Due to the fact that cost of health care is getting higher and higher, issue has been raised in health imbursement methodology, especially in health insurance policy. In fact, just not long ago, last year, there is one insurance company in my country refused to pay compensation fees to the insureds who passed away from the influenza A virus infection. At the end, the Malaysian government has to stand up and negotiate with the insurance company. The insureds were paid and the problem got settled. However, the reflection of the case above is that the issues with health insurance companies is still there that concerns need to be raised to re-evaluate and improve the current situation.
Malaysia has developed national health insurance system where the governement will help paying parts of the medical care cost for all of the population. At the same time, people continue buying private insurance. For instance, nowadays, more and more people who can afford, started to purchase medical card. Medical card is like an umbrella during raining days. The question is why Malaysians want to take out money from their own pocket to get a medical card since they can always turn to the government hospital for health care services?
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| "Insurance is like an umbrella during raining days?" |
Like I mentioned earlier, health care cost at private health care centers has been increasing over the years as they are profit-driven centers. This could have caused some patients who are not so rich to go back to public health care services, for example, government hospital. More and more patient go to government hospital, but the total hospital beds and number of doctors employed by the government do not increase at the same time. As a result, patients have to wait longer to see the doctors and medical attention given is lesser. Who would like to wait in pain or in a sick condition? By paying an affordable amount of premium, you are covered by insurance which mean now you can go for a better quality of healthcare, so why not?
In this case, the population is now divided generally into two groups. First group, who have good insurance, receive a good quality of medical care, cost is no longer a worry. Another group, who have poor insurance or none at all, receive very little. Due to competition, a private health center is more likely to give a better healthcare services. While, in the government hospital, payment to health providers is based on salary system which means medical treatment is not influenced by incentives. This may result in a drop of quality of health care. Hence, for those without insurance who couldn't afford private healthcare cost, they loss assess to a better healthcare services which may produce a desireable disease outcome.
In addition, those who are under insurance coverage pay a fixed amount of money for premium per month. They may think that it will be a waste if they don't utilize the health benefit. There will be no hesistance in seeing a doctor for treatment as all the medical cost is covered by insurance. If this becomes a trend, it would pose a threat to the health system. The health care sector would become a larger fraction of the economy, more health care spending is thus washed out. Besides, medical resources can be wasted too. As a result, the health care system in one country may become inefficient due to the poor health insurance system.
So, what is the soulution for the above problems? Probably, managed care health plan can be considered. Read more about managed care in my next post. =)
References:
1) Lecture note by Prof. Laksono Trisnantoro,Dr. Sigit Riyarto :Provider Payment Mechanism
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