) were present, the Hospital Director of University Hospital outlined the subcontracting of Health Ministry-approved tenders to other crony-linked companies:

A RM100 million Health Ministry contract was tendered to Faber, which subcontracted it to Propel-Johnson (another Renong subsidiary) for RM65 million, handing Faber a RM35 million profit for doing nothing! Surely this is an abuse of sorely-needed taxpayer money meant for the health of the nation.

Another Health Ministry contract worth RM60 million tendered to Faber was subcontracted to Propel-Johnson for RM40 million, and in turn subcontracted for RM25 million. Clearly, RM35 million was siphoned by crony companies. None of the EPU staff members present challenged the Hospital Director's revelations.

How can Chua Jui Meng argue that the above privatisation has been beneficial to the health service? Will he give us his assurance that no such privatisation or corporatisation will ever take place again? There must be open tendering, not crony tendering.

The government's policy of corporatisation/privatisation of healthcare has been a failure and resulted in limited resources being abused in a despicable way by crony companies.

Why is there a contradictory policy over healthcare financing between the Health Ministry and Education Ministry? The corporatisation policy at University Hospital (UH) has not been cost effective (as the 250 percent increase in cleaning service charges following corporatisation shows). How can this be justified?

In March 2000, the hospital further increased its charges by over 100 percent for many essential lifesaving procedures. Electro cardiacgram (ECG) increased to RM40 (from RM20), exercise ECG RM240 (RM120), angiogram RM1,300 (RM600), emergency heart pacing wire RM700 (free).

Is this the hallmark of a caring society? Many patients are now opting not to come to UH as a result of these exorbitant charges. Surely, it is unethical to deny patients these facilities just because they can't afford them.

Patients who can't afford these fees are refused these essential procedures and referred to Bahagian Kebajikan (Welfare Section). Almost always, only a small proportion of the cost is waived and patients who really can't afford are allowed to pay in installments.

Many patients feel humiliated going through this process, particularly if they are told that they should depend on their children or relatives to foot the bill. It is an increasing problem that poor patients are simply not undertaking these procedures because they find them financially prohibitive.

Are teaching hospital facilities, funded by the taxpayer, increasingly going to cater for middle class and rich members of society only? Does the Education Ministry not agree with the creation of a "caring society" as outlined in Vision 2020?

Healthcare in any civilised and moral society should be at the point of need and should not dependent on how much money you have in your pocket. Malaysia can afford it! We spend only about 3.5 percent of our GNP on health. Britain, one of the stingiest countries in Europe, spends about 7 percent. A poor country like India spends close to 6 percent of its GNP on health. Why are we so stingy?

Rather than farming out essential health services (cleaning, laundry, etc) to crony companies who drain the health services of much needed financing, extra money should be invested in the health service to improve the salaries of staff. This will go a long way in preventing the brain drain to the private sector.

The majority of hardworking and highly professional medical staff would like to see a fair increase in their salaries. They are not asking for 400-700 percent increases (to match private sector salaries), but a fair working wage commensurate with the hours they put in and the enormous responsibility they bear. A 20-30 percent increase in the salaries of health care professionals across the board would be welcome and certainly within our country's budget.

Most government doctors believe in the ideals of their profession, where healthcare is provided on the basis of need, irrespective of a person's economic or social standing. However, it is widely acknowledged that doctors and support staff in the government sector are very poorly paid.

The government health service runs on a great deal of goodwill and idealism on the part of healthcare professionals. For this reason, despite the meagre amount spent on health by the nation, the Malaysian healthcare system has been rightfully lauded as one of the most cost effective in the world in terms of the quality of care, number of patients treated and the range of services provided.

A responsible government would further nurture and strengthen its health service rather than see it as a cash cow to generate income for crony companies. This will ultimately destroy the morale and goodwill in the government sector and costs will escalate exponentially. Healthcare professionals will sacrifice for the public but certainly not for crony companies who want to exploit the health service for monetary gain.

If this type corporate mentality is allowed to gain a foothold, it will lead to a significant number of Malaysians being denied good healthcare. The US spends about 15 percent of its GNP on health, a major reason being the widespread commercialisation of the health service. We can ill afford this scenario as a developing nation!

The corporatisation package announced in 1997 promised an almost 100 percent increase in the salary of professors and lecturers working in University Hospital. This was to be done by dramatically increasing their "clinical allowance".

In addition, they were to be allowed three sessions of private work to further supplement their enormous increase in salaries. However, quite understandably this pay review failed to impress the non-medical staff of the university who saw it as blatant discrimination.

The increase in the university doctors' salaries was not afforded to hospital support staff (nurses, lab technicians, porters, etc). The most support staff were to expect was a 17 percent pay increase. This naturally created quite a sense of alienation and distrust between doctors and support staff.

Fortunately, this sorry state of affairs did not come to fruition as the corporatisation of UH was put on hold because of the recession. Can the Education Ministry give us the assurance that the earlier, and terribly unfair, pay review of UH doctors will not be reintroduce?

The Health Ministry and Education Ministry must have a pay review of their healthcare professionals which is uniform and fair.

Why should Education Ministry doctors be given amazing increases in salaries and Health Ministry doctors treated as second class citizens? This does not create a good working relationship between staff of the two ministries.

It is well known that working in a teaching hospital confers many advantages - generous sabbatical leave for professional development, opportunities for research, excellent facilities, and a hospital which is relatively well staffed with doctors, many of whom come from the Health Ministry for training. All in all, it is a much sought after working environment.

Thus, the differential pay scale and opportunities for private work for Education Ministry doctors are understandably seen as blatantly unfair and grossly insensitive, considering all the additional perks they already get.

UH is currently undergoing refurbishment of its wards. Unfortunately, the public wards have not been completed and renovations have not even started on the Intensive Care and Cardiac units while two private wards are almost complete.

There seems to be an obscene haste in completing the private wards so that private work for the university doctors can begin as soon as possible. Surely UH has got its priorities wrong! What kind of example is it setting for future doctors of our nation?

It is also well known that UH is facing a nursing crisis with an unprecedented spate of resignations recently, due to the increased workload of nurses and their low salaries. Recruitment of nurses to the private wards will no doubt add to this crisis. The private wing will probably contribute to the declining nursing care in government wards. Ultimately, it is the government sector patients who will suffer.

There is a fundamental conflict of interest by allowing UH doctors to treat private patients within the hospital. The monetary incentives in the private side will mean lesser emphasis on government wards, which will no doubt see increasing involvement of relatively junior Health Ministry trainees in the care of non-private patients.

The MoE's healthcare policy is creating a two-tier health service. Is UH the guinea-pig for the ultimate commercialisation of the healthcare sector? Does the government have a hidden agenda? Will it give Malaysians a categorical assurance that there won't be a piecemeal privatisation of healthcare?

DR AVICENNA is a pseudonym of a concerned government doctor.