The government should reveal the full details of its new healthcare financing system - set to come into force next year - which will put an end to the current free treatment enjoyed by Malaysians at public hospitals.

Expressing alarm at the proposed health financing scheme, the Consumer Association of Penang (CAP) today urged the Health Ministry to explore other alternatives and warned that the new system will punish the poor.

The consumer organisation however conceded that the present healthcare delivery system had been a financial strain due to escalating costs.

"Based on current trends, costs are expected to keep on rising due to the greater demands on the present healthcare system, the introduction of expensive new technology and ever-increasing drug costs," said CAP president SM Mohamed Idris in a statement.

"However, transferring the burden to the public is a stopgap measure that will not address underlying problems," he added.

According to the government, the current free healthcare system is unsustainable. The budget allocations for healthcare, which was RM1 billion in 1983, had since ballooned to RM9 billion last year.

Health Minister Dr Chua Soi Lek said on Sunday that the government presently subsidised 98 percent of healthcare treatment.

"This cannot go on as there has been a significant escalation of healthcare costs in recent years," he said.

Patients to pay more

While it has been decided to put an end to the free healthcare system, the government has yet to announce details of the new scheme.

Nevertheless, it warned that at least eight million Malaysians will have to pay significantly extra for treatment at government hospitals beginning next year, though it is no clear how much more it will be.

A few, however, will continue to enjoy the present free system - the one million civil servants, some 200,000 disabled people, about 435,000 pensioners, around 250,000 hardcore poor and the unemployed.

Mohamed Idris is worried that the poor who are not exempted will suffer under the new system.

"It is understood that the new financing scheme will be conducted along the lines where those covered are entitled to receive a basic health package. Patients who can then afford or are covered by other means of financing (private insurance, out-of-pocket payments, etc) can enjoy additional health packages.

"A national health financing scheme that allows for the rich to pay for more treatment would surely accelerate the trend of the healthcare system to cater more for the wealthy rather than the poor and needy," he said.

He warned that the new system may also result in boosting healthcare costs, instead of reducing it.

"Knowing that an insurance or financing scheme (and not individual patients) will be paying the bill, doctors can raise the bill by performing unnecessary surgery, encouraging longer stays in hospital and use of unneeded sophisticated technology," said Mohamed Idris.

"These 'abuses' have been documented in the United States, Europe and Australia. It is expected that as doctors' charges rise dramatically, the public will be forced to pay even higher premium rates. The end result will be an explosion of medical costs," he added.

'Poor-friendly' alternatives

CAP has offered possible 'poor-friendly' alternatives since the proposed new scheme was first made public three years ago.

Among others, it suggested that instead of implementing a totally new system, the present Socso (Social Security Organisation) scheme be modified to include the support for financing of healthcare.

"Socso's services can be extended to include medical care in general, and not be restricted for the treatment of industrial accidents and occupational diseases. The annual 'profits' of Socso (which actually represents a significant subsidy to the state by workers) could thus be transferred to the Health Ministry through hospital payments," said Mohamed Idris.

"Since Socso covers all employees earning below RM2,000 per month, the poor and lower income wage-earners would be able to draw on their contributions to finance their medical bills in government clinics and hospitals, thus easing the financial strain of the Health Ministry," he added.

He said that if the existing Socso contributions are still insufficient, it could be raised marginally.

"An increase of only RM1 a month by employees plus another RM1 by employers would yield at least an extra RM200 million a year in Socso contributions, which could be used to finance medical treatment," he noted.

The CAP president agreed that the current charge of RM1 for outpatient treatment at government facilities could be too low, and this too could be raised slightly.

"Based on the 2004 total outpatient attendances at government health facilities, raising the outpatient rate to RM5 could bring in close to at least another RM200 million," he said.

In the long-term, Mohamed Idris said that focus on preventive measures nationwide will further reduce healthcare expenditure.

"For instance, accidents constitute one of the major causes of hospitals and deaths in government hospitals. Placing more emphasis on safety measures that will reduce road accidents, occupational accidents, and improve safety in playgrounds, etc. will contribute tremendously towards alleviating the financial burden on public healthcare services," he added.