00:00Hi, welcome back to Consider This. I'm Melissa Idris. Let's continue our discussion about Bank
00:15Negara's proposal for introducing a base medical and health insurance takaful plan,
00:22also known as the base MHIT plan. Joining us on the show now is Professor Dr. Sharifa
00:27Ezat Wan-Puteh, who is a professor of public health medicine at UKM's Faculty of Medicine.
00:34She's also the dean of the School of Liberal Science there. Prof, thank you so much for joining
00:39me on the show today. So tell me when you first read the white paper, what was your initial reaction?
00:46What did you think about what was being proposed? Yeah, thank you so much, Melissa, for having me
00:51here. I think the white paper which was proposed by sort of Ministry of Health, of course, it was a
00:57collaboration of experts as well. About two years ago, yeah, 2022. So the white paper sort of designated
01:05a few pillars how to strengthen the so-called healthcare in Malaysia. And of course, it will
01:11include, definitely include not only the public, but also the private sector. And one of the strengths
01:18of this white paper, not only that it takes into consideration of working together, but also it
01:23looks at future healthcare reforms and how to tackle not only things like aging, NCD, but also emerging
01:31diseases. So these are some of the strengths of the white paper. Not only is it timely, but it is also
01:37used as, you know, the roadmap ahead for healthcare in Malaysia. Yeah. So if we were to look at the base
01:43MHIT plan that was big, that's now being proposed. And the idea is that it will maybe provide some
01:52insurance cover for the people who don't have insurance cover, don't have enough insurance
01:57cover. There are people who have come out to raise concerns about how the plan is designed. There are
02:04some people who say this is a great first step. Where do you sit, Prof? Do you see benefits in introducing
02:11this plan now? Do you see risks in the way it was designed? Right. Okay. This perspective is more of
02:18myself. Yeah. And of course, I look at, you know, published literatures and sorts on answering this
02:25forward. When we want, if Malaysia is to go forward with a Malaysia healthcare reform, and some of the
02:32proposed area would be to include some sort of premiums by certain population. Now, this premium can cover
02:39a lot of population. In general, we have so-called the lower income, the middle income, and of course,
02:45we have what we always say as the T20 or the top-level income earners. Now, this is not a problem for the
02:51top-level income earners. They can always go into their private health insurance or their coverage by
02:56their own providers. So this is not an issue. So more of the plan by Bank Negara so-called, so the MHIT,
03:03or this will also include some of the micro insurance for the lower and also middle income
03:08population. Now, of course, the lowest income of those and also the persons who do not or not able
03:15to pay premium for certain reasons, these are basically covered by the government. So the public
03:19sector is going to be there as a safety net as well. So having said that, it's not to say that
03:25I do understand that not all of us can actually pay premium for certain reason. Now, this very much
03:30depends on your income level and whether you're willing to pay and things like that. So the insurance
03:36by right, they should also cover not only the lower income or also the middle-level income, but also the
03:43top-level income earners who are able to pay more premium. So in a way, the coverage will cover all of
03:48these. But of course, the benefit will also depend on how much you pay the premium, right? I mean, I mean,
03:53looking at, you know, even in the private sector, this very much depends on your premium level and the
03:59coverage that it brings. But coming from the so-called the bank negara and also the MHIT, I foresee that
04:05they will have more coverage, you know, some of these things, example for essential drugs, essential
04:10medicine, and of course, essential procedures, this will be covered through some of the benefit packages
04:15by this insurance premium. The premium will be the tricky part because, you know, we can always say
04:21that you pay premium, but how much, you know, what is the level that people are able to pay, you know,
04:27comfortably without breaking the bank, you know, and things like that. But of course, you know, this fund,
04:32the central fund will be used to sort of cover or reimburse the providers that's going to provide
04:39services for the population.
04:40Right. So do you think it's a good idea? Because we've been having conversations about the rising medical
04:47inflation, the burden on the public sector, healthcare, how would this help the broader
04:56reform agenda? Does this, how does this move the conversation from, how does this change the game
05:04in any sense of the word, Doctor?
