[Pihak IJN mengkritik tulisan MGG mengenai kisah seorang bekas penderma darah yang tidak berhak mendapat rawatan di IJN kerana tidak mampu. Inilah masalah projek penswastaan di mana wang lebih diutamakan dari nyawa seseorang. Padahal dulu IJN itu adalah satu unit HKL. Harga dan nilai nyawa seseorang itu telah diukur dengan wang - bukannya kemanusiaan. Padahal penderma darah itu telah menyelamatkan bukan satu dua orang, malah ramai yang tidak dikenalpun mereka itu tanpa mengharapkan sedikit pun balasan. Sepatutnya kerajaan menghargai penderma darah dengan memberi keistimewaan buat mereka - jika tidak sudah ramai rakyat malaysia yang mati kekurangan darah - termasuk banyak pak menteri hari ini. - Editor]

Penterjemah: KTK6

JAWAPAN MGG PILLAI KEPADA MAKLUM BALAS DARI PENGURUSAN IJN

Berani Anda Mendapatkan Rawatan Perubatan Tanpa Membawa Wang?

(Re: How Dare You Have No Money For Medical Treatment)

Tajuk Artikel : Berani Anda Mendapatkan Rawatan Perubatan Tanpa Membawa Wang?

Sdr. Pillai,

Merujuk kepada artikel saudara yang bertajuk 'Berani Anda Mendapatkan Rawatan Perubatan Tanpa Membawa Wang ?' yang disiarkan pada 15 Mac 2001.

Pihak pengurusan IJN mengambil berat tentang isu yang dibentangkan di dalam artikel saudara itu. Kami merasakan bahawa jika kisah pengalaman seorang penderma darah yang berusia 72 tahun itu benar, maka kami memerlukan lebih banyak maklumat mengenai beliau bagi membolehkan bantuan disalurkan.

Beberapa orang doktor di IJN membangkitkan kisah itu dengan saya, seorang dua membayangkan bahawa apa yang saya tulis pada masa akan datang tidak boleh dipercayai lagi disebabkan apa yang telah saya tulis itu. Tetapi kenyataannya, berdasarkan pendedahan dari surat tersebut, orang miskin yang tidak mempunyai apa-apa itu terpaksa pergi ke serata tempat untuk mengumpulkan tanda tangan dan menyediakan bukti-bukti yang mengesahkan tentang dirinya yang miskin sebelum dibenarkan oleh hospital kerajaan untuk mendapat rawatan di IJN. Ini bukanlah salah pihak IJN, memandangkan IJN adalah sebuah organisasi swasta. Tetapi hospital-hospital kerajaan tidak akan mengeluarkan surat-surat rujukan dengan sebegitu mudah. Rujukan-rujukan yang seumpamanya kini perlu ditandatangani oleh seorang doktor pakar, dan doktor pakar pula dikehendaki agar menghadkan bilangan kes-kes untuk rujukan.

Penderma darah yang berusia 72 tahun itu, yang merupakan bapa kepada kawan anak lelaki saya, akhirnya mengambil keputusan untuk tidak menjalani pembedahan daripada terpaksa menempuhi berbagai kesulitan itu. Adalah sesuatu yang boleh dipersoalkan apabila petugas-petugas yang tidak dapat bertolak- ansur sanggup melihat seorang yang miskin melalui berbagai kesulitan bagi mendapatkan rawatan yang sepatutnya layak diterima olehnya. Bayaran kos perubatan sebanyak RM100,000 yang dimaklumkan kepadanya itu, menurut kenyataan beberapa orang doktor di IJN kepada saya, adalah terlalu tinggi. Mungkin itu benar. Tetapi sekalipun kos sebanyak RM25,000 dikenakan, mereka akui, akan melebihi kemampuan seseorang yang berpendapatan biasa. Kita sedang menyentuh perkara-perkara yang berkaitan dengan polisi /dasar-dasar untuk orang-orang awam di sini, dan saya tidak bercadang untuk memulakan perbahasan tentang itu. Namun jika begini cara yang perlu dilalui oleh orang-orang miskin di Malaysia bagi mendapatkan rawatan perubatan yang diperlukan, maka sudah pasti ada sesuatu yang tidak kena dengan sistem tersebut.

