KUALA LUMPUR, Jan 27 — Dzulkefly Ahmad has denied claims that Malaysia’s health care system is on the verge of collapse, compared to the United Kingdom’s National Health Service (NHS).
In an interview with business weekly The Edge published yesterday, the health minister also said the Ministry of Health’s (MOH) RM45.27 billion budget for this year is “commendable”, even though it is “still not sufficient.”
“Ideally, yes we want to have more funding. However, to say that it is not sustainable, it has been sustained all this while anyway,” Dzulkefly was quoted saying, in response to The Edge asking if Malaysia’s public health care system is not sustainable now.
“And honestly, the Malaysian health care system is not about to crash, compared to the UK’s NHS. Every jurisdiction and every country is suffering, even the US.”
Unlike Malaysia’s MOH that does not publish data on emergency waiting times, elective care wait lists, or backlogs, NHS England publishes monthly data releases on backlogs across the NHS, including operations data, cancer waiting lists, general practitioner (GP) referrals, and A&E waiting times.
In a January 6 press release, UK Prime Minister Keir Starmer set out a plan to tackle hospital backlogs. The NHS’ waiting list currently stands at 7.5 million, of which more than three million patients have been waiting longer than the NHS’ 18-week target for referral to treatment.
Anecdotally, doctors in Malaysia’s public health service have said that patients are now stranded in the emergency departments of government hospitals for up to a week. CodeBlue reported in December 2022 that critically ill patients were waiting up to six days in Raja Permaisuri Bainun Hospital’s (HRPB) emergency department in Ipoh, Perak, for ward admission. Some specialist doctors have sarcastically called this “corridor medicine.”
On the other hand, NHS England reported an increase in patients waiting more than four or 12 hours for emergency admission from August 2010 to December 2024. From January to December 2024, approximately 1.66 million people have waited more than four hours in A&E. NHS England seeks to improve its operational target for admission, transfer, or discharge within four hours to 78 per cent by this March.
In his interview with The Edge, Dzulkefly acknowledged that Malaysia, as an upper middle income economy, should be spending 5 per cent to 6 per cent of its gross domestic product (GDP) on health. Currently, Malaysia is spending 4.5 per cent, comprising 2.3 per cent by the government and 2.1 per cent to 2.2 per cent by the private sector.
“But there is no way that I can ask for an additional huge quantum from the PM or MