A view from the hospital bed in Malaysia

B K Tan

SINGAPORE (Mar 18): It started the day after I returned to Penang from Singapore, a visit filled with the usual shopping and dining, as well as catching up with friends and relatives. An earache prompted a quick visit to the GP, but it didn’t mar the family reunion dinner that night. But by the first day of Chinese New Year (Tuesday), it was obvious that the heavy coughing and phlegm was not the usual over-merrymaking, hangover or food-poisoning mishap. Still, I hung on with 4,000mg doses of paracetamol and an antibiotic course over the next two days, thinking it to be a bad case of the usual flu and believing that “this too, shall pass”.

By 5am on Thursday, however, I was being wheeled into the accident and emergency ward of a private hospital. Dengue, with bleeding in the lungs, it was pronounced. Had I walked through a jungle trail recently? Nope, I had been walking the urban jungle of Singapore malls and Changi Airport, if that helps, I answered in between wheezing through the ventilator tubes and what not. Of course, it was also likely that I had been bitten where I reside — George Town’s heritage enclave with its ambience of crowded tenements, clogged drains and brackish canals.

The difference between private and public hospitals became obvious in the following days. Anyone knows that you need to place a deposit first, thank you, before they roll you in. Not a problem for me, I have a credit card. I also have a premium insurance plan (not MySalam, folks) but initially, the health maintenance organisation (HMO), which “negotiates” between insurers and hospitals, could not find my insurance policy. It was a caring, private not-for-profit hospital, so I was sure they would not cut off the oxygen.

The billing administrator who had been huffing and puffing up the stairs between me and her office for a while was apologetic but as it got sorted out and as she noted my terms and benefits, she asked solicitously, “Don’t you want a single-bed room?” A four-bedroom is fine, I replied. In my mind, single-bed rooms are usually too cold, and they are for terminal cases where a maid or a relative has to suffer along with you.

In any case, I never got to test the executive suite upgrade because my oxygenation level was deteriorating and fluctuating badly, along with other issues. I was soon upgraded to the intensive care unit (ICU), a minimalist floor of special beds with red-uniformed nurses (not because of the Lunar New Year but to categorise them separately from other wards). Four days after entering the private hospital and going through all the tests and scans the specialists required (I was assigned two — a general physician for the dengue and a chest specialist for the lung problem), it was obvious that while I was supposed to tough it out, the chest infection was not good.

Could it just be dengue with chest complications? My wife conducted a series of second opinions and reviews and concluded that I should transfer to — surprise, surprise — not some spanking-new private facility but the old 1882-built Penang General Hospital, said to be the best place for infectious diseases, including dengue.

As the ambulance’s siren wailed to clear the Penang traffic, here was where the public and private worlds changed. With permission granted, an emergency bed was ready and I was rushed through to the Penang GH ICU with no credit card swipe and no deposit-taking. It was then I realised that that’s the motto of the public health service — to be the frontline and backline when the going gets tough.

I was informed later that even if I were a foreigner or undocumented worker, admission is immediate for infectious diseases, the rationale being if the hospital were to insist on legal or monetary verification, patient zero would be back in the world and who then would take responsibility for a pandemic — all for want of a valid credit card? A virus does not discriminate.

Within 24 hours, they determined my problem was not dengue. It was viral influenza A, subtype H1N1. Not a bacterial infection in the lung but severe viral pneumonia. Strapped with an oxygen mask and tubes of fluids and medicines flowing in through the veins of both hands, the mind got a high as one stared at the surrounding scene of organised chaos, ICU beds being filled and emptied, and the daily crowd of medical interns passing by to discuss your special case.

Reflecting on MySalam

Lying there on the ICU bed, ventilator-strapped, cathethered and constipated, one could do nought but reflect, like on the MySalam insurance scheme for 36 critical illnesses recently announced by the Malaysian government, and what not. The debate on the scheme is still on going, but if I were a B40 (bottom 40% income group) person, the insurance scheme would not cover infections like mine or many of the hundreds of illnesses that hit people, whether B40, M40 (middle 40%) or top 20. On the other hand, if you have cancer, RM8,000 ($2,659) will be too little, too late.