Walaupun kerajaan tidak menetapkan sebarang polisi bagi penderma-penderma darah mendapatkan rawatan perubatan percuma di IJN, Kementerian Kesihatan telah mengenalpasti langkah-langkah bagi membolehkan seseorang yang tidak berkemampuan seperti beliau mendapat subsidi terhadap bayaran rawatan perubatan dan bil hospital, sama ada sebahagian atau sepenuhnya. Kriteria yang ditetapkan untuk langkah tersebut adalah seperti berikut :-

1. Beliau mesti dirujuk ke IJN oleh doktor pakar dari hospital kerajaan,
   
   

2. Menyediakan dokumen sokongan seperti : Laporan status sosio-ekonomi yang mengesahkan tahap pendapatan ibubapa/ keluarga dari jabatan Kebajikan Masyarakat atau jabatan kebajikan perubatan hospital kerajaan yang membuat rujukan.
   

3. Menerima rawatan di wad kelas ketiga (jika dimasukkan ke hospital), dan
   
   

4. Mematuhi tarikh pembedahan yang ditetapkan oleh IJN.
   

IJN yang memulakan operasinya sebagai sebuah hospital kerajaan telah dikorporatkan di dalam bulan September 1992 dengan 100% ekuiti dimiliki oleh kerajaan di bawah Kementerian Kewangan Incorp. Di antara objektif-objektif pengkorporatan adalah untuk:

1. Menjadi pusat rujukan kebangsaan bagi penyakit- penyakit yang berkaitan dengan jantung.
   

2. Meneruskan tanggung jawab sosial kerajaan untuk menyediakan rawatan pakar kepada kakitangan- kakitangan kerajaan dan mereka yang tidak berkemampuan.
   

Apabila sebuah institusi seperti IJN, dibina dengan wang dari tabung kerajaan dan diswastakan tanpa berfikir panjang dan diserahkan bulat-bulat - walau sebaik mana yang telah dilakukan oleh IJN, sejarah bagaimana ia diswastakan adalah menyedihkan, kemudian bersikap tidak ubah seperti setiap hospital swasta di dalam bandar, sudah tentu ada sesuatu yang tidak kena. Bagaimana IJN boleh 'meneruskan tanggung jawab sosial kerajaan untuk menyediakan rawatan pakar kepada kakitangn-kakitangan kerajaan dan mereka yang tidak berkemampuan?' Bagaimana seorang yang begitu menjaga harga diri tetapi sakit, yang tidak pernah berurusan dengan jabatan kebajikan masyarakat boleh mendapatkan surat-surat/dokumen-dokumen sokongan yang ditetapkan oleh IJN jika rawatan perubatan segera diperlukan? Inilah satu kepercayaan bahawa seorang yang miskin perlu tunduk sehingga menafikan rasa kehormatan dirinya bagi melayakkannya mendapat rawatan percuma.

IJN tidak pernah terikat dengan tanggung jawab untuk menyediakan rawatan percuma. Begitulah cara ia ditubuhkan. Orang yang berusia 72 tahun itu, disebabkan telah mendapat beberapa episod serangan sakit jantung yang tidak berapa serius, telah membuat keputusan bahawa beliau tidak akan membenarkan sesiapapun meragut rasa hormat pada dirinya juga tidak untuk keluarganya menanggung beban hutang, tidak lain dari satu contoh masalah yang dihadapi oleh rakyat apabila mereka memerlukan rawatan perubatan. Kepada siapa tidak perlu dipersoalkan jika kosnya adalah sebanyak RM25,OOO, sebanyak ini yang diberitahu kepada saya tentang bayaran yang dikenakan oleh IJN, atau RM 100,000. Jika ternyata RM100,000 yang saya sebutkan itu adalah salah (seperti yang diberitahu kepada saya walaupun bayaran IJN adalah lebih kurang suku dari itu), adakah orang itu akan dirawat? Saya meraguinya. Tidak juga sekarang, biarpun semua bayaran yang dikenakan itu ditarik balik.

Kami perlu menegaskan di sini bahawa walaupun IJN adalah satu badan korporat, bayaran yang kami kenakan adalah berpatutan. Dan, kami boleh memberikan jaminan kepada sdr. dan juga pesakit itu bahawa untuk satu angiogram yang normal atau angioplasty atau pembedahan jantung (bypass), bilnya tidak pernah mencecah RM100,000.

