KUALA LUMPUR, Oct 24 — The Ministry of Health’s (MOH) new Rakan KKM initiative promises specialists a pay package comparable to that of private hospitals, according to Rakan KKM’s official website.
Under the scheme, specialists will be able to earn “a similar level of extra income” to what they would receive in private hospitals, without having to leave their public roles or take up external locum positions.
Currently, MOH specialists are allowed to take one day off per week to do external locums at private hospitals, as permitted by a 2017 MOH circular. Through this FlexiHours plan, specialists have been able to supplement their income.
Rakan KKM represents a shift from the FlexiHours system, as MOH specialists will be kept within public hospital settings, benefiting both the specialists and the government hospitals that rely on their expertise.
In addition to specialists, Rakan KKM is expected to pay other public health care workers involved in the programme, such as medical officers and nurses. Under the MOH’s existing full-paying patient (FPP) scheme, revenue from the collection of fees is distributed between the government and participating specialist doctors. Support staff are paid overtime.
Rakan KKM’s website says that health care workers, other than specialist doctors, will be “formally paid” under Rakan KKM. The “extra profit” from Rakan KKM will also go to the hospital itself, besides the overall public health care system.
According to the website, there will be “no diversion of currently available resources” from the public health care system to Rakan KKM, as it will make use of “untapped capacity”, such as out-of-hours capacity. Rakan KKM also plans to invite retired health care professionals, including specialists and nurses, to fill gaps in the system.
However, critics argue that if Rakan KKM offers pay commensurate with private hospitals, many health care workers – including specialists, medical officers, and nurses – will want to join Rakan KKM, potentially widening disparities in both health care services and staffing.
This could create further unfairness for those excluded from the programme, who are already grappling with understaffing, bed shortages, and limited resources.
Doctors in the public health service have also questioned capacity for the creation of separate hospital wings for a separate group of patients under Rakan KKM, highlighting bed shortages in various government hospitals. Patients are still reportedly placed on beds in corridors or disaster camp beds.
Despite the promises, the Rakan KKM website is sparse on crucial details, using buzzwords like “premium economy”, “raise the floor”, and “raise the ceiling”. These terms offer little clarity on how the programme will operate or achieve its ambitious goals.
What Is Rakan KKM?
According to the website, Rakan KKM aims to address rising health care costs by offering “premium economy” services at selected public hospitals for elective outpatient, daycare, and inpatient care.
These services will be priced above cost but below those of private hospitals. The programme’s initial funding comes from the Ministry of Finance and potential investments from government-linked investment companies (GLICs).
Rakan KKM’s website does not state which specialty services will be provided. Even as the programme seeks to generate revenue, Rakan KKM doesn’t appear to be a full-fledged service because specialists and other health care professionals can only spend their “extra time” on the programme.
Patients under Rakan KKM are promised three benefits: personalised care, the ability to choose their specialists, and additional privacy and comfort in wards. Unlike private hospitals that often list the names of their specialists on their websites, many MOH hospitals do not do so.
CodeBlue previously reported that the FPP service has shut down in three of 10 government hospitals since the Covid-19 pandemic that initially provided the service. The remaining MOH hospitals that still provide FPP mostly limit it to obstetrics and cardiology.
Rakan KKM will begin with a few specialist hospitals and gradually expand nationwide. Prime Minister Anwar Ibrahim, in his Budget 2025 speech last Friday, named Cyberjaya Hospital as one of five that will launch Rakan KKM.
Cyberjaya Hospital is a very new hospital, having just begun operations only two years ago in November 2022. It doesn’t even have a website, only a Facebook page.
Rakan KKM seeks to retain health care workers and improve services for both the B40 and M40 income groups.
Details on pricing and operational specifics remain scarce, though the website emphasises that Rakan KKM is meant to offer value without directly competing with luxury private health care services.
A rollout timeline has yet to be confirmed. A “professional team” will be appointed to oversee the initiative, with a properly-governed special purpose vehicle (SPV) under consideration to manage the programme.
Galen Centre: T15 Should Have The Right To Access Health Care Like Everyone Else
Azrul Mohd Khalib, chief executive officer of the Galen Centre for Social Health and Policy, commented on the lack of details surrounding the programme in a recent interview on Astro Awani’s Consider This with Melisa Idris.
Azrul noted that while the goals of Rakan KKM are clear, such as improving health care worker retention, many specifics remain vague. He particularly highlighted concerns about equity, particularly for those in the T15 income group, who might be expected to opt for private health care, potentially excluding them from public services that their taxes support.
“The problem right now is that there is a certain uncomfortable premise for which this programme is being introduced, which was implied by the prime minister or the finance minister in his speech the other day, which is that it seems like there is concern that the T15, so to speak, whatever that definition is, which still hasn’t been clarified, are taking up space in the public health care sector, and therefore, we somehow need to make room for the B40 to be able to access more of the public health services.
“So it’s basically implying that if you can afford it, if you’re T15, you have the means, you shouldn’t be there (in public health care). That should be for the B40, and you should go and pay more, and you should be in private health care so forth.
“And this is a problem for me because many of these people we talk about are taxpayers, and I would argue that as taxpayers, they should have the right to be able to access health care, for which everybody is entitled to,” Azrul said.
Azrul also expressed concern about the programme’s description of “premium economy” services, saying it should truly offer a premium experience rather than a mere upgrade from basic services, which could also lead to problems.
“If we’re going to be paying for Premium Economy, then let’s ensure it is truly premium, not just sub-economy plus or something. We’ll see what happens. At the end of the day, we’re suggesting that if the government is going down this path, it should start thinking about packaging or bundling services, similar to a courier service.
“You have seven-day delivery, three-day delivery, and same-day delivery options.
“So instead of waiting three weeks or even two weeks for your screening results, you might be able to pay a little extra to receive them earlier. You could see the consultant much sooner, and if you really have the means, you could see the consultant the same day as your test – but there will be problems with that model as well.”
