The purpose of the Health White Paper (HWP) is to transform the Malaysian health system to achieve better health and wellbeing for the people.
The experience of the Covid-19 pandemic has shown that there is an urgent need to transform the national health system to meet future shocks, stresses, and challenges.
The new and transformed health system should withstand potential pandemics and should be future-proofed. But if one was to examine the paper in greater detail, it is more about reforming the Ministry of Health (MOH) rather than the national health system.
It is a known fact that Malaysia has a a distinct dual health system, with little collaboration until the recent pandemic happened.
And with the pandemic over, both systems seem to be functioning independently of each other again. In the HWP, private health care is viewed as a sector that the MOH can rely on to provide additional services and resources if such a need ever arises, for instance, during the pandemic.
Public (MOH) and private partnerships should be enhanced to help to balance resource utilisation across the public, private, and non-profit sectors. The concept of public-private partnerships was mentioned in the HWP, including the procurement of community and hospital care.
This is to reduce waiting time, particularly for high-demand services that the private sector has access to.
We recognise that the role of the private health sector, including private medical schools, is important when it comes to overall health resources, delivery, training, financing, and ownership of the health care system.
In 2021, Malaysia spent 5.1 per cent of its GDP on health and private sources, accounting for 42.1 per cent of the total health expenditure.
According to the MOH Health Facts 2021, the number of doctors (with Annual Practising Certificates) in 2020 in the private sector was 16,196, or 26 per cent of the total number. Some 38 per cent of dentists, 35 per cent of pharmacists, and 34 per cent of trained nurses are working in the private sector.
Out of 61,823 hospital beds, there are 17,628 beds or 28.5 per cent in private hospitals. There are also 8,419 medical clinics, 3,053 dental clinics, and 604 hemodialysis centres serving patients in the private sector.
Private hospitals admitted 24 per cent or 774,197 of total patients in 2020. There are a total of 38 medical programmes and schools in the country, six foreign medical school branch campuses, 21 private medical schools, and four accredited foreign universities running medical programmes.
In 2022, there were 3,934 medical graduates who graduated from local medical schools. There is hardly any post-graduate training in private hospitals, even though there are more experienced specialists working in the sector, compared to public hospitals and universities.
In terms of ownership of private hospitals, the two largest groups, IHH and KPJ, are owned by Khazanah and the Johor state government respectively. The Selangor and Terengganu state governments also own private hospitals through Selgate and TDM. Therefore, we have a situation where the government is involved in both public and private health care.
In the HWP, the MOH will be transformed in its delivery of services, but private health sector facilities and schools look set to stay the same. The MOH is also looking to the private sector as another source of facilities and services.
Why is there no transformation of delivery and training in the private health sector? In private clinics and hospitals, most medical practitioners are operating as individual practitioners, and some of them have practising rights in several facilities.
While this is beneficial to the practitioner and the private health facility, is this good for consumers (patients and families) and the health system? The provider payment mechanism in the private sector is based on a fee-for-service model.
Should we continue this system? Will we see the separation of prescription and dispensation in the private sector? Or will the patients be allowed to decide where to get their medications?
Why does a country with 34 million people need so many schools and about 5,000 medical graduates (both local and overseas) a year? Why is the public sector (MoH) the source of trained specialists for the private sector?
Why is the government involved in both public and private health care? These are some important questions that are missing in the HWP. The transformation of the national health system must include the transformation of private health delivery and training system.
Chua Hong Teck, PhD, is a health analyst.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.