‘1Care’ and the politics of healthcare in Malaysia

Abstract

Two duelling slogans, '1Care for 1Malaysia' and 'Tak Nak [Reject] 1Care', provide a succinct representation of what can arguably be considered the most contentious issue in healthcare for Malaysian society spanning the last three decades. The tagline '1Care for 1Malaysia' invokes the health plan that was prepared by the Ministry of Health (MOH) for the Tenth Malaysia Plan (2011-2015) (MOH c. 2010). The health plan is a comprehensive overall policy document that sets the vision and direction for the nation's healthcare sector. Central amongst the various programmes described in the document is a statement of intent for a 'restructured Malaysian health system' (ibid.: 51) that revolves around the establishment of a long-awaited social health insurance scheme. '1Care' refers to this proposed national health financing scheme. Its announcement by the MOH at the Tenth Malaysia Health Plan Conference on 2 February 2010 met with diverse responses, with the most vocal resistance coming from the Citizens' Healthcare Coalition (CHC), which organized a series of seminars between February and June 2012 to garner support for a stand against the plan, and a 'Tak Nak 1Care' campaign initiated through the internet.

The political economy of health financing reform in Malaysia

“…Stakeholders identified specialist clinics in particular as vehement opponents of 1Care, since they would likely lose patients and revenues under a system that incorporated a family medicine ‘gatekeeper’ who would only refer to patients to them who could not be treated by a GP (Interview no. 9, 2015; Leng and Hong, 2015). Conversely, interviewees argued that non-specialist GPs who had fewer patients (and lower revenues) would be potentially open to a capitation-based system that would increase their patient numbers, with their support or opposition depending critically on the capitation rates to be agreed with the government (Interview no.…”

“…In 1999, the government’s declaration of its intent to corporatize public hospitals, to enable them to function along commercial lines, was a key tipping point in the politics of reform. A vocal and well-organized opposition to this reform emerged: the Citizen’s Health Initiative coalition, organized by non-governmental actors and activists and academics from the Malaysia Medical Association, University Sains Malaysia and the Consumer Association of Penang (Leng and Hong, 2015). With elections approaching, the government backed off of its corporatization proposal, and even increased funding for public hospitals (Kuhonta, 2011).…”

“…This plan outlined major transformation in the healthcare financing system, again stressing the introduction of an insurance-based model. ‘1Care’ ended up being ‘arguably … the most contentious issue in health in Malaysian society spanning three decades’ (Leng and Hong, 2015). The substance and rationale for the reform appears to have shifted from a focus on the need to limit public spending on health (Barraclough, 2000), which was central to PM Mahathir’s justification for earlier reform proposals, to a desire to pool public and private health spending and thus improve the efficiency of health spending.…”

Fostering inclusive growth in Malaysia

“…Reforming the financing structure to ensure sustainability of the healthcare system has long been a government target (OECD, 2015e). Attempts to introduce a public healthcare insurance system have not met with agreement among stakeholders, despite intensive debates regarding cost sharing and the impact on quality and access to the services (Leng and Hong, 2014). Irrespective of whether public healthcare insurance is utilised in the future, rising healthcare costs accompanying population ageing will need to be accounted for in fiscal planning (Lee, 2015).…”