For more than six decades, the Ministry of Health (MOH) has been providing universal health coverage to all Malaysians that is nearly free at the point of care, irrespective of their socioeconomic status.
This is the main point of pride for our national health service, praised by grateful Malaysians who weep upon hearing that treatment or diagnostics for cancer like an MRI scan is free in this country.
Yet, Prime Minister Anwar Ibrahim’s administration appears to be taking a Robin Hood approach to health care with a new privatisation programme called RakanKKM, potentially destroying the basic identity of MOH’s health service.
Health Minister Dzulkefly Ahmad has repeatedly described RakanKKM as the creation of “private wings” in public hospitals, indicating the government’s move towards privatisation of the MOH.
It is puzzling that the MOH has not announced details about RakanKKM with the planned creation of a special-purpose vehicle using investments from government-linked investment companies (GLICs), telling the public to simply await Anwar’s announcement in the upcoming tabling of Budget 2025 in Parliament this Friday.
Did the MOH find out first whether private hospital wings run by public universities along with their public wings – notably Universiti Malaya and Universiti Kebangsaan Malaysia – were successful in retaining specialist doctors? A senior consultant at Universiti Malaya says no.
Did the MOH engage other key stakeholders like associations representing doctors, consumers, and patients; think tanks working on health financing reform; or even private hospital groups to understand the actual cost of running a hospital?
Telling Malaysians to wait for the Budget speech is fait accompli; the government should bear in mind that bad public policies can and have been reversed after public uproar.
RakanKKM is clearly not intended as a mere “expansion” of the current full-paying patient (FPP) service in the MOH, given that the FPP service has ceased operation for years since the Covid-19 pandemic in at least three of 10 MOH hospitals that initially provided FPP.
The FPP service is now no longer available in the northern or southern regions, only in the Klang Valley, Sabah, and Sarawak. Most of the remaining seven government hospitals that still offer FPP limit the service to obstetrics, while a couple of cardiac centres offer cardiology.
These FPP restrictions are due to bed and staff shortages – not just specialists, but also medical officers and nurses, as it takes a team to provide health care.
Dzulkefly’s post on X late last night, following the first town hall for MOH staff on RakanKKM that wasn’t open to the media, just throws up more questions than answers, when the minister posted that the new programme wouldn’t repeat the “mistakes” of the “Private Wing-FPP”.
What mistakes were these? The FPP service was never intended to be private wings in public hospitals, according to Chua Hong Teck, one of the administrators involved in the original set-up, as MOH did not want to create inequality.
Lots of buzzwords were thrown around in the health minister’s post, like “raising the floor”, “raising the ceiling”, and “premium economy”. Suddenly, nurses are brought into the picture too, with Dzulkefly saying that RakanKKM is aimed at curbing the attrition of both specialists and nurses.
First of all, the only health care professionals who receive a direct share of FPP fees are specialist doctors – because the service was meant to retain only them; other support staff just get paid overtime. More importantly, nurses in MOH hospitals have all been diverted from specialist clinics to wards due to severe shortages since the start of the year.
The current state of the FPP service – with first-class wards and specialist availability not guaranteed – is wildly at odds with expectations from potential customers of RakanKKM, who demand the same standards as conventional private hospitals.
It would be a betrayal of public trust if the MOH were to allow private patients under RakanKKM to pay to jump the queue for services, like the VIP lane in a Universal Studios theme park.
Even if RakanKKM were to recruit retired or senior consultants in private service, there is no legal mechanism allowing this. Private specialist doctors may also be reluctant to serve in RakanKKM not just because of pay, but out of fear of increased liability because MOH hospitals aren’t required to meet standards under the Private Healthcare Facilities and Services Act (PHFSA) 1998.
This Robin Hood approach to health care will only end up hurting the poor and the middle class. The “rich” – by rich, we mean a CEO who makes more than RM80,000 a month, not the salaried T20 whose household income is only RM10,000 to RM24,000 monthly – seek health care wherever they can get it, whether it’s private, public, or overseas. Not all treatments are available in Malaysian private hospitals.
Just because one has private insurance doesn’t mean they’re “rich”. Studies on financial toxicity in cancer show the extreme difficulty faced by cancer patients, who are driven to tears trying to access their insurance benefits.
While countries are moving towards a universal approach, like universal basic income, Malaysia is regressing by privatising our national health service in a misguided attempt to further squeeze the middle class, even though the middle class are the ones paying the most taxes to fund the public health care system.
It’s not the government’s job to enter business and make money. Who is the “rakan” in RakanKKM? Is MOH’s friend now GLICs, whose main priority is to turn a profit for their shareholders (read: not stakeholders)? Does RakanKKM aim to make quarterly net profit of over RM620 million, which, even if it did, would just be a fraction of the MOH’s RM41 billion budget for 2024?
The government’s job is to raise revenue from taxes and to spend public funds wisely. A health and social insurance scheme, which funds both health and aged care, would be able to raise tens of billions of ringgit annually, while keeping health care free at the point of care.
Contributions from all should be collected to create a sense of shared responsibility for the public health service – including the B40, even if it’s as little as RM10 monthly from this group. The government can help to bear the cost of contributions from only those who absolutely cannot pay, like the hardcore poor, children, retirees, and the unemployed.
Ipoh Timor MP Howard Lee recently urged GLICs to invest in mobile wound care units to help decongest public health clinics. This isn’t a sexy proposal, but investing in community care might actually be a more worthwhile use of GLIC funding than an incessant focus on specialists and medicalisation of the health care system.
All Malaysians should oppose the privatisation of MOH to protect our national health service.
Editorials represent the views of CodeBlue as an institution, as determined through debate in the newsroom. CodeBlue’s Editorial Board comprises editor-in-chief Boo Su-Lyn, senior health writer Alifah Zainuddin, and sub-editor Chua Chern Toong.
