The ongoing manpower shortage crisis happening at the facilities under the Ministry of Health has been the hot topic of discussion for a while now. According to the health minister, action has been taken to resolve the issue.
While we do get timely responses from the ministry, one cannot deny that these responses are not effectively translated into tangible results on the ground. Not at this point in time, at least.
This situation was epitomised in a viral Facebook post, in which a government health care facility was apologetically appealing to patients that their wait at the emergency department would be more than five hours long due to shortage of available medical officers.
Our health care system is modelled after the National Health Service (NHS) of the United Kingdom. The welfare state is obliged to provide free health care for its people.
By emulating this utopian system, we also set ourselves up to inherit the calamitous repercussion that is plaguing the NHS currently.
The average waiting time from setting up an appointment to see a general practitioner in the United Kingdom is several weeks. By the time you get to see the general practitioner, you would have probably recovered from your common cold. This has prompted many in the UK to self-medicate for simple ailment at their local pharmacy.
In contrast to UK citizens, most Malaysians have the luxury of accessing private general practitioners’ clinics, which are a stone’s throw away from their residence at an affordable rate, provided they do not stay in remote areas.
For those who are unwilling to pay out of their pocket, the emergency department of the public hospitals offers next-to-free services which are available around the clock. At the first glance, this appears to be an impeccable system where both the poor and the rich are able to get access to health care, thereby addressing the pertinent issue of health care equity.
However, with the finite resources available at the government health care facilities, it would be implausible to fulfil the burgeoning health care needs of the people. In other words, this is in a way, a zero-sum game.
The nominal charge applicable to Malaysian citizens when they visit government health care facilities is nowhere sufficient to cover the operating cost of running clinics and hospitals.
On one hand, the health care practitioners are demanding higher pay that is commensurate with rising cost of living.
On the other hand, the fee ranging from RM1 to RM5 for visiting government clinics has been stagnant for many years.
As a result of the imbalance between the sheer workload and paltry pay as compared to the private health care sector, many health care practitioners decided to leave the government service. This contributes to the manpower shortage crisis that is crippling the public health care system.
This results in the existing health care system becoming even more understaffed and health care workers even more overworked. This propels the vicious cycle where there is a further exodus of health care workers leaving the public health care system.
Now, the question is how do we break this vicious cycle and move towards a more sustainable health care system. There is no simple solution for a complex problem.
It has to be a multipronged approach where we need to revamp the delivery of the health care system. We need to be mindful not to compromise health care workers’ well-being while prioritising patients’ needs.
The silver bullet that has the potential to solve this conundrum is by having social health insurance. Although this strategy is blatantly unpopular and unappealing to voters, this is a necessary step towards a sustainable health care system.
To solve the problem of ever rising and overwhelming workload at the government facilities, we need to tackle both demand and supply problems simultaneously.
The first strategy is to introduce social health insurance with co-payment. This scheme is largely similar to private medical insurance, except that the entity providing this should be a non-profit driven government organisation.
This is to ensure the cost-effectiveness and affordability of this insurance scheme. On top of the monthly premium, there is an additional copayment each time the insured seeks treatment at the health care facility.
To augment effectiveness, additional incentive in the form of tax-rebatable amounts for those who did not exceed a certain health care visit annually could be included. This would, to some extent, curb the demand for health care needs while circumventing the potential morally hazardous exploitation of the social health insurance scheme.
The second strategy is to collaborate with private medical centres and hospitals. Depending on the co-payment amount, the social health insurance should also cover private health care facilities, however, with a significantly higher copayment component.
This would allow patients in the M40 group to gain access to private health care facilities, especially those without company or group medical insurance.
As long as the co-payment is set within the range that is affordable for them, this move could effectively divert a portion of M40 patients to private health care facilities, thereby alleviating the workload at government health care facilities.
With the two strategies above in place to mitigate the demand, the third strategy addresses the supply of health care workers. The crux of the exodus of health care workers partially lies in the discrepancy in the remuneration between private and public health care facilities.
The increasingly worsening manpower shortage crisis will remain an insurmountable problem if we do not reassess the mismatch in workload and salary between private and public health facilities.
From a general perspective, the private health care facilities have significantly less workload compared to public health care facilities per health care worker. However, the remuneration is usually higher at the private health care facilities.
In order to tackle this, we will need to re-visit both charges at the private and public hospital and find a narrowest acceptable gap. With higher charges at public health care facilities, the increase in revenue can then be repurposed to increase the pay of public health care workers.
Once the pay gap between private and public health care facilities is narrowed, it will indubitably discourage more health care workers from leaving to the private sector.
Furthermore, with the differences in charges narrowing between public and private hospitals, a proportion of patients might opt for better equipped private hospitals at a marginally higher payment, thereby further reducing the burden at public hospitals.
With the three strategies outlined above, it could reduce the demand for public health care facilities and discourage the loss of talent from public health care facilities.
However, before social health insurance is plausible in the Malaysian context, voters will need to be educated and convinced on its pivotal role to ensure a sustainable health care landscape for all.
The author is a medical officer, who holds a Master in Public Health, has been in the service for almost eight years and holds a special interest in health care financing. CodeBlue is providing the author anonymity because civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