Insurance for selected critical illnesses is basically a marketing category created and upsold to add on to term or life insurance policies. It is obviously good — for insurers. The industry is all about managing risk and the actuarists have done all the morbidity calculations, so if payouts are hefty, you probably would not be seeing this product around. My view is it distracts from a more comprehensive approach to healthcare reform — in short, public health services structured to prevent and treat all illnesses.

And why discriminate by income class when everyone is a taxpayer, whether by direct or indirect tax? If I am registered as a B40 income category but my burger business does well and my income moves up, does that disqualify me from future protection? The devil, as they say, is in the details.

The best social responsibility role a foreign insurer could have now is to divest, pay your dividends and taxes. The solution to our fiscal constraints is not more public- private partnerships, which blurs where profits go and who absorbs the costs. And it is the taxes collected that enabled a 2019 budget increase of 7.8% (RM2 billion) for the health sector (total RM29 billion) which, if properly spent and monitored, will generate a healthy outcome.

Back to the bed

Once discharged from the ICU to the common ward, I could see why many prefer private hospitals to the government-run ones. The difference is in the service and “hotel provisions”. If you need help in a private hospital ward, just press the button. In the Penang Hospital respiratory ward, there is no button. I vainly tried the modest royal wave to no avail. Guttural call-outs did not always work because in a respiratory ward, every other person sounds the same. I learnt that it is all in the eye contact.

Services at government hospitals have transformed over the years, certainly with a better focus on delivering quality service, comfort and pain minimisation to patients. But it is an overworked sector. The issue is not just underfunding, but whether our health services get the best value for the money used.

Look up the profit records and profit margins of Bursa Malaysia-listed pharmaceutical and facility management, waste and cleaning service suppliers with their long-term monopoly contracts, and ponder.

Just a day before Chap Goh Meh (15th day of Chinese New Year), the ward doctor said simply, “You can go home today.” I guess it is not everyone that gets to sample two ICUs and two hospital wards within a two-week festive season.

My family and I are grateful to the professionalism and dedication of the staff at Penang GH ICU, led by Dr Lim Chew Har, and the doctors and nurses at the respiratory ward, headed by Dr Goon Ai Khiang.

Billing and financing

Meanwhile, I found out that the private hospital was still totalling up the fees and charges even though I had transferred out a week before. And I try not to speculate on the discussions between the HMO and the hospital.

My wife went to the Penang GH billing department. I had been treated by the best ICU and medical centre on infectious diseases up north. Ample drugs, fluids as well as nursing and medical care had been provided unconditionally. Okay, the hospital food was just decent. The billing clerk took note of my wife’s government pensioner card. I am listed as “spouse”. Okay, then, the bill’s sum total is RM0.00. And do remember to come back to the chest clinic for another X-ray in two months, they say.

What should I make of this? Isn’t this pricing unrealistic in a globalised world of unfettered capitalism, market-driven healthcare and financing?

It’s not Malaysia Baru policy as the administration is still new. It’s Malaysia Lama but should be understood in its context. Over the decades, the runaway rentier state with its cronyism and corruption had sucked so much from the assets and resources of the country that subsidised healthcare for the urban working class and rural poor was probably one of the few patron-client obligations that remained. Perhaps that is why national healthcare insurance proposals in whatever form had sat on the back burner for decades because it would have been a big burden and tested the legitimacy of the old order.

As for the future, what’s wrong with allocating more funds to build an even stronger public healthcare service? One of the benchmarks of a developed country is how it treats and cares for its people affordably and equitably, irrespective of class, ethnicity and whether you live in the city or the countryside. 

B K Tan is a director of think tank Institut Rakyat. He was managing director of The Edge Communications Sdn Bhd. The views from the hospital bed are his personal opinion.

This story appears in The Edge Singapore (Issue 873, week of Mar 18) which is on sale now. Subscribe here