KUALA LUMPUR, Oct 3 — Two senior doctors have raised concerns over the Ministry of Health’s (MOH) plan to expand ‘private’ full-paying patient service via RakanKKM.
Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) president Dr Shanmuganathan Ganeson said the real issue is not necessarily retaining specialists in public service, as many are not actively seeking to leave due to a saturated private sector. He argued that government specialist doctors often enjoy stable working conditions, leave opportunities, and other benefits, reducing the incentive to move.
“With a bit of incentive for further training, fair play in promotions, and an improved salary scale, most can be retained,” Dr Shanmuganathan told CodeBlue when contacted. “Those with a high appetite for risk will leave anyway, and no private wing or ‘rakanship’ is going to keep them.”
The private general practitioner (GP) said that the RakanKKM programme could only succeed if managed by an experienced private-sector body, free from government interference.
“If the Health Ministry (MOH) runs it, it would likely fail. The continuity of leadership in MOH is abysmal, with government servants prone to transfers, retirements, or being at the mercy of political leadership,” he said, while highlighting the lack of business acumen within MOH.
Dr Shanmuganathan cautioned that any involvement of government-linked investment companies (GLICs) in managing RakanKKM must be meticulously scrutinised.
“Health care is one of the most sensitive sectors to manage. Look at the past performances and lack of governance of entities like Lembaga Tabung Haji (TH), the Employees Provident Fund (KWSP), and the Armed Forces Fund Board (LTAT).
“TH has gone under once. KWSP has been battered at Battersea, and LTAT being busted is no secret. Any consideration of using these entities to manage must be done with the finest tooth comb,” he said.
The MOH’s RakanKKM initiative aims to introduce private wings in public hospitals to provide additional revenue streams and create new opportunities for specialists. However, critics argued that without proper management and oversight, the programme risks turning into a platform for monopolies and corruption.
Dr Shanmuganathan warned that if senior specialists dominate the proposed private wings, junior doctors might leave the public sector even faster. “I foresee cartels of self-serving senior specialists ready to monopolise the private wings, and the junior specialists will leave for the private sector even faster,” he said.
RakanKKM Risks Repeat Of UMSC Failures
Dr Shanmuganathan said the biggest risks facing the RakanKKM programme are potential cartelism, interference from MOH, and sudden policy changes that could deter institutional investors who are typically risk-averse.
He pointed to the UM Specialist Centre (UMSC), the private wing of the University Malaya Medical Center (UMMC), as an example of what could go wrong.
“There is potential abuse between the public and private wings at UM because there is no proper Radio Frequency ID system or billing system in place. Audits are also infrequent,” he said, citing information from a consultant involved in hospital set-ups.
According to him, internal cartels could form to control slots in the private wings, leading to restrictive conditions such as requiring a minimum of 10 years of service before being eligible to practise in the private wing.
“In Australia, once you have the Fellow of the Royal Australasian College of Physicians (FRACP), Fellowship of the Royal College of Anaesthetists (FFARCS), Fellow of the Royal Australasian College of Surgeons (FRACS), or similar qualifications, all specialists have equal rights regardless of seniority, race, or political affiliations, with their Fellowship training set as the benchmark. This is what we need,” Dr Shanmuganathan said.
“So any new venture like RakanKKM must learn from the UMSC experience. If it’s managed with private funds, then that type of corruption will not happen. But if they use taxpayers’ money with civil servants still running it, you can expect a mess,” he added.
Private Wing Specialists May Misuse Funds, Neglect Public Service
Dr Shanmuganathan said there is also potential for misuse of public resources, such as drugs and disposables, obtained for free by private wing specialists but billed to private patients.
“A medical device or equipment may be bought under public funds and used free of charge by the private wing. These and other moral hazards must be foresighted.
“Corruption during purchase in the setting up of these wings will invariably rear its head. This has previously happened in another institute, where the Malaysian Anti-Corruption Commission (MACC) was called in. At this juncture of the nation’s recovery, all these must be preempted,” Dr Shanmuganathan said.
Another problem is the neglect of the public service by the private wing specialists. In universities, even the academic teachings can suffer when making money in the private wing becomes a priority.
“Here it is vital that monitoring via IT is done. If specialists hardly spend any time on the government side, government pay cuts should be implemented or contracts are not renewed or private wing practice can be suspended,” Dr Shanmuganathan said.
Not all hospitals will be able to run private wings due to a shortage of specialists, lack of expertise, and insufficient allied and administrative staff. Additionally, there will be competition among specialists to be placed in the more lucrative hospitals.
“At the onset, all specialists involved in the programme, must indemnify themselves. There is no running away from this.
“The ethical and moral issues are the biggest hurdle. But so is the lack of funds and the right business strategy to address top-notch care for Malaysians. It’s almost 30 years since Singapore MOH implemented their hybrid system, and Bloomberg has repeatedly voted Singapore as having the best health care system in this part of the world.
“The benchmark Singapore uses is still the Royal Colleges UK for specialist qualifications. Like Australia, once you achieve this, all are considered equal. Locally, we have to manage the benchmark issue. It is not insurmountable.
“The RakanKKM programme should be run on a not-for-profit platform just like Singapore, the NHSTrust, and the Australian system,” Dr Shanmuganathan said.
Public Health Care Vs GLIC Interests: RakanKKM Faces Conflicting Priorities
Dr Milton Lum, former president of the FPMPAM and the Malaysian Medical Association (MMA), said that any initiative involving public hospitals must consider two fundamental points: the mission of the MOH to provide care for the majority of the population, especially for those who cannot afford private hospital services, and the differing priorities of GLICs.
“MOH hospitals provide care for the majority of the population, including for conditions not treated in the private sector. Meanwhile, GLICs have shareholders. How does RakanKKM reconcile these fundamentally different objectives?”
“What will the GLICs contribute to RakanKKM? Will this programme impact the equity, safety, and quality of health care? What are the guardrails to address potential abuse? And what will the governance and organisational structure be?” he asked.
Dr Lum noted that FPP services are currently available in 10 MOH hospitals, where many specialists have been offering private practice for over a decade. However, he questioned whether these FFP services have been properly evaluated.
“Have the FFP and MOH specialists’ private practice been assessed? What has been the impact on the safety and quality of care provided to patients? Such information is necessary to inform decision-making on RakanKKM,” he said.
Another concern is legal accountability. “Will MOH be liable in tort if negligence occurs?” Dr Lum asked. He warned that these unresolved questions cast doubt on the viability, sustainability, and safety of the RakanKKM proposal.
Until more detailed information is provided, Dr Lum said the viability, sustainability, and safety of the RakanKKM proposal remain uncertain. “Until details are available, the jury is still out on the programme’s potential,” he said.
Dr Lum also highlighted the irony of Health Minister Dzulkefly Ahmad announcing RakanKKM at a cancer congress, considering the economic strain cancer care places on patients. “It was strange that the proposal was announced at a cancer congress when cancer is one of the leading causes of catastrophic health expenditure.”
