Cheer for the poor

BY KHIRTINI K KUMARAN

The Covid-19 pandemic badly affected the country’s economy and healthcare facilities. One of the worst to be hit is those in the lower-income group.

But thanks to the government’s Skim Peduli Kesihatan untuk Kumpulan B40 (PeKa B40), this group can still enjoy access to healthcare. ProtectHealth Corporation Sdn Bhd, owned by the Ministry of Health (MoH), is the scheme administrator.

ProtectHealth CEO Dato’ Dr Anas Alam Faizli talks to The Health on the effects of rising healthcare costs and how PeKa B40 has benefitted the poor.

How is the low-income group affected by rising healthcare costs?

A vital strength of the Malaysian health system is its success in providing broad and meaningful protection from the financial risks associated with the high cost of healthcare. This undoubtedly significant success is achieved through a geographically widespread public delivery system, which offers equitable and universal access to a wide range of services at minimal out-of-pocket cost.

With the increasing cost in healthcare, the most affected group is the low-income group or B40. The presence of the Covid-19 pandemic has further added to the burden of the B40 group to obtain quality healthcare. For example, with an ageing population, the utilisation of healthcare services has increased. Ageing leads to higher vulnerability to diseases and higher incidences of co-morbidities (more than one disease condition existing together). Other issues associated with low socioeconomic status among older adults are related to malnutrition and inadequate diet.

How can we reduce healthcare costs?

One of the effective ways to reduce healthcare costs in Malaysia is via strategic purchasing, which aims to increase health system performance by effectively allocating financial resources to providers. A strategic purchaser allocates funds in a way that actively promotes improvements in service quality and efficiency and makes choices based on:

• the need for different health services;
• the availability of effective medical interventions;
• the relative cost-effectiveness of various interventions;
• how people access these services, e.g. available only in urban areas; and
• the quality and efficiency of services delivered by providers.

A strategic purchaser may select certain health facilities/healthcare providers to contract with, eg., those which offer a lower price and/or better quality. In PeKa B40, ProtectHealth is the first in the country that has successfully purchased services from both public and private providers, with PeKa B40 benefits discharged through General Practitioners (GPs), lab partners, Klinik Kesihatan (KK) and MoH Hospitals.

Additionally, ProtectHealth has managed to save the Government over RM10 million through price negotiation of the Drug Eluting Stent (DES), which is one of the Health Aid provided under PeKa B40 program.

Other efforts to reduce healthcare costs in Malaysia also include strengthening & enforcement of government policy on regulation for drug pricing and pooling of financing resources in a country using the Government’s initiative to purchase healthcare services/drugs/equipment through central negotiations (higher purchasing power).

What would an affordable healthcare financing scheme entail?

As we know, Malaysia is among the few nations globally that can provide its citizens affordable and even accessible medical care and has achieved excellent outcomes. However, Malaysia’s health system faces new challenges in the face of a rapidly evolving context— characterised by demographic and epidemiological transitions, a shifting socio-cultural environment, technological changes, and rising income levels. All these have contributed to a nutritional shift, increasing health risks, and new user expectations.

Changing the healthcare system is not an easy task. It requires in-depth scrutiny of every aspect, including political will, engagement, and feedback from all stakeholders.

The future healthcare financing scheme should entail:

• Solidarity in the rich subsidising the poor & healthy subsidising the sick
• Basic healthcare accessibility to all regardless of the social-economic background
• Contribution is based on social-economic status/income, such as progressive tax payment whereby the Government subsidises the poor.
• The healthcare benefit should cover those which are essential, practical, and cost-effective.
• The contribution of the financing should be according to ability-to-pay – wealthier people contribute more
• Different segments of society are included in the same scheme to ensure a large financing pool.
• Single or few national/non-profit third-party payers to negotiate and mitigate increment of healthcare cost

To what extent have the objectives of the PeKa B40 scheme been met, and what are your plans?

The focus of PeKa B40 is to reduce the burden of NCDs through early screening and treatment to expand access to quality healthcare. This, in return, will reduce the cost of living and the wellbeing of the target population. At the same time, the PeKa B40 initiative aims to strengthen public-private partnerships while prioritising primary healthcare.

 PeKa B40 has successfully met the objectives via all the benefits offered. Since PeKa B40 was implemented, the MoH has successfully detected non -communicable diseases (NCDs) among the B40 group, especially for newly diagnosed cases. As of 31 July 2021, out of 519,454 recipients screened, a total of 34.8 per cent (181,149) recipients had been detected to have at least one of the non-communicable diseases, namely diabetes, high blood pressure, high cholesterol, anxiety, and depression.

 The implementation of PeKa B40 reduced the financial cost burden on that group. They will not have to use their own financial resources (out of pocket expenditure) to purchase health screening and medical equipment.

Additionally, the Government save massive costs through early treatment by prevention of complications.

The MoH via ProtectHealth can negotiate the price of services and medical devices through more cost-effective methods so that the scheme’s sustainability can also be emphasised. Moving forward, our plan consists of:

• Repeat screening for the high-risk group & educate on healthy lifestyle to maintain healthily
• Extend the package to include treatment to prevent loss to follow up as a result of lack of continuity of care after being screened in the private sector
• To further revise the work process and future expansion plan, revise and formalise the performance or quality indicators and their standards, and propose a methodology for measuring outcome
• To double the efforts in promoting PeKa B40 and explore the best method of reaching the target population.
• To enhance the effort and resume outreach programmes in the more underserved areas once the MCO has lifted.
• To increase promotion via multiple platforms, including social media such as Facebook, Twitter, and Instagram
• To widen and strengthen partnerships, especially with agencies related to the B40 group.
• To do risk profiling of all the screened beneficiaries. This will identify the high-risk group for future repeat screening and establish the Wellness Module to manage high-risk beneficiaries to prevent their health from deteriorating.

What are the critical challenges faced by ProtectHealth in coordinating PeKa B40 during the pandemic?

The main key challenge is the decreasing number of health screenings. The number of beneficiaries screened increased exponentially since its launch, with a peak in December 2019. However, it dropped dramatically after the enforcement of the Movement Control Order (MCO) on March 18, 2020, and until now. These are basically associated with the recipient’s concern over Covid-19 infection, total movement control orders, money constraints to pay transport fares due to loss of income, and more priority on purchasing necessities such as food rather than seeking healthcare.

What are the efforts being taken to promote the PeKa B40 initiatives further?

Various activities were carried out to promote PeKa B40 to the target group via multiple platforms. This includes media launch, print and electronic media, social media, outdoor advertisements, on-ground activities, exhibitions, interpersonal communication, publications, distribution of promotional materials, and sharing information through the PeKa B40 website.

Aside from that, briefings and talks about PeKa B40 were done almost weekly on various occasions, like community programs organised by the Government, private agencies, and NGOs.

Various messages and information were shared through this platform, such as recipients’ eligibility, PeKa B40 benefits, the importance of health screening, the latest data analysis associated with NCDs, healthy lifestyle practices, Covid-19, and many more. — The Health