05:07Okay. If you look at, in general, for those who are paying or going to pay the premium later on,
05:15there will be packages or what we call as benefit packages that will be covered, that will cover
05:22this population. They will be able to access healthcare providers which are in the package,
05:28meaning that if, let's say, if you want to go into a private hospital, as long as this private
05:33hospital are also engaged in providing healthcare for the MHIT premium providers, the population are able
05:41to go and seek services even in the primary care or in the private hospitals. So then, then it depends
05:50on the benefit packages, of course, and also, you know, how much premium that you actually pay. So this
05:55very much depend on that. But you are able to have more options, meaning that at the moment now,
06:02let's say I am a lower income population or a middle income population, my access would only be to the
06:09public providers, right? And this is one of the reasons why, you know, there's a long queue, there's
06:14so many dissatisfaction, you know, some of the drugs may be too generic and, you know, there's so many
06:20complaints about this. But what happens is that once you have so-called the premiums for those who are
06:26paying the premiums, they will have more options. So there will be not only the public providers, but also they
06:33are able to engage private providers who are in the sort of medical card. So then you will have more options
06:42to go to the private sector nearest to you. At the moment, if I'm a middle income or lower income, and I don't have
06:48private health insurance, or my employer does not pay for me, I'm not able to access private healthcare.
06:53Okay, so this is one of the, I guess, tools the government is rolling out to help people maybe
07:03alleviate some of the burden on the public healthcare system. But I want to ask you, the detail, the devil
07:09is in the details, and it's all about implementation for this. If I understand correctly, they're looking
07:14to roll out this plan next year. What do you think needs to be clarified in the time period in between,
07:21or what needs to be refined to make sure that it achieves what it is setting out to do?
07:28Right. I think more information needs to be disseminated to the population. Not a lot of people
07:33sort of aware of this. And we must engage the media, not only example, Melissa, you are in the media as well,
07:41and also some NGOs who are able to correctly point out that this premium by right, there is still a
07:48safety net, which is the public providers. But for those who are able to pay premium, or they have
07:54coverage by their employers, this is actually a benefit, because then they will be able to have
08:00access to more providers, either the public or the private. And this would give more choice, and they are
08:06able to seek healthcare, you know, a wider choice, but also, I think it will be faster in some sense.
08:14So but then, you correctly pointed out, you know, the devil is in the details. So we must make sure
08:21the matching of the population income with the premium, we don't want, you know, a premium that is
08:26too high for certain level of population. Example, if you're earning just 2000 per month, you're not able to
08:33pay a monthly of, let's say, 100 premium per month, example. So the matching of the premium level and
08:39also the population must be there. So this is more targeted towards, you know, a certain amount of
08:44income. So the middle level income, definitely, and also maybe even the lower income, but they are
08:50sort of the upper, lower income, they are able to pay premium, or they are covered by their employers.
08:55So with that, that clarity needs to be there, because people are doubting whether one, how big is the
09:02premium that you have to pay, and people are scared because there's a lot of insurance now,
09:06that incurs a high premium. And in the end, that most of these are, you know, they have to cancel
09:12their account or whatever, because they are not able to sustain the premium level that is being
09:18imposed on them. So things are some good things. And a quick one, I understand that it is all the way,
09:24it will cover people all the way up to the age of 85. Why is that significant, Prof?
09:29Prof? Ah, I think this is very important because the one that consumes the some of the most health
09:35care in general would be the elderly. And this is where all of us are going to go at one point in
09:40time. And it's Malaysia, as you know, are already going transitioning into the aging population sort of
09:46level, where you have a high number of people aged 60 and above, or 65 and above, depending on which
09:51country you are. So they are the ones that consume most of the, you know, healthcare being, you know,
09:57they are imposed with chronic diseases, they have the least immune system. And this is where the
10:02inpatient care becomes a burden for a lot of people. So I think that coverage is, I think,
10:07is very important, you know, having an insurance coverage for elderly as well. Most of the private
10:12healthcare, because they are risk rated, Melissa, they do not actually cover elderly care because they
10:18have all these existing problems. You have osteoarthritis, you have prior cesarean, you have blah, blah, blah,
10:25and so on. So they don't actually include elderly or people who have existing diseases into the
10:30network. So what happens most of the time, example in certain countries such as South Korea and things
10:34like that, even though you are elderly, you were covered before. But once you age a certain age,
10:40or you have some very chronic diseases, you are being opt out and you have to pay yourself. So now this
10:45is the problem. So that will lead to catastrophic health expenditure. And this is something that we don't
10:50want to happen to Malaysian population. Definitely. Prof, thank you so much for your time. I really
10:55appreciate you joining us and sharing some of your insights. That was Professor Dr. Sharifa Izzatwan
11:00Putih, who's wrapping up this episode of Consider This. I'm Melissa Idris, signing off for the evening.
11:05Thank you so much for watching and good night.
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