• Malaysians are voting with their feet by moving to Selangor and Penang

    Media Statement by Dr. Ong Kian Ming, MP for Serdang, on the 30th of May, 2017

    Malaysians are voting with their feet by moving to Selangor and Penang

    In the Migration Report 2016, which was released on the 26th of May, 2017, it was reported that the two states with the highest net migration was Selangor followed by Penang. In the period of 2015-2016, Selangor experienced a net migration of 19,400 persons while Penang experienced a net migration of 12,000 persons (See Chart 4 below).
    Source: Migration Report 2016

    The willingness of people to move to Selangor and Penang is not a short-term phenomenon. According to the data from the 2011 to the 2016 Migration Reports, the net migration for Selangor and Penang were 125,400 and 49,800 respectively making Selangor and Penang the top two states in terms of net migration (See Chart below)

    Source: Migration Reports 2011 to 2016

    The figures from the Migration Reports clearly shows that Malaysians are voting with their feet by moving in large numbers to Selangor and Penang. This is a clear indication that Malaysians have confidence in the state governments of Selangor and Penang under Pakatan Harapan (PH).

    The achievement of Penang is even more remarkable when one considers that it is only the 8th most populous state in Malaysia and yet, it is able to attract the 2nd highest number of net migrants in the entire Malaysia. According to the 2016 Migration Report, “for the period of 2015-2016, Pulau Pinang registered the highest positive effectiveness ratio of migration at 58.4 per cent. This means that the people of Pulau Pinang will be increased by 58 persons for every 100 of inter-state migrants that migrate in and out of the state”.

    On the other hand, the two states with the largest outflow of population are Wilayah Persekutuan Kuala Lumpur and Perak with a net outflow of 163,400 and 40,000 respectively from 2009 to 2016. The reasons for these migration patterns were not given in the Migration Report. But it is likely that the state of Perak is losing population because of better job prospects in places like Selangor and Penang. For Kuala Lumpur, it is likely that it is losing population because of high housing prices and possibly, the more attractive policies offered by the Selangor state government.

    According to the 2016 Migration Report, 61% of out-migrants from Kuala Lumpur moved to Selangor in the period from 2015-2016 while 62% of out-migrants from KL moved to Selangor in the period from 2014-2015 (See Chart 6 below).

    If these trends continue, Kuala Lumpur will soon be a city comprising of mostly rich Malaysians and expatriates and also poor migrant workers.

    Dr. Ong Kian Ming
    Member of Parliament for Serdang

  • 自愿制的健康保险计划能否解决目前的医疗服务差距

    自愿制的健康保险计划能否解决目前的医疗服务差距

    2017521

    我父母年龄都超过70岁以上了 我父亲是名已退休的建筑师,并拥有自己的私人执业。而我母亲则是一位家庭主妇。据我所知,本地目前没有任何私人医疗保险从业愿意为这样年龄的长辈提供医疗保险计划。

    去年,我父亲自掏腰包在一家人医院接受过心脏绕道手术。最近,我母亲不得不去进行椎手术,当时的她面临种选择:昂贵的私人医院,等候时间颇长却有大量政府补贴的大学医院及两者之间的后者马来亚大学医疗中心。最后,她选择了后者

    在上个月,一名退休公务员的丈夫来到我的服务中心来寻求经济援助,以便购买自己的癌症药物。 尽管身为公务员配偶的他是有资格来享受政府退休医疗计划,但他也被告知自己必须支付治疗过程中所需要服用费用高达数千令吉的药物。

    我的父母和退休公务员的配偶所面对的上述问题,正好反映了我国所面临的其中一个医疗保险问题大部分都面对到左右为难的选择, 若非是在时间上妥协,即选择公共部门更长的等待时间或有的补贴药品,就是得付出高昂的费用,选择越来越高攀不起的人医院

    当然,若我的父母有购买医药保险的话,尽管在选择私人医院后也必然能大幅度减轻自己的医疗费用。同样地,若该名退休公务员的配偶有购买医药保险,也能帮吗负担部分昂贵的治疗费用。

    因此我们面临的问题是:明年教育部打算推介的自愿医疗保险计划是否能解决上述的挑战呢?迄今为止,我们不知道这个答案。原因很简单,目前我们对此医疗计划所了解的讯息根本少之又少。

    当然,我们可以从字里行间里解读这次医疗保险计划的出发点。其中可以被假定的理由是为了降低普遍对老百姓都很昂贵的私人医疗保险费用。

    若这次的医疗保险主要都采用自愿制,可能部分原因是为了避免重蹈覆辙,如上次般强制性登记一马健保计划所面对的反弹。若真如此,卫生部势必又会面对经济成本上的挑战。

    任何自愿制的医疗保险计划都必须设法避免一面倒地招致社会里最不健康的人民来登记。举个例子,所有被私人医药保险公司拒绝的长辈和本身就带有疾病如哮喘和癌症的病人都来登记报名,那该保险费用或政府的补贴会非常高。

    大部分先进国家的医疗保险计划都采用风险平摊机制。有了大量来自各背景,年龄,健康状况的人们参与了这样的医药保险计划的话,那比较健康和比较少用这些医疗服务的人们便能更有效地补贴那些长辈,以便有机会使用这些医疗服务。若该计划是采取自愿制的话,那风险摊平机制的效益就不存在了,因为大部分自愿参与计划的都是老弱残穷的百姓。

    其中的解决方案是政府可以想方设法来吸引比较年轻和健康的国民购买和参与这样的医药保险计划。举个例子,对那些尤其是兼职或频繁转换工作的青年一代,医药保险卡都被普遍地接受。所以,若政府能提供类似私人医药保险但费用较低的选项,那这些风险较低的族群将会更有诱因来选择新计划。

    政府也可以通过税改制度来提供更多诱因,比如让这个医药保险计划被纳入扣税的选项,同时要求雇主将员工所享受的医药保险服务纳进收入的一部分,进而鼓励更多员工选择更新更便宜的保险计划。

    负责掌管和运营这个计划的机构也对这样的自愿制医药保险计划的可持续性发展扮演很重要的角色。若交给一般追求利润最大化的私人公司去打理的话,那我们将面临保险费更高,减免选项更多和医药服务被合理化的风险。

    若交由政府来管理这个计划的话,有了向私家医院施压和谈判的权利,以便能控制医病的成本和费用,那对政府和购买保险的百姓在长期来说都是最佳的方案。可迄今为止,部长只透露该计划将由非政府机构来管理,但目前该非政府机构的身份不详。

    长期来看,政府很可能有意将更多的人纳入此健康保险计划,包括那些已在享用政府医院服务的使用者。若此举能有效地控制医药服务的开销,提高受益覆盖率和保护国民免于遭受重大健康事件,那我们便会无任欢迎这项计划。可是,由于这份计划缺乏细节,透明度和对政府动机的不信任,这让我们对这项复杂却对百万国民非常重要的公共政策无法进行诚恳和理性的辩论。

    王健民博士
    槟城研究所的总经理

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