Nephrologist Suggests Merit System To Reward Hospitals With Good NCD Programmes

Dr Lim Soo Kun from University of Malaya Specialist Centre says public hospitals should get bigger budgets if their programmes are able to curb chronic conditions.

KUALA LUMPUR, Oct 21 — Two physicians and a doctors’ group have urged political parties contesting the 15th general elections to address health care financing, primary care, and screenings for Malaysia’s non-communicable disease (NCD) crisis.

When it comes to NCD financing in government hospitals, Prof Dr Lim Soo Kun, a nephrologist and associate professor at the University of Malaya Specialist Centre, proposed that the government consider a merit system to give a bigger budget to public hospitals with good NCD programmes. 

“I think one aspect the government can consider is a well-designed merit system to award the regional hospitals with more budget allocation for implementing good programmes to combat NCD.

“We should also reduce compartmentalisation of the health care system. For example, MOH versus MOE (Ministry of Education) hospitals. As you may know, MOE hospitals receive less budget and are expected to generate income ourselves,” Dr Lim told CodeBlue.

A report recently released by the Ministry of Health (MOH) and the World Health Organization (WHO) revealed that the direct health care costs for diabetes, cardiovascular disease, and cancer in Malaysia exceed RM9.65 billion yearly. The data for this figure was derived from hospitalisations, medical tests, medications, and primary care consultations in the year 2017. 

The National Health and Morbidity Survey (NHMS) 2019 estimated that one in five Malaysian adults are living with diabetes, one-third are living with hypertension, and half are overweight or obese. 

As Malaysia is an ageing nation, the MOH-WHO report estimated an increase in the country’s health and economic burden from chronic conditions.  

Primary Care To Reduce Burden On Tertiary Sector 

Prof Dr Lokman Hakim Sulaiman, pro vice chancellor of research and professor of public health at International Medical University.

Dr Lim also advocated for the strengthening of primary care to reduce overcrowding in the tertiary health care sector.

“If we can have better primary care support, we can reserve hospitals only for real emergencies. This can make sure we have efficient utilisation of health care resources. Of course, for this, public education is equally important.”

Dr Lokman Hakim Sulaiman, pro vice chancellor of research at the International Medical University (IMU) and director of IMU’s Institute for Research, Development and Innovation (IRDI), addressed the need to establish more primary outpatient clinics in the community,such as “basic facility GP-like/ Klinik 1Malaysia services” and mobile clinics.

As a whole, Dr Lokman’s vision for primary care focused on community services and local government:

  • Elderly care: Strengthen and expand care for the elderly, including services at home and a community support system.
  • Mental health: Enhance and expand mental health services, including services in the community.
  • Enhance local government health service capacities to deal with dengue, food poisoning, zoonoses (leptospirosis and rabies), and environmental health issues. Empower them to take ownership of these health issues.

Dr Lim also drew attention to the inequalities of receiving a kidney transplant. According to the nephrologist, almost all kidney transplant centres are located in the Klang Valley, leaving patients from the east coast and east Malaysia at a disadvantage.

“I would strongly suggest setting up regional centres to make sure equal access to transplantation services. This is applicable to other organ transplants. For example, liver, heart-lung, et cetera.”

Dr Lokman made the following proposals for NCDs:

“Address the silent epidemic of NCD and its risk factors – diabetes, cardiovascular diseases, cancers, and mental health:

  • Restructure the disease control programme of MOH – upgrade NCD Section to Division (and formalise the establishment of the National Centre for Infectious Diseases [NCID])
  • Re-establish a (politically) independent Health Promotion Board with funding from a proportion of “sin tax” – to empower non-governmental organisations (NGOs) and communities as partners in health.
  • Empower NGOs, civil societies, community, and individuals towards healthy lifestyles.
  • Incentivise healthy and de-incentivise unhealthy behaviours.
  • Smoking and vaping generational end game – continue the work towards tabling the RUU (Control of Tobacco Product and Smoking Bill 2022).”

Primary Care Crucial For Successful NCD Screenings

Federation of Private Medical Practitioners’ Association, Malaysia (FPMPAM) president Dr Steven Chow. Picture from

The Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) held that the delivery platform for mass health screenings should be conducted through a medical practitioner at the primary care level, with a general practitioner or family doctor performing the screenings.

FPMPAM president Dr Steven Chow Kim Weng stated that the proper approach to a medical screening starts with the taking of a full medical history, full physical examination and finally, laboratory tests.

“The duty of care of the doctor does not just end with the laboratory results. Screening must be followed by appropriate counselling and medical intervention if there is a clinically significant abnormality,” Dr Chow told CodeBlue.

Another reason why it is absolutely vital for health screenings to be done at the primary care level is the “issue of false positive and false negative.”

According to Dr Chow, doctors have reported cases of patients becoming devastated and suicidal upon receiving a false positive result, which was subsequently found to be normal.

This problem of “overdiagnosis” and “wrong diagnosis” that is based on laboratory results carries many adverse impacts for the normal individual, who could be subjected “to further investigative procedures, long-term treatment, the danger of loss of work and health insurance cover.”

“For health screening to be effective, there must be concomitant programs to improve health literacy. The messaging and implementation must also involve civil society and not via mere political rhetoric.”

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