Malaysia’s Health Agenda: Complex But Crucial – Nadiah Wan

Singapore and Indonesia are allowing foreign health care labour. Unless global and structural trends are reversed, Malaysia must start planning for the liberalisation of our health care labour market.

As we await another change of guard in our line-up of policymakers, I would like to share some of my thoughts on some important conversations that should not be missed when discussing our nation’s vision for health and a healthy population.

Holistic Health Policy Development

Health is not just the domain of the Ministry of Health (MOH) per se. There are various sectors and issues that affect the performance of the health delivery system and population health outcomes.

For example, Social Determinants of Health (SDH) – i.e. non-medical factors like income, housing, food security, early childhood development and others – have a huge impact on health outcomes.

According to the World Health Organization (WHO), SDH factors can account for between 30 to 55 per cent of health outcomes. More importantly, social, behavioural and environmental factors alone account for 70 per cent of the determinants of health.

By not establishing health-related policies as part of other ministry plans and creating inter-ministerial platforms to address these issues, we are effectively ignoring a large part of what drives good health outcomes. In addition, private corporations can and should do more to assess and address these issues as part of their overall environmental, social and governance (ESG) commitments.

A Coherent Human Capital Development Strategy and Policy

The training of health care professionals is long and arduous, not in the least because it often relies not just on classroom learning, but also hands-on training involving real-life patients.

University hospitals and postgraduate programmes are under the purview of the Ministry of Higher Education, while MOH also offers parallel pathways to specialisation and training programmes for nurses and allied health professionals.

Often, training offered or sponsored by the private sector also rely on MOH hospitals as a clinical base for training. The Covid pandemic disrupted many of these training programs, putting the future pipeline of talent at stake.

Meanwhile, trained Malaysian nurses, doctors, and allied health professionals continue to leave for other countries due to the depreciation of our ringgit, rising inflation, and the increased demand for health care professionals in other countries.

While I support changes to the Employment Act that will see better regulation of working hours and longer maternity leave, the truth is that for a sector that is chronically short of workers and overwhelmingly employs women of childbearing age, these policies will likely introduce a further labour crunch.

Countries like Singapore and even Indonesia, which historically had very inflexible policies, have moved to liberalise their health care sector labour markets to address these issues, allowing foreign health care labour, and revising health staffing ratios and employment regulations.

Unless global and structural trends are reversed, Malaysia must start planning for a similar liberalisation, all while ensuring the quality and safety of care is maintained.

Public-Private Partnership for Resilience

The Covid pandemic made us all realise that a parallel public and private system with very few intersections is not resilient. It took a worldwide pandemic to jolt us out of inertia and in two years, we managed to achieve things that many had talked about but secretly never believed would materialise – things like outsourcing of health services to the public sector or running a national immunisation campaign almost entirely through private health care providers and other achievements.

It is to the credit of the MOH that in times of crisis, it brought all players from the private sector and civil society to the table.

However, the danger is usually when the crisis has passed. With no immediate need looming, these initiatives have been kept on the backburner.

Tellingly, the Budget 2023 that was announced earlier this month had no mention of bolstering outsourcing initiatives to the private sector.

The mechanisms by which these public-private partnership (PPP) initiatives were delivered must be maintained, even if not at the scale required during the Covid pandemic.

By keeping these initiatives going, improvements can be made to the policies, processes, and channels of communication so that all parties may response immediately should a need arise.

The ongoing PPP initiatives can also serve as a catalyst to explore other areas of potential collaboration, especially in a very volatile world where large-scale risks can emerge rapidly, whether it is flooding due to climate change or supply chain disruptions from wars.

Reform of Health Financing Takes All Hands

Policymakers often seek the perfect solution to the holy trinity of cost, quality, and access.

As with other economic policies, the discussion often boils down to one of philosophy – should the rakyat be accountable for some part for the cost of their health care, given that the cost is linked to in no small way to their own lifestyle choices.

Driven by demographic changes, larger economic forces, evolving regulations, technology and innovation, amongst other factors, our health care inflation rates have consistently outstripped national inflation.

Stuck between the proverbial rock and hard place, the government will have to seriously look at health financing reform to find a viable way forward.

Social and private health insurance schemes need to be seriously considered, alongside a review of how health care costs are accounted and budgeted for in both the private and public sectors.

Areas of urgent need are mental health, ageing and geriatrics, and preventive health, which traditionally are policy exclusions for most private health insurance schemes and see increasing out-of-pocket expenses.

It will take collective leadership from both public and private sectors to undertake the scale of reform we need within the tight fiscal space we have as a country.

Health as An Economic Sector

The 12th Malaysia Plan had identified medical tourism as an economic sector to develop. Covid introduced massive disruptions to this market and recovery has been slower than expected.

During the lockdowns in Asia, countries in Eastern Europe seized the opportunity to further develop in this area, with Turkey, Croatia, and others capitalising on increasing inflows of medical tourists from Europe and the Middle East.

While its understandable that most of the focus of MOH has been on ensuring the health of our own people, it would be foolish to ignore the economic potential of our health system investments.

The development of the medical tourism sector and the health economic sector extends beyond having the Malaysia Healthcare Travel Council as a facilitator.

There is a need for considered industrial policy and planning alongside a more robust framework encompassing not just health care providers, but also payors, suppliers, and others within the health ecosystem.

Ultimately, having a thriving private health care sector and foreign inflows from medical tourism will allow us to develop and fund further investments into the health system that serves Malaysians too.

In the End

Health means many things to many people. It is not just about the actual provision and access to care; it is also about creating employment and developing talent, funding, and investment as well as building and maintaining resilience.

No complex problem has an easy answer, but I hope that the leaders of both public and private sectors are prepared to come together to commit to a substantial agenda with clear outcomes in terms of a building a larger health ecosystem, human capital development, and strategies to revive and sustain health care as a public good as well as an economic sector.

In fact, the private health care sector views these issues seriously as it affects the overall long-term sustainability of the industry.

The rakyat too must be accountable to educate themselves on these issues to understand the impact of their decisions and contribute constructively to deciding what health means for all Malaysians.

Nadiah Wan is the CEO of Thomson Hospital Kota Damansara and Group CEO of TMC Life Sciences Berhad. The views expressed are her own and do not represent that of any organisation the writer is associated with.

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

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