It is not perfect, but the first thing we must most certainly appreciate is our public healthcare system, says the writer. — 123rf
LUIGI Mangione’s alleged gunning down of American health insurer United Healthcare’s CEO Brian Thompson sent ripples throughout the American health insurance industry, and wider still, throughout much of corporate America.
The outpouring of public support for Mangione, who is being accused of what is essentially a stone-cold murder, has caught quite a few quarters by surprise.
To briefly summarise, there are millions of Americans who are deeply frustrated by their experiences with their health insurance.
In the United States, there is no government healthcare that is accessible to the general public. Most normal Americans must have health insurance of some kind to be able to afford healthcare in a system that is almost entirely private.
This makes for a massive health insurance industry; and within that industry, profits are basically a zero sum game. The more health insurers have to pay out in claims, the smaller their profits.
Thus, it is in the industry’s interests to pay out as little as possible to the individuals they cover, to maximise their profits. As a result, many Americans struggle to get the full healthcare they need covered properly by their insurance company.
The process is incredibly frustrating, deeply demoralising, and often, ultimately fatal.
This is where the groundswell of support for Mangione comes from. Some argue that instead of a murderer, Mangione is some sort of freedom fighter or revolutionary.
The comparison is an interesting one. We are used to tales of armed struggle against oppression. The United States, Malaysia, and other countries have used violence to repel foreign invaders.
The comparison some make is that some large corporations employ business practices that are so predatory, extractive, and detrimental to people’s health, that in terms of their effect on normal citizens, these corporations can be compared to, say, a foreign occupying force.
For those who subscribe to such views, armed resistance is seen as a form of legitimate response.
The debate around these issues will go on for a substantial amount of time. America has a strange relationship with gun violence.
I suspect that the first school shootings in America burned such shootings into the national consciousness, paving the way for the recurrence of such senseless violence. It is possible that Mangione has started a similar trend. Only time will tell.
Coming back to Malaysia, the first thing we must most certainly appreciate is our public healthcare system.
Unlike in America, every single Malaysian has the opportunity to avail themselves of the public, taxpayer-funded healthcare system. There is no doubt that this healthcare system is not perfect. Nevertheless, we should be very proud of the fact that access to healthcare is not contingent on a Malaysian’s ability to pay.
Malaysia also happens to be home to a very robust private healthcare system.
If you have ever visited one of these super high end private hospitals, with what one friend of mine described as “self-playing pianos and elaborate aquariums”, you would be forgiven for thinking that you were in a five star hotel rather than a hospital.
The presence of private healthcare in and of itself is generally a good thing, as more options for Malaysians is generally a good thing.
Malaysia’s private healthcare industry is of course vastly different from America’s. That said, we must be very careful to ensure that it does not evolve in unwanted directions.
Recently in the news, there has been talk of frightening anticipated hikes in private health insurance rates.
Those with significant experience as patients in private hospitals may not be surprised at this news.
There is considerable anecdotal evidence surrounding such experiences. When it is learned that a patient is covered by good health insurance, we hear of cases where all kinds of expensive tests are ordered, unnecessarily expensive medication prescribed, and so on.
When the costs of such treatment is not perceived to be borne directly by either the patient or the healthcare facility, the attitude seems to be: “Why not take as many steps as possible in order to maximise profit?”
One sometimes might get the impression that if the patient or the healthcare facility were the ones bearing the costs directly, we would see a vast reduction in the number of tests ordered, the number of procedures recommended, and the cost of the medications prescribed.
Needless to say, someone does pay the price of these inflated treatments; to make a long story short, that someone is the buyers of private health insurance – an after effect we are already beginning to see here in Malaysia.
On Friday, Bank Negara passed measures to help the public with the rising premiums of their medical and health insurance.
Earlier this month, however, Prime Minister Datuk Seri Anwar Ibrahim and Health Minister Datuk Seri Dzulkefly Ahmad began discussing a system based on something called diagnostic- related groups (DRG) as an approach to keep rising healthcare costs down.
Under the current system, when a patient comes in to a private healthcare facility, the patient’s bill is based on what tests, treatments, procedures, and so on the patient goes through.
Under a DRG based system, the patient’s bill is instead based on what the patient is diagnosed with.
As I understand it, under this latter system, it doesn’t matter how many or how few tests, procedures, and so on are conducted. All that matters is what the patient is diagnosed with, and whether the patient is cured – this alone determines the cost that a patient is supposed to pay, not what treatments they undergo.
Thus, healthcare facilities are incentivised to treat and cure the patient as cost-efficiently as possible.
There are a few potential “side effects” of a DRG-based healthcare system, but many of them can be mitigated by also incorporating value-based care, where the health outcome of the patient is another factor in the costing.
I am not a doctor or healthcare expert, and even if I were there would not be enough space in this column to discuss and compare all the various advantages and disadvantages in the systems mentioned above.
That said, it seems to be a wise move to start exploring and discussing alternative approaches like a DRG-based system to work towards keeping healthcare costs from skyrocketing due to practices that may be considered unethical.
Nathaniel Tan is strategic communications consultant. He can be reached at nat@engage.my, and he would like to wish everyone who celebrates a Merry Christmas! The views expressed here are solely the writer’s own.
