Thứ Hai, 17 tháng 6, 2013

Prescription for reform

Southeast Asian countries need to spend more to improve healthcare services, increase accessibility and reform the industry to approach global standards, say experts in healthcare finance.


Southeast Asia for years has been well known for medical tourism, attracting upper-income patients from around the world to experience Oriental hospitality and advanced medical technology. The frontrunners include Singapore, Thailand and Malaysia.


While foreign patients are treated well in luxurious hotel-like hospitals, millions of other Southeast Asians lack access to even minimum-standard health care. Countries in Southeast Asia have recognised this and are trying to remove these barriers.


The Philippines, for instance, passed a new Sin Tax Act on Jan 1, increasing tax rates on cigarettes and alcohol. The government expects to raise US$6.03 billion over five years to improve equality and accessibility to healthcare services.


Malaysia is in the process of transforming its system, which will integrate the services of public Healthcare costs are only going to rise in the future as societies age and a growing number of older people require longer-term care. For that reason, countries need to invest now to put good systems in place, said John Langenbrunner, an adviser on national health insurance to the Ministry of Health of Indonesia, and a former lead health economist with the World Bank.


Thailand currently spends less than 5% of gross domestic product (GDP) on healthcare, compared with 17% in the United States.


The US, however, is an anomaly because of spectacular inefficiencies in an insurer- and litigation-driven system that even the Obamacare reforms will do little to fix. For a normal country, 5-10% of GDP can pay for a high-quality system with fair access for all.


“[Southeast Asian countries] are not the big spenders in the healthcare industry,” said Mr Langenbrunner. “This will be a problem because populations in this region are going to age. Consumers are also getting rich and they require more for good healthcare services.”


The fragmentation of insurance systems is also another problem. In some countries, China, for instance, there are many insurance schemes. Civil servants may have more health benefits than the poor.


Mr Langenbrunner is working with the Indonesian government to help integrate the insurance system to improve equality and accessibility. The challenge is in implementation.


He notes that the rich in Indonesia have no problem obtaining quality care in private hospitals because they are covered by insurance carrying high premiums. In contrast, the poor still have problems getting access to primary care or have to wait for hours before they can see doctors in public hospitals. Similar discrepancies exist in Thailand.


“The [insurance] framework actually is good, but the challenge is the implementation. How to pull money from the rich to help the poor, create a good benefit package and set up IT system are still the questions” he said.


On the delivery side, the lack of medical staff, nurses and physicians is also a big problem, as are facilities and equipment, particularly in remote areas.


“You can go to the remote areas in Indonesia and find that nobody is there. On financing, Indonesia may be graded A or B. But for the delivery side, the country needs to improve this,” he said.


In his view, developing the healthcare industry needs a strong economy, given the budget that will be needed, and political will as good support. Now is an opportune time for Indonesia because its economy is strong and its government is supportive of reform.


While healthcare expenditure is essential, wasteful spending is endemic in many countries.


David Evans, director of the Department of Health System Financing with the World Health Organisation, said many developed and developing countries were paying too much for medicine and inefficient hospital service.


They normally do not negotiate for the most suitable prices for drugs, but accept prices that may be two or three times higher than they should be. Moreover, some countries face limits in the types and amounts of generic medicines they can buy, and end up paying more for brand-name products.


Hospital inefficiencies are also a problem, in Mr Evans’ view. Patients who have insurance to cover their medical costs may stay in hospitals longer than they need to.


“These are problems elsewhere. In the US, estimated waste from inefficient medical services and expensive medicine is around 30-50% of total expenditure, while the average globally is roughly 20-40%.”


The inefficiency is also an excuse for donor countries not to support money for healthcare investment in low-income countries, he added.


Mr Langenbrunner urges developing Asian countries to focus on strengthening primary-care service to reduce healthcare costs that patients have to pay. Primary-care services will help patients not waste time in hospitals, saving money in their pockets.


He raised the United Kingdom as a good example as 85% of patients are treated on an outpatient basis or outside hospitals. The number in Indonesia is 40-45% and in China 40%.


“Chinese people are getting rich. They have cars, they have good roads. So, when they are ill, they drive to hospitals instead of consulting doctors at primary-care services,” he said. “The reason they don’t go to primary-care services is that they don’t trust the doctors. We have to fix this.”


Evans also supports Langenbrunner’s view that accessibility and equality can be improved by diverting money from the rich to help the poor.


“It might be an ideal for developing Asian countries to have equality in getting access to healthcare services. But if we cannot create accessibility and equality, social unrest will take place. And this is not acceptable,” said Evans.


Malaysia is among the countries carrying out a healthcare system transformation by bridging the gap between the services of the public and private hospitals in order to help all people get access to quality care.


Datuk Dr Nour Hisham, Health Director-General of the Ministry of Health, said his country’s vision was to transform the healthcare service by combining two healthcare systems, public and private hospitals, into one. The rich nowadays can go to private or public hospitals and receive good medical services whenever they are in need, but the poor have no option. They have to go to crowded public hospitals and wait for hours.


The question for the government is how the poor can gain access to private hospitals.


“Even today, some of the rich prefer going to the public hospitals because they have good physicians. The problem is congestion in public hospitals, where the poor also come for treatment,” said Dr Nour.


To bridge the gap between the public and private hospitals, he said the ministry needed to strengthen the services in the public hospitals first. Normally, patients will go to government hospitals because they offer affordable medical treatment charges and quality doctors.


The government has to reduce the congestion at public hospitals by encouraging patients to use day-care or primary care services. This solution will help not only reduce the number of patients going to public hospitals, but also the money they have to pay.


Patients who do not have serious diseases can go to primary-care services, get medicine and go home. There is no need for them to stay in hospitals and spend more for unnecessary expenses.


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Prescription for reform

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