• 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

  • Feedback and Clarification on the East Coast Rail Link (ECRL)

    CEO of SPAD
    Encik Mohd Azharuddin bin Mat Sah
    Block D, Platinum Sentral, Jalan Stesen Sentral 2,
    Kuala Lumpur Sentral, 50470 Kuala Lumpur

    Yang Berusaha Encik Mohd Azharuddin,

    RE: Feedback and Clarification on the East Coast Rail Link (ECRL)

    Based on Section 84 of the Land Transport Act 2010, SPAD began the 3-month process of public consultation and seeking public feedback on the East Coast Rail Link (ECRL) on the 8th of March 2017.[1] As a Member of Parliament and a concerned citizen, I hope that SPAD can provide clarification and information on the following points raised below.

    1. Provide detailed breakdown of the cost of the ECRL

    In a report by the Edge in November 2016, Transport Minister Dato Seri Liow Tiong Lai said the following to explain the increase in the estimated cost of the East Coast Rail Line (ECRL) from RM29 billion to RM55 billion. “Previously, the length [of the rail link] was 545km; now it is 600km and this does not include the part from Gombak to Port Klang”[2] But on the 13th of May, 2017, during the signing ceremony of Phase Two of the ECRL project, which covers the track from the Integrated Transport Terminal (ITT) Gombak to Port Klang, the Treasury Secretary General, Tan Sri Irwan Serigar was reported to have said that the construction costs for this section for this section of the ECRL was RM9 billion, which, combined with the RM46 billion cost for Phase One for Wakaf Bahru in Kelantan to ITT Gombak in Selangor, would bring the total cost of the ECRL to RM55 billion.[3] This contradicts what was said by Liow Tiong Lai. In the interest of transparency, the government should publish a detailed breakdown of the estimated cost of the entire ECRL including the cost of the 7 segments of the ECRL and the 6 Spur Lines:

    The government should also provide an estimated breakdown of the land acquisition costs which will involve the government buying 8699 lots of private land covering 8376.88 acres or 3390 hectares.

    2. Clarify if the cost of the project only involves a SINGLE TRACK railway line as it is described in the EIA report

    In the Executive Summary of the Environmental Impact Assessment (EIA) report on the ECRL, it is stated that ‘the ECRL will be an electrified single track railway line built on a double track formation, approximately 532.3km for the main line with another 65.9km of spur lines.”  Does this mean that only a single track will be built for the ECRL even though a railway base that is wide enough for two tracks will be built? If this is the case, then the government needs to explain why a project which costs an estimated RM55 billion will only pay for ONE TRACK.

    I would like to point that the promotional video and materials shown in the public display, on the MRL website and in the youtube videos all indicate that the ECRL has two tracks, not one.

    3. Clarify the total length of bridges and viaducts for the ECRL

    In a statement on the 9th of November, 2016 by Minister in charge of the Economic Planning Unit (EPU), Datuk Rahman Dahlan, he said that the ECRL will involve building 110km of bridges.[4] Based on the SPAD public display drawings, a section by section calculation showed 69 bridges with a combined length of 17.7km and 33 viaducts with a combined length of 74.6km. Therefore, the total length of bridges and viaducts (assuming that viaducts are also bridges) is 92.3km. There is a difference of 17.7km between Rahman Dahlan’s statement and our calculations based on the SPAD public display drawings. A difference of 17.7km can translate into billions of ringgit of construction costs. This needs to be clarified by the government.

    4. Explain the rush to sign the agreement for Phase 2 of the ECRL connecting ITT Gombak with Port Klang

    My colleague, ADUN for Damansara Utama, Yeo Bee Yin, had earlier raised the issue of the missing link from ITT Gombak to Klang in the current EIA report available for public display.[5] SPAD responded by saying that there was no missing link and that the link from ITT Gombak to Klang is part of Phase 2 of the ECRL project. SPAD also said that “when the due processes are completed and the extension is ready for execution, SPAD will hold a public display of the conditionally approved railway scheme for this alignment prior to execution”[6] If the due processes have not been completed, why did the government sign a supplementary agreement with the China Communications Construction Company (CCCC) during Najib’s visit to Beijing recently for Phase 2 of the ECRL Project?[7]

    Dr. Ong Kian Ming
    Member of Parliament, Serdang

    [1] http://www.spad.gov.my/media-centre/media-releases/2017/public-inspection-railway-scheme-east-coast-rail-link-ecrl-opens
    [2] http://www.theedgemarkets.com/article/liow-explains-big-jump-ecrl-cost
    [3] https://www.nst.com.my/news/nation/2017/05/238867/najib-witnesses-signing-ecrl-phase-two-construction-agreement
    [4] https://www.nst.com.my/news/2016/11/187009/statement-ecrl-project-not-hastily-decided-proposed-2007
    [5] http://www.malaysiakini.com/news/379638
    [6] http://www.malaysiakini.com/news/379772
    [7] https://www.nst.com.my/news/nation/2017/05/238867/najib-witnesses-signing-ecrl-phase-two-construction-agreement

