I must begin by saying that I have a lot of respect for Health Minister Dzulkefly Ahmad. Dr Dzul, as we affectionately call him, is a good man and is trying his very best to fix the public health service and the Ministry of Health (MOH). He genuinely cares for the service and the staff.
However, it appears that the government does not plan to invest a lot more in the public health service, i.e. there will not be any major increase in health spending in the upcoming Budget or the near future.
In addition, we see no concrete plans for a meaningful solution to improve the conditions and remuneration of health care professionals that serve the people of the nation. This ties up the Health Minister’s hands.
Hence, Dr Dzul is looking for alternatives to support our health care professionals. The Full Paying Patients (FPP) scheme is one such suggestion.
Dr Dzul and all of us in the health profession are acutely aware that health care professionals in MOH are demoralised and exhausted, and that there is an enormous drain of human resources from the public sector to the private sector and abroad — not just of specialists/doctors, but also of nurses, pharmacists, and other allied health professionals.
The nursing shortage is at a crisis level. Health care professionals in the public health service see no future.
Having said this, I am of the opinion that the FPP scheme is not a good one.
Firstly, most of us who serve in the public health service do so because we want to make a difference in the lives of Malaysians – especially those who cannot afford to seek health care in the private sector.
Secondly, most of us who work in the public health service have no time at work for anything else – from the time we arrive to the time we leave, it is a non-stop roller-coaster of work.
If specialists used their time for the FPP scheme, it would mean that other patients would not be cared for, and younger colleagues would have to shoulder that burden. Hence, care for these patients may be compromised.
Thirdly, who will benefit from the FPP? It will be the upper and middle segments of the middle class — not the poor, not the sizeable 60 per cent of the population that desperately needs and depends on public health services.
It would worsen the divide that the private health service has created – those who have money can easily access health care, while the poor are further marginalised.
Fourthly, who are the specialists that will likely take up the FPP scheme? The hardworking ones will think many times before they use the FPP scheme, if at all.
However, there are some specialists who do not pull their weight in the public health service. They come late to work, they do not see many patients, and they leave right on time.
These are likely the specialists who will take advantage of the FPP scheme. Some others who are thinking of moving into private practice will also use the FPP scheme to test the waters.
We need better and more sustainable and reformation-based changes to the public health service. We need a progressive improvement in the conditions and remuneration for our health care staff.
We cannot allow them to continue being demoralised without any hope for the future. They work long hours, with more and more demands placed on them. The Covid-19 pandemic has proven how poorly we support them and their families.
Private health insurance (PHI) and social health insurance (SHI) are not good solutions. See the excellent commentary and insightful discussion by Jomo Sundaram and Nazihah Noor.
We need increased spending on public health services, with an increased focus on preventive health efforts. This can come from improving tax-funded health care.
For far too long, we have allowed the public health service to decay. There are no easy fixes or solutions, but I do believe that we can salvage the public health service and keep all categories of health care professionals within the service.
They should be given better conditions, environments, and support that can allow them to focus fully on their jobs and not worry about resources for patients or their families’ needs.
Basic health is a human right and not one where citizens should have to pay to receive.
Dr Amar-Singh HSS is a consultant paediatrician and child-disability activist.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
