The Malaysia Medical Association (MMA) and Citizens Health Initiative (CHI) have reiterated calls for the establishment of a non-profit, government-controlled national health insurance scheme based on a community-rated system.

Speaking at the National Healthcare Conference yesterday, MMA president Dr P. Krishnan and CHI coordinator Dr Chan Chee Khoon continued to express their support for the implementation of the national health financing scheme funded by taxation and compulsory contributions from employers, employees and the self-employed based on payroll and income.

Krishnan and Chan said the establishment of such an insurance scheme should be at the forefront of healthcare reforms alongside the integration of public and private sector primary healthcare systems.

The fund will act as a single payer of all healthcare costs at primary care level and act as the principal funding source for public sector healthcare which will continue to be subsidised from government coffers.

Patients who opt for private sector healthcare will be reimbursed from the insurance fund up to the ceiling level determined by the scheme.

Both organisations opposed the involvement of commercial insurance in the national health financing scheme and the implementation of a risk-rated insurance system which will exclude the poor, elderly and unhealthy from receiving proper medical attention.

"The national health financing authority (which is to administer the national insurance scheme) must be wholly owned by the government, and managed as a non-profit entity. It should not be privatised," stated Krishan.

"The national health financing authority should be based on the fundamental principle of equity in health financing and the shared responsibility of all citizens. The affluent has a social responsibility to subsidise the poor and collectively share the financial burden of healthcare, each according to his or her own ability to do so," he said.

Chan said the CHI also recently launched an Internet poll asking members of the public to state their preference of healthcare funding.

Although it has received a modest number of responses so far, Chan said 58 percent of those polled were in favour of a publicly-operated national health insurance scheme while 25 percent were willing to pay higher taxes to fund the public health service if reliable service can be guaranteed.

The MMA and the CHI both endorsed the community-rated system of health insurance.

Under this system, the total healthcare cost is averaged over the entire population and the same premium is paid irrespective of age, sex or health status unlike the risk-rated system where premiums will be higher for insurers regarded as health risks.

The arguments against risk-rated health insurance, according to Chan, are well-known, with the most objectionable consequence being that those who will need health care most would least be able to afford it, provided that there is no outright exclusion of high-risk subscribers.

The MMA has submitted a memorandum to the government in November last year detailing proposals for healthcare reforms, including proposals for a government-operated, community-rated national health insurance scheme, while the CHI has drafted a Citizens Health Manifesto incorporating similar proposals for reform.

However, according to news reports last week, a proposal for risk-rated insurance health scheme proposed by the Employees Provident Fund and the Life Insurance Association of Malaysia is pending approval by the Treasury which is at odds with the community-rated system proposed by the MMA and CHI.