• 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

  • Will the Voluntary Health Insurance Scheme address current health care gaps?

    (This article can also be read at the Penang Institute in KL Column in the Malaysian Insight, 21nd May 2017)

    Both my parents are over 70 years of age. My father is a retired architect who had his own private practice. My mother is a housewife. As far as I know, there are no private medical insurance providers who offer medical insurance plans for people their age.

    My father had to undergo a heart bypass last year at a private hospital and he paid the expenses out of his own pocket. My mother had to go for a spinal procedure recently for which she had three options: a costly private hospital option, a heavily subsidised option at Universiti Hospital but with a longer waiting time period, and an in-between option with the University Malaya Medical Centre (UMMC). In the end, she chose the in-between option.

    The husband of a retired civil servant came to my service centre last month to seek financial assistance to purchase his cancer drugs. Even though he is eligible for the government pensioner’s medical plan as a spouse of a retired civil servant, he was told that he had to pay for the drugs he needed to take as part of his cancer treatment which costs thousands of ringgit per treatment.

    The problems faced by my elderly parents and the spouse of the retired civil servant illustrate one of the major health care challenges in this country. Many people are caught between the public healthcare sector which is either rationing its services through time i.e. longer wait times or the supplies i.e. limiting the amount of subsidised medicines, and the private sector which is already expensive and likely to become even more so over time.

    Of course, if my parents had access to a health insurance scheme, that would have significantly decreased their medical expenses even if they chose the private hospital option. Similarly, if the spouse of the retired civil servant had a health insurance scheme, that would cover at least part of his very expensive cancer medicines.

    The question then is this: will the Voluntary Health Insurance Scheme announced by the Minister of Health to be rolled out next year, be able to “solve” the health care challenges illustrated above? The answer, for now, is that we simply do not know for the simple reason that very little of the details of this insurance scheme have been made public.

    Of course, we can read between the lines and try to guess the motives for the rolling out of such an insurance scheme. The putative reason is to decrease the cost of private health care, which almost everyone acknowledges is very costly for the average Malaysian.

    But if this new health insurance scheme is totally voluntary, partly to avoid any possible backlash from the previous experience of trying to introduce the mandatory 1Care health insurance programme, the Ministry faces another cost related challenge.

    Any voluntary health insurance scheme must somehow avoid the problem of attracting mostly-unhealthy people from enrolling in such a scheme. For example, if only the elderly who currently cannot buy any private sector health insurance and others with pre-existing congenital health problems such as asthma or cancer buy into such a scheme, the premiums would have to be very high or the government subsidy for such a scheme would have to be very high.

    Most health insurance schemes, especially those in developed countries, work on a risk pooling basis. With a large pool of people from all backgrounds, ages and health conditions enrolled in a health insurance scheme, those who are healthy and who do not use much health services are effectively subsidising the insurance cost for the elderly and those with congenital diseases who are high users of health services. If the proposed health insurance scheme is voluntary, the risk pooling benefits may disappear if the majority of those who enrol in it are old and / or already sick.

    One way which the government can overcome this problem is to attract the young and the healthy to buy into this health insurance scheme. For example, medical insurance cards are increasingly popular among the younger generation these days, especially those who do not have employers who provide healthcare benefits, those who are freelancers or part-timers and those who switch jobs very often. If the government can provide a lower-cost option to existing private health insurance schemes, these lower risk individuals may be tempted to switch to this new option.

    The government can also provide other incentives such as tweaking the tax system to make this new health insurance scheme tax deductible and at the same time, force employers to count the health benefits enjoyed by their employees as income (and hence taxable) so that some employees may want to switch to this new and cheaper insurance scheme.

    The sustainability of such a voluntary insurance scheme, apart from risk pooling, also depends on the entity which is in charge of running this scheme. If it is a private company that prioritises profit maximisation, then we face the danger of ever increasing insurance premiums, higher deductibles and other forms of health care rationing.

    But if it is a government run scheme, with the ability to put pressure and negotiate hard with private hospitals to control costs and charges to patients, the long terms prospects will be much better, for the insured as well as for the government. So far, the Minister has said that it will be run by an NGO but has not disclosed the identity of this NGO yet.