  • 希望联盟将中止PEMANDU并对此过去的所有活动进行会记审查。

    (2017年5月5日)希望联盟宣言和政策委员会所公布的媒体声明

    希望联盟将中止PEMANDU并对此过去的所有活动进行会记审查。

    首相在2010年高调地设立首相署表现管理和履行单位(PEMANDU)。自从成立以来,PEMANDU就投入了大量的资金和力量来用于宣传活动,协作国阵政府自吹自擂多项成果。实际上,它并无法履行多项关键绩效指标,甚至是免于向国会和人民负责,甚至最近也陷入了潜在的利益冲突之嫌。所以,希望联盟承诺若赢得第14届大选后,将废除所有与新成立的PEMANDU Associates私人有限公司的合同,并对PEMANDU所有过去的活动进行全面的会记审核,包括公布PEMANDU董事们的薪酬以及所有财务上的金流。与其从外界聘请昂贵的顾问来提供咨询和指导公务员的工作,希望联盟希望直接向公务员赋能,提供恰当的资源来改革整个制度,以使他们的表现能够更专业,独立,透明和有效。

    (i) 无法为实现高收入国家而提高大马国民人均收入(GNI per capita)的目标

    2010年的经济转型计划报告已阐明要在2020年前必须达到1万5000美元的国民人均收入。(请参阅图表1)


    来源:2010年经济转型计划的大蓝图,第9页

    自此以来,从2011年至2015年的经济转型计划报告都反复阐明了这个目标。然而根据以下图表,已清楚地显示了我们离1万5000美元的国民人均收入的目标还很遥远。事实上,马来西亚的国民人均收入在6年之间仅仅提高了490美元,即从2010年的8,636美元增长至2016年的9,057美元。

    图表1:2010年至2016年的国民人均收入(美元)

    来源:国家统计局的国民人均收入数据,汇率是来自参考世界银行各年美元兌马币的平均汇率

    来自民主与经济事务研究中心(IDEAS)的研究主任Ali Salman过去也曾带出此议题,并质疑马来西亚是否还能在2020年前实现高收入国家的目标[1]

    (ii) 问责上的失败

    在一份Malaysian Insight的报道中,一名PEMANDU的执行员表示:PEMANDU是向经济策划单位(EPU),首相署和国会负责[2] 然而,我们不太了解他口中所说的问责制究竟为何,因为PEMANDU的CEO伊德利斯从未前往国会回答任何有关议题。更明确地来说,他从未在国会上回答或说过任何话。既然他同时领导两项理应为国家带来改革的计划-经济转型计划(ETP)和国家转型计划,却不屑在国家最重要和民主的机构回应任何问题,我们为此感到羞愧。

    另外,就算PEMANDU自2015年就向外界发步ETP和GTP的年度报告,但却不曾在国会上提呈这些报告给国会议员。没有任何有关财务上的资料,也没有告诉大家过去的活动所耗费的资金。根据某些报道,PEMANDU的职员是领着比首相还要高的薪酬[3]

    再来,正当联邦政府大力呼吁审慎开销之际,PEMANDU还大胆地向政府分别索取1000万和1500万令吉来承办2015年和2017年的全球转型论坛。[4]

    尽管穷尽良好和透明化施政等的华丽字眼,PEMANDU并没有以身作则。

    (iii) 利益冲突

    100巴仙由财政部拥有的PEMANDU机构所有职员目前已都被转入伊德利斯所拥有50巴仙的PEMANDU Associate私人有限公司。从2017年起,PEMANDU Associate将销售自己的服务给政府,并安置自己的员工在一些关键部门来继续执行经济转型计划。同时,这间公司还能自由地向其他国内外的政府部门提供自己的服务。再来,伊德利斯在2017年更担任了上市公司,马来西亚喜力有限公司(Heineken Malaysia)的董事会主席。

    因此,伊德利斯兼任上市公司的董事会主席和有机会渗入联邦政府内部运作的私人公司的主席,不禁令人怀疑这是否有涉及利益冲突。[5] 迄今为止,他仍未现身来说明这些有关利益冲突的课题

    有鉴于此,希望联盟一旦赢得第14届选举后,便会马上中止所有PEMANDU Associate私人有限公司的政府合约。我们将对PEMANDU Corp和BFR机构过去的所有开销进行全面的会记审查,包括在2015年和2017年的全球转型论坛向明星讲师所付的薪酬。我们也会进一步地揭露PEMANDU各位董事们的薪酬。

    最后,与其大手笔地聘请外部顾问,希盟会直接将原有的资源投入在公务员的身上,以激励和授权他们表现得更专业和独立。希盟耶呼吁所有退休公务员加入我们,共同改革公务员制度以恢复昔日的廉洁,透明化和有效施政。

    Dr. Ong Kian Ming (DAP) 王建民博士 (行动党)
    Wong Chen (PKR) 黄基全 (公正党)
    Dr Dzulkefly Ahmad (AMANAH) 祖基菲里博士(诚信党)
    Dr Rais Hussin (PPBM) 莱益胡欣博士 (土团党)

    [1] http://www.ideas.org.my/news/press-statements/government-intervention-causing-malaysia-to-lose-competitive-edge-as-average-income-of-malaysians-drops-by-15-according-%E2%80%8B%E2%80%8B-to-latest-epu-figures/

    [2] https://www.themalaysianinsight.com/s/2430/

    [3] http://www.malaysiakini.com/news/149861

    [4] http://www.malaysiakini.com/news/377108

    [5] http://www.beritadaily.com/idris-position-in-pemandu-and-heineken-questionable-says-dap-man/

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