Is IJN Discharging All Civil Servants + Pensioners Due To Cost?!

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Is IJN (Institut Jantung Negara) discharging all civil servants and pensioners, following an MOH directive due to government cost-cutting measures?!

Take a look at the viral claim, and find out what the facts really are!

Updated @ 2024-02-27 : Added new section on KKM’s response to these claims
Originally posted @ 2024-02-26

Claim : IJN Discharging All Civil Servants + Pensioners Due To Cost!

A letter posted by CodeBlue has gone viral, in which a pensioner claimed that the National Heart Institute (IJN) is discharging all civil servants and pensioners, following a Ministry of Health (KKM) directive due to government cost-cutting measures.

Here is the anonymous pensioner’s letter (archive), which is rather long. So feel free to skip to the next section for the facts!

At a recent visit to our National Heart Centre (Institut Jantung Negara, IJN), I was shocked to be informed that I was being discharged. This happened despite 25 years of my receiving extensive care at IJN with many admissions and multiple procedures.

I was informed that the reason I was being discharged was a Ministry of Health (MOH) directive that all civil servants and pensioners should be discharged to the MOH cardiac centre nearest their home.

I protested that my problem was highly complicated; the senior IJN cardiologist agreed with me. But I was told that their hands were tied as the government was cutting costs.

I also found out that my predicament is shared by numerous other pensioners and civil servants all over the country, these past months.

So, with a literally sinking heart, I returned home and arranged to see the doctors at the MOH cardiac centre near my home. This was not easy as I had to make an appointment and the clinic was busy.

I finally got to see the doctor two and half months later; I was concerned as I was going to run out of medication soon.

The doctor I saw was a young medical officer. One look at my referral letter from IJN, with my complicated problems, she looked worried and immediately spoke to the cardiologist.

Fortunately, she pushed for me to see the cardiologist the same day; I am very thankful to her. The cardiologist I met was a pleasant young man. I found out that he had just qualified as a cardiologist in the past six months or so.

He was very thorough in his examination and assessment, and then said to me, “Uncle, you should not be managed at our centre. We only have three cardiologists here and all of us do not have the expertise to handle your case.”

I had already recognised this because, at IJN, the senior cardiologist often involved two or three other colleagues in discussing my case; sometimes with extra cardiologists coming into the cardiac laboratory to support each other during each of my many complicated procedures.

So, while I was “stable” at the time of my untimely discharge from IJN, my condition often deteriorates suddenly.

In addition, the young MOH cardiologist said, “I am also afraid, Uncle, that we do not have a number of the drugs that you are on and will have to use substitutes”. This made me very worried as I have a number of drug allergies.

IJN had gone through a number of drugs before they found the ones that both worked and were safe for me to use.

The MOH cardiologist then said he would write a new referral for me to go back to IJN, and that I would have to make an appointment with IJN as a new patient and hopefully get back the same senior cardiologist.
This would be another hassle and possibly two to three months of waiting, or longer.

Yes, I recognise that the reason for the MOH directive was a cost-saving one – no need to pay IJN for the many pensioners and civil servants that use its services.

But I asked myself many searching questions.

Surely there should be some common sense in allowing the IJN cardiologist to choose who can be sent back to MOH centres and who they should keep, due to the complicated nature of their disease and care?
After all, IJN is our National Heart Centre, a centre of excellence. Why is MOH deteriorating cardiac services in the country?

I have faithfully served the country as a civil servant for 35 years. Is this how I am repaid? Is this the Madani way to treat pensioners?

If anyone says it is a simple matter to go and get a new referral back to IJN, I would like to give that person a swift kick on their backsides. The hassle to everyone is enormous, especially with busy cardiology services in IJN and MOH.

If I sound distressed, it is because I am! I could be far more aggressively vocal, for all the hardship and distress that this has caused me and my loved ones.

I plead with the Madani government and anyone who will listen at MOH, please do not continue with this blanket directive and have a return to sanity.

I say with all honesty that I probably would be dead, except for the prompt and expert care I received at IJN from senior cardiologists.

Show less

No Evidence IJN Discharging All Civil Servants + Pensioners Due To Cost!

Fact #1 : It Was A Personal Opinion

Let me start by pointing out the disclaimer at the very bottom of the article, which states that the letter was published as a “personal opinion”.

This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

Fact #2 : Letter Did Not Provide Any Evidence

I think it is also important to point out that the letter appears to be published “as-is“, without any additional context or verification. Unfortunately, the letter itself does not provide any evidence on its own.

Was the pensioner really discharged from the National Heart Institute (IJN) because of cost-cutting measures, or because he was deemed well enough to be transferred back to the referring hospital?

Is this a new KKM policy, or was it already in effect for some time? Did the other hospital really not have the necessary medicine he needed? Were the substitutes the pensioner received not the proper ones? Were his fear of allergic reaction to those substitute drugs well-founded?

It is simply impossible to tell, without knowing his full history, and what exactly he is talking about. He didn’t even mention what drugs he was on, and what substitutes he received! But let’s see what we can find out, shall we?