Terdapat satu kepercayaan di dalam mana-mana organisasi bahawa satu-satunya bayaran yang dikenakan adalah apa yang diberikan (preskripsi) secara rasmi oleh pihak pengurusan. Apabila bidang perubatan menjadi satu perniagaan yang mementingkan wang, inilah yang berlaku. Pengurusan akaun menjadi amat penting. Doktor-doktor pakar mungkin berpegang teguh pada 'Oath of Hippocrates', dan menjalankan tugas dengan baik, tetapi yang mengawal mereka adalah akauntan. Sama ada ianya di dalam IJN atau sebarang hospital-hospital swasta di dalam bandar. Bolehkah pihak IJN memberitahu saya ke manakah pula orang miskin yang tidak mendapat rujukan untuk pembedahan jantung itu harus pergi bagi menyelesaikan masalah perubatannya itu.

Kami harap dengan penjelasan yang disebutkan di atas, sdr. kini telah mendapat gambaran yang sepenuhnya tentang pusat sakit jantung di negara ini, Institusi Jantung Negara.

Saya faham bahawa IJN adalah sebuah hospital swasta, dan di dalam kapasiti itu, telah melaksanakan tugas dengan baik. Tetapi ia menjadi satu tempat di mana orang-orang miskin boleh mendapatkan rawatan dengan bayaran yang minima hanya sekiranya mereka bersedia untuk mengorbankan rasa hormat dan harga diri mereka. Saya tidak menyetujui rancangan pengkorporatan IJN itu sejak dari mula lagi, dan masih berpegang teguh tentang hal itu. Saya mempunyai satu pandangan luar tentang kesihatan am dan perubatan yang berbeza dengan IJN. Itu tidaklah, seperti yang dikatakan oleh seorang doktor di IJN, menjadikan pandangan saya itu salah. Tetapi ia mencabar pandangan luar yang meluas. IJN telah ditubuhkan, sebagai kesan dari peristiwa pembedahan jantung Perdana Menteri pada tahun 1988, bagi menyediakan sebuah pusat jantung yang baik sebagai tambahan kepada Hospital Besar Kuala Lumpur. Tiada perbelanjaan yang dikeluarkan. Kemudian ianya dikorporatkan dan tidak lagi dibuka kepada mereka yang memerlukannya, kecuali mereka sanggup mengenepikan rasa hormat dan harga diri, ataupun tidak mempunyai wang.

MGG Pillai

Alawiyah Hj. Yussof
Eksekuti Perhubungan Awam
JN

27 April 2001

**************************

-MGG Pillai-

-Terjemahan KTK6-

Rencana Asal:

Date: Sun, 29 Apr 2001 15:43:21 +1000 Subject: Re: How Dare You Have No Money For Medical Treatment

Dear Mr Pillai,

We refer to your article ?How Dare You Have No Money For Medical Treatment?? posted to
sk@kists.malaysia.net,sangkancil@lists.malaysia.net, skmgg@listerv.net.gw.com on 15 March 2001.

The Institute?s Management views your article with much concern. We feel that if the 72 year old blood donor experience was true, we wish to have more information of him before we can assist.

Several doctors at IJN raised the story with me, one or two suggesting that what I write could not in future be trusted because of what I wrote. But the fact remains, as the letter reveals, that a poor man without means must go round collecting signatures and provide evidence he is poor before the government hospital would allow him to be treated at the IJN. This is not IJN's fault, since IJN is a private organisation. But government hospitals do not give these referrals easily. These referrals can now only be signed by a specialist, and the specialist is told to restrict his referrals.

The 72-year-old blood donor, the father of my son's friend. has, in the end, decided that the obstacle course is not worth it, and will not undertake surgery. It is a curious assumption of bureaucrats that the poor can be made to run an obstacle course to get the treatment he is entitled to. The RM100,000 he was told it would cost is, IJN doctors tell me, is too high. Perhaps it is. But the RM25,000 it does cost, they admit, is beyond the capability of the average man. We are getting into the area of public policy here, and I do not want to start a debate on that. But if this is how the poor in Malaysia can get access to needed medical care, then surely something is wrong with the system.

Although the Government has not set any policy for free treatment in IJN for blood donors, the Ministry of Health has identified ways for under privileged patients like him to have his treatment charges and hospital bill subsidised by the Government, partly or fully. The criteria for the above are as follows :-

§ He must be referred to IJN by a specialist from a government hospital,

§ Produce a supporting document ie : Socio Economic Status Report certifying the parent/family?s income status from the Social Welfare Department or from the Medical Welfare Department of the referring government hospital

§ Receive treatment in our third class ward (if admitted), and

§ Adhere to the surgery date set by IJN

IJN which started as a government hospital was corporatised in September 1992 with 100 percent equity owned by the Government under the Ministry of Finance In corporated. Part of the objectives of corporatisation are to

§ be the national referral centre for heart diseases

§ continue the Government?s social obligation to provide specialised treatment to government servants and the underprivileged.

When an institution like IJN, built with governmnt funds and privatised without thought or concern and handed over on a plate -- whatever good IJN does, its history of how it got privatised is murky, then behaves like every private hospital in town, surely something is wrong. How does IJN "continue the government's social obligation to provide specialised treatment to government servants and the underprivileged?" How does a proud but poor sick man, who has no dealings with the social welfare department get the supporting documents IJN require if urgent medical attention is needed? It is this belief that the poor can have his nose ground to the ground that his self-respect must be denied him before he is entitled to free treatment.

IJN is under no obligation to provide free care. That is how it is set up. The 72-year-old man, who since has had a few minor heart attacks, has decided he would not allow anyone to take away his self-respect nor his family to be burdened with debt, is but one example of the problems old people face when they seek medical treatment. Not just in IJN, but every where. To whom it does not matter if the cost is RM25,000, which is what I am told IJN charges, or RM100,000. The man is clear in his mind what he was told it would cost. How would he recognise who told him this when he is a sick man desperate for treatment? I cast no aspersions about IJN in what happened, but I stand by what I said about the RM100,000. If indeed if the RM100,000 I mentioned is wrong (which I am told was mentioned though IJN's fees is about a quarter of that), would the old man have been treated? I doubt it. Nor would he now, even if all fees are waived.

We need to stress here that although IJN is a corporatised body, our charges are competitive. And, we assure you as well as the patient that for a normal angiogram or angioplasty or open heart surgery (bypass), the bill has never reached RM100,000.

There is a naive belief in any organisation that the only fees are what is prescribed officially by the management. When the practice of medicine becomes a lucrative business, this is what happens. The accounting bottom line is all important. The specialists could be imbued with the Oath of Hippocrates, and do a good job, but those who control him is the accountant. Whether in IJN or any of the private hospitals in town. Could IJN tell me where a poor man who is not given a referral to it for heart surgery go to resolve hismedical problem.

We hope with our explanation above, you now have a better understanding of the country?s heart centre, Institut Jantung Negara.

I understand IJN is a private hospital, and within that confines, does a good job. But it is a place where the poor could get treatment at nominal rates only if they are prepared to swallow their self-respect and pride. I was against the corporatisation of IJN from the beginning, and am remain so still. I have a worldview of public and medical health different from IJN's. It does not, as one doctor at IJN suggested, make my views wrong. But it challenges the prevailing worldview. IJN was set up, in the wake of the Prime Minister's open heart surgery in 1988, to provide a good heart centre as an adjunct to the General Hospital Kuala Lumpur. No expense was spared. It was then corporatised. and it is no more open to those who need it, unless he swallows his self-respect and pride, or if he does not have the money otherwise.

M.G.G. Pillai
pillai@mgg.pc.my

Alawiyah Hj Yussof
Public Relations Executive
Institut Jantung Negara

27 April 2001

Original reply from IJN:

Subject: Re: How Dare You Have No Money For Medical Treatment (fwd)

Dear Mr Pillai,

We refer to your article ?How Dare You Have No Money For Medical Treatment?? posted to
sk@kists.malaysia.net,sangkancil@lists.malaysia.net, skmgg@listerv.net.gw.com on 15 March 2001.

The Institute?s Management views your article with much concern. We feel that if the 72 year old blood donor experience was true, we wish to have more information of him before we can assist.

Although the Government has not set any policy for free treatment in IJN for blood donors, the Ministry of Health has identified ways for under privileged patients like him to have his treatment charges and hospital bill subsidised by the Government, partly or fully. The criteria for the above are as follows :-

§ He must be referred to IJN by a specialist from a government hospital,

§ Produce a supporting document ie : Socio Economic Status Report certifying the parent/family?s income status from the Social Welfare Department or from the Medical Welfare Department of the referring government hospital

§ Receive treatment in our third class ward (if admitted), and

§ Adhere to the surgery date set by IJN

IJN which started as a government hospital was corporatised in September 1992 with 100 percent equity owned by the Government under the Ministry of Finance In corporated. Part of the objectives of corporatisation are to

§ be the national referral centre for heart diseases

§ continue the Government?s social obligation to provide specialised treatment to government servants and the underprivileged.

We need to stress here that although IJN is a corporatised body, our charges are competitive. And, we assure you as well as the patient that for a normal angiogram or angioplasty or open heart surgery (bypass), the bill has never reached RM100,000.

We hope with our explanation above, you now have a better understanding of the country?s heart centre, Institut Jantung Negara.

Alawiyah Hj Yussof
Public Relations Executive
Institut Jantung Negara

Mr MGG Pillai original article:

How Dare You Have No Money For Medical Treatment?

The Sun yesterday on its front page (15 March 01) had a proud Malaysian who had donated 32 pints of blood. He is amongst the few thousand who would also rush to donate when blood is need urgently. But not enough do. So, the government sweetens it by offering concessions that include special attention and rates in hospitals. Those who donate see that as some recognition for what they do -- and accept the of paying less should they be ill as a bonus that could come in useful in old age. But could they claim it? Not, not if you are 72, need open heart surgery. The General Hospital in Kuala Lumpur referred a 72-year-old man, a blood donor for more than 30 times since he was 40, to the Institiut Jantung Negara for he was told he need open heart surgery. The IJN offered him a package deal of angiogram, angioplasty and, if necessary, open heart surgery for RM100,000, take it or leave it.

This man probably could not raise RM20,000 for treatment, let alone five times that; he lives in the lowcost flats a stone's throw from the hospital; he is not a government pensioner. The IJN did not want to hear any of that, nor that he was a regular blood donor. Normally, you undergo an angiplasty, a proceedure which "balloons" out the plaque that prevents blood from flowing through the artery to the walls of the artery so that it can. It is an intermediary step to a full coronary arterial bypass surgery, or open heart surgery as we commonly know. When it is done, the heart surgeon is on standby. But this "in for a penny in for a pound" rate and the high cost boggles the mind. The blunt take-it-or-leave-it offer to the man made it quite clear to him that the IJN does not want anyone who cannot pay the usurious sums demanded.

One reason for this is the unnecessary tests, and seeing more specialists than you knew they were, adding to the cost. After all, the hospital must recover costs of the mindboggling cost of specialised equipment. Is the government interested? Hardly. The pharmaceutical companies have raised the prices of drugs by up to 30 per cent, making even commonday drugs out of reach. A common item like pain killers cost 20 cents each before the price rise; it should be more now. The health minister's request that generic drugs be used to cut cost is a spurious suggestion. When I wrote about in in my column in Harakah, one private medical doctor wrote me to say he had dispensed generic drugs where possible, but they were not many reliable suppliers or manufacturers around. He agreed he did it as a matter of practice, as his father did before him. But he is a rare bird.

I heard of this 72-year-old when his son wanted to talk to a heart surgeon there for help. I gave him several numbers but told him he should look at other options. Even if you have the money, but are not titled high enough, you can be given a runaround. A few months ago, I had arranged to have lunch with a Dato', prominent in his field, after his checkup at the IJN. But at lunch-time, the cardiologist still had not completed the tests, interrupted by several hours when more important Tan Sris and Datos' came for their checkups. So, even if you have the money, you must expect to be pushed around.

Malaysia in its mad, ill-thought out rush to ensure we have the cheapest paid medical facilities in Southeast Asia, made it beyond the reach of the majority of Malaysians in whose name the IJN was built. It was originally the heart unit of the KL General Hospital. The Prime Minister needed bypass surgery, he could not be flown overseas, so it was done here. He then ordered the heart unit, which was about to be set up as the IJN, be given the best medical equipment money could buy. When it was all in place, it was privatised to a medical crony of his. And soon, market forces, not the health of those who needed it, took over. The IJN, despite its excellent complement of specialists in cardiac problems, today stands testimony to the worst of Malaysia Boleh. The KL General Hospital would soon follow: it is privatised to a company controlled by a son of the Prime Minister.

As for the 72-year-old man, he has since been rushed to hospital for problems connected with his medical problems, and complicated by the hospital doctor telling him unequivocably that he would die within weeks. This leaves the suspicion that the high charges were quoted so that he would not die on them and upset their statistical chart of successes. When you do not have money, you should not live; you have no business, in this convoluted scheme of things, to seek medical advice. The specialists we have here is to impress the world that we have facilities other drool over, not so that its people can make use of them. We have become a nation of Marie Antoinnettes, who when told people demonstrated for bread, famously asked why they did not eat cake? Within months, the French Revolution broke out, and she lost her head, as the Madurese recently in Kalimantan. Meanwhile, my friend's father awaits for that merciful release to that Great Hospital In The Sky.

M.G.G. Pillai
pillai@mgg.pc.my