    In the long run, it is very likely that the government wants to expand this health insurance scheme to more and more people, including those who are currently using government hospitals. If such a move can control healthcare costs, increase accessibility and protect Malaysians from catastrophic health events, then we should welcome it. But because of the paucity of details and the lack of transparency and trust in the motives of the government, it makes is much harder to have an honest and rational debate on a complicated but very important part of public policy that impacts millions of people in the country.

    Dr Ong Kian Ming is the Member of Parliament for Serdang, Selangor and is also the General Manager of Penang Institute in Kuala Lumpur. He holds a PhD in Political Science from Duke University, an MPhil in Economics from the University of Cambridge and a BSc in Economics from the London School of Economics.

  • 针对东海岸衔接铁道(ECRL)的意见反馈和疑点

    陆路公共交通委员会首席执行员
    莫哈末阿兹哈鲁丁先生
    Block D, Platinum Sentral, Jalan Stesen Sentral 2,
    Kuala Lumpur Sentral, 50470 Kuala Lumpur

    致莫哈末阿兹哈鲁丁先生

    回复:针对东海岸衔接铁道(ECRL)的意见反馈和疑点

    根据2010陆路公共交通委员会法令》84条文,陆路公共交通委员会(SPAD)38 展开了为期3个月的公共咨询和寻求公众对东海岸衔接铁道(ECRL)计划的意见和反馈。[1] 我身为国会议员兼关心此议题的百姓,想要请委员会来解释以下课题。

    1.      提供东海岸衔接铁道计划的成本和详情

    根据201611The Edge的报道,交通部长拿督斯里廖中莱说明了东海岸衔接铁道(ECRL)的成本将从290亿令吉增加至550亿令吉。此工程的轨道全长545公里,现在却增至600公里,还不包括鹅麦综合终站至巴生港口终站的那一段。 [2] 可是,财政部秘书长丹斯里莫哈末依尔旺于517日在第二期铁道计划的签署仪式上披露。单单鹅麦综合终站至巴生港口终站的费用就耗资90亿令吉,因此整个计划的兴建费用,包括首阶段由丹州的华卡岜鲁至鹅麦的铁道,总共为550亿令吉。[3] 显而易见的是,此番言论与廖中莱的声明有所出入。为了公众利益,政府应全面公布整个计划的成本和详情,包括7个铁路段和6个支线。

    此外,政府也应公布征用土地的成本,包括涉及8699处覆盖范围达8376.88亩或3390公顷的私人土地的征用费用。

    2.      要求解释此计划是否如环境衝击报告中所示般使用单轨系统

    正如环境影响评估(EIA)报告说明,整个衔接铁路计划全长532.2公里加上另外的65.9公里,而且是在双轨道上建设单轨铁道。这是否意味着在足以容纳来回轨道的空间只建一道铁轨路线?假如真的如此,为什么要耗资550亿令吉去建造一条单轨铁道。

    我想要提醒大家此计划所公开展示的影片或资料,都一再显示是双轨系统,而非单轨。

    3.      要求公开各段铁路和高价天桥长度

    119掌管经济策划单位的首相署部长拿督斯里阿都拉曼达兰曾说涉及的桥梁全长110公里[4] 可是根据陆交会所展示的高架桥却只有区区92.3公里(6917.7公里的天桥和33座共74.6公里的高架桥组成)相差17.7公里但却会涉及数十亿令吉的承建费。政府需要解释这些疑点。

    4.      要求解释为何第二阶段(连接雪州鹅麦至巴生)未敲定细节,就匆忙签署协议书

    百乐镇州议员杨美盈较早前曾指出连接雪州鹅麦至巴生路线图从环境冲击评估报告里消失。[5] 然而,过后陆交会则交代此鹅麦至巴生路线为第二阶段的计划。它们也曾强调当评估报告完成后和路线动工之前,会再向大家公开展示。[6] 因此,目前尚未完成环境冲击报告,政府为何趁首相拿督斯里纳吉日前官访北京时,仓促和中国通讯建设公司签署鹅麦综合终站至巴生港口终站的第二期计划的补充协议呢?[7]

    王建民博士
    沙登区国会议员

    [1] http://www.spad.gov.my/media-centre/media-releases/2017/public-inspection-railway-scheme-east-coast-rail-link-ecrl-opens

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