KUALA LUMPUR, Nov 4 — In a rare acknowledgement, a high-ranking Ministry of Health (MOH) official says the public health service is approaching the “end” of its capacity to independently meet the country’s growing health care needs.
Rather than the oft-cited perspective of staff and facility shortages (i.e. insufficient supply of health care), MOH deputy secretary-general (finance) Norazman Ayob pointed to the problem of excessive demand for health care, as Malaysians become increasingly ill with chronic conditions.
He said the government is now actively shifting towards public-private partnerships (PPP) to manage demand and alleviate strain on the overstretched public health care system.
“When we look at 148 or 149 of our hospitals, I can say about 80 over per cent of these hospitals are where the bed occupancy ratio has exceeded 100 per cent,” Norazman told the MIH Megatrends 2024 conference here last October 25, organised by MOH in collaboration with KPJ Healthcare.
“As far as public health care is concerned, I think as far as capacity is concerned, we are actually on the verge of, I would say, the end of our capacity.”
At the MOH’s flagship conference, Norazman said the public health care system is under pressure from an ageing population and the rising prevalence of non-communicable diseases (NCDs) among Malaysians that can be prevented with lifestyle changes.
According to the National Health and Morbidity Survey (NHMS) 2023, nearly 2.3 million adults in Malaysia live with three NCDs out of diabetes, hypertension, high cholesterol, or obesity. Among Malaysian adults, about 16 per cent have diabetes, 29 per cent have hypertension, and 33 per cent have high cholesterol. More than half of adults (54 per cent) are overweight or obese.
Dr Mahyuddin Mohamed from MedTweetMY, a health information account on X run by doctors, recently urged Malaysians not to consume too much sweet food and drinks, pointing out that multiple complications will arise by age 45 to 50 for those who get diabetes in their 20s or 30s.
“I’ve already amputated the legs of many people. Pay RM1 to amputate your leg for what? Exercise moderation,” the consultant orthopaedic surgeon posted on X, quoting a video of a young woman drinking a “mega” cup of hot chocolate milk and eating a huge soft cookie with mochi and kunafa filling. The person who posted the video wrote: “Nasib baik KKM seringgit“, referencing the RM1 outpatient fee in MOH health care facilities.
Consultant cardiologist Dr Beni Rusani posted on X recently that the heart attack patients he sees are getting younger – from age 28 to now just 23 years old as his youngest – attributing this to risk from smoking, obesity, and high cholesterol.
No Space To Accommodate New Facilities Or Equipment
According to Norazman, the MOH has begun leasing rather than purchasing medical assets and is outsourcing high-demand services – including cardiology, cardiothoracic, radiology, and nephrology – to 91 private hospitals, leveraging on private sector capacity.
“Most of our (MOH) facilities are already at saturation point, meaning, even if we add more machines or laboratories, we wouldn’t have the space to accommodate them. That means we would need to build a new block, an extension to the current building, or a new hospital altogether, which would incur more cost to the government.
“So, long term, we feel that this (PPP) is actually more beneficial for us,” Norazman said.
According to KKMNow data last updated on September 6, nine states have bed utilisation rates above the national average of 55.8 per cent: Perlis (83.1 per cent), Melaka (80.2 per cent), Kedah (78.9 per cent), Terengganu (76.5 per cent), Sabah (75.1 per cent), Pahang (72.8 per cent), Perak (69.9 per cent), Negeri Sembilan (66.7 per cent), and Sarawak (61.8 per cent).
The data, however, appears incomplete, with information from major hospitals such as Sultan Idris Shah Serdang Hospital, Ampang Hospital, Selayang Hospital, and Pulau Pinang Hospital either unavailable or incomplete.
Based on the available data, at least 23 out of 148 hospitals listed on KKMNow report bed utilisation rates of 80 per cent or higher. Two hospitals, Seberang Jaya Hospital in Penang and Seri Manjung Hospital in Perak, have bed utilisation rates exceeding 100 per cent.
Another 44 hospitals have utilisation rates between 50 and 79 per cent. The list includes Universiti Malaya Medical Centre (UMMC) and Hospital Canselor Tuanku Muhriz (HCTM) UKM – both Ministry of Higher Education hospitals – for which data is also missing.
No Way Government Can Keep Building Hospitals
The MOH’s budget allocation for 2025 was raised to RM45.27 billion, a 9.8 per cent increase from RM41.22 billion allocated this year. But according to Norazman, “there is no way” the government can keep expanding the health budget indefinitely.
“Now, what we’re trying to do is, instead of going on to build more hospitals or even more clinics, we will now try to have PPPs with regards to services,” Norazman said.
Norazman referenced the Health White Paper, tabled in Parliament last year, that outlines plans to strengthen primary health care and reduce reliance on hospitals. Currently, 37 per cent of the Health Ministry’s budget supports hospitals, while only 18 per cent goes toward primary clinics, a ratio he said MOH aims to reverse.
“If you do the maths, whenever a patient goes to the hospital, the cost of treating that patient will be far higher than if the patient remains in the clinic or receives primary care. So we want to make primary health care the first line of defence,” he said.
During debates in Parliament, multiple MPs on both sides of the divide frequently urge the MOH to build new hospitals or health clinics in their constituencies.
Private Sector Partnerships: Madani Medical Scheme, Tunku Azizah Hospital Lease
Norazman said that partnerships between MOH and the private sector can take many forms. He first cited the Madani Medical Scheme, which started in 2023, where private general practitioners (GPs) in the scheme are reimbursed by the government for patients qualifying for subsidised treatment for minor ailments like fever, cough, and cold.
“In a way, this eases congestion and reduces waiting times at some of our public clinics (klinik kesihatan),” he said. Another example is the construction of health care facilities.
“Currently, we obtain a budget from the government on an annual basis, and then the Public Works Department appoints a contractor, initiating the procurement process. However, it takes nearly a year, or even a year and a half, before you can see the commencement of the project.
“To speed up this process, we are advocating to any private sector willing to build, say, an MOH clinic to our specifications. We will lease the building from them, but the equipment and manpower will still come from the MOH,” he added.
Norazman cited Tunku Azizah Kuala Lumpur Hospital as an example of a project built using a PPP model.
“The hospital is still under lease from the private sector for the next 22 years. It’s a 25-year concession: three years for construction, and for the next 22 years, we are leasing from the private contractor or the private sector.”
MOH Weighs Outsourcing Of Lab Services
In addition to PPPs with private hospitals and clinics, the government is also considering outsourcing laboratory services. Norazman said proposals have been submitted to the MOH to outsource and centralise laboratory services.
“We are actually keenly looking into it. In fact, we are going to have a proof of concept, hopefully soon, with one of the largest laboratory providers in the country, where we may outsource our laboratory services to them. But of course, it still remains to be seen whether they can cope with our capacity.
“For example, if you look at one of our hospitals in Terengganu, to manage that one single state hospital, even for that particular private laboratory service provider, it feels kind of challenging. So yes, we are considering, and we welcome it if there are other proposals.”