Fact #3 : IJN Is Still Treating Government Patients

From what I can determine, the National Heart Institute (Institut Jantung Negara / IJN) is not discharging all civil servants and pensioners due to new cost-cutting measures. In fact, it is still treating civil servants and pensioners, because it is fully-owned by the government, under the Minister of Finance Incorporated.

In fact, IJN clarified this on 5 August 2023, when similar accusations by “Concern [sic] Pensioners” went viral on WhatsApp and social media, claiming that IJN has been privatised, and refuses to treat retired civil servants, and was instead transferring them to other hospitals.

As IJN clarified, while it operates privately under the Malaysian Private Healthcare Facilities and Services Act 1998, under the purview of the Health Ministry, its primary mission is to provide exceptional medical services to all Malaysians, including government employees, retirees, and citizens.

However, the Public Service Department (JPA) requires all civil servants and retirees (and their dependents) to get a referral from a doctor or cardiologist from public or private clinics / hospitals, before they can seek treatment at IJN because it is a cardiac tertiary hospital.

Patients with government GL may refer to the JPA circular Appendix SR. 2.1.1 (G) provided in the official MyPPSM portal or refer to their human resources on the process, as every government agency has its own terms and requirements on their employee’s eligibility and coverage when seeking treatment at our centre.

Back in August 2023, IJN said that about 84.7% of its patients came from the public sector – government employees, pensioners, and their dependents. Only 14.9% are private, paying patients, while just 0.4% were foreign patients.

Fact #4 : KKM Issued IJN Follow-Up Circular In 2002

Interestingly, it appears that this Malaysia Ministry of Health (KKM) policy started in October 2002 – more than 21 years ago!

That was when the Office of the Director General of Health in Malaysia issued circular no. 12/2002, called (translated) Guidelines for Follow-Up Treatment at the National Heart Institute for Government-Dependent Patients (PDF).

Fact #5 : Government-Dependent Patients To Be Discharged After 12 Months

According to the October 2002 guidelines (officially called Pekeliling Ketua Pengarah Kesihatan 12/2002 Garis Panduan Rawatan Susulan di IJN untuk Pesakit Dibiayai Kerajaan), here is the pertinent section that I translated:

i. patients who are not undergoing surgery or invasive treatments in IJN do not require follow-up treatment at IJN, and should be transferred back to the referring hospital after consultation, examination, and treatment.

ii. patients who are waiting to undergo surgery or invasive procedure within 1 year can receive follow-up treatment at IJN until treatment is completed.

iii. the follow-up treatment period for patients who have undergone surgery or invasive procedure at IJN are:

6 to 12 months of follow-up treatment at IJN after surgery / invasive procedure
1 to 2 years of follow-up treatment after last surgery for paediatric patients with “complicated” heart issues that require multiple surgeries

iv. Patients with complications that need to be warded, or require intensive care, by cardiothoracic specialist, or cardiologist, will receive follow-up treatment according to their condition. Such patients will be transferred to their referring KKM hospitals when IJN specialists determine that they no longer need to be treated at IJN.

v. Patients who were referred to KKM hospitals can be referred back to IJN when necessary. The follow-up treatment will depend on the conditions stated above.

Fact #6 : Anonymous Letter On CodeBlue Was Criticised

In response to the letter being posted on CodeBlue, Datuk Dr. Christopher K.C. Lee – who was the former National Advisor for Infectious Diseases in the Malaysia Ministry of Health and a member of the Selangor Public Hleaht Advisory Council (SELPHAC), stated that only stabilised patients would be asked to return to cardiologists and doctors at other MOH hospitals for their follow-up. He also pointed out that this would free IJN to attend to other people who need more urgent care.

Only pensioners/civil servants who are stabilized will be asked to return to cardiologists/physicians at MOH for followup. This allows others who really need IJN care the opportunity to do; without clogging up IJN & running up the bill there. Pls see the Big Picture!

In response to a CodeBlue editor pointing out that the “issue is not about stability at the point of discharge, but complexity”, he responded:

Complexity can be subjective. In particularly complex cases, there can be discussions with the MOH cardiologists. However, most cases can be ably managed by the MOH cardiologists & shd be referred back. This has been in practice for a while & helps to keep the system sustainable.

Perhaps the anonymous letter should not have been posted “as-is”, without providing the necessary context as this isn’t a new policy – the circular was already in effect since October 2002.

Fact #7 : KKM Refutes Claims

On 26 February 2024, the Malaysia Health Ministry (KKM) issued a statement, refuting those claims, and clarifying the partnership between IJN and KKM hospitals.

I wrote a separate article on this, which you read for more context: KKM Refutes IJN Discharging Pensioner For Cost Reasons Claim!

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Dr. Adrian Wong has been writing about tech and science since 1997, even publishing a book with Prentice Hall called Breaking Through The BIOS Barrier (ISBN 978-0131455368) while in medical school.

He continues to devote countless hours every day writing about tech, medicine and science, in his pursuit of facts in a post-truth world.

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Is IJN Discharging All Civil Servants + Pensioners Due To Cost?!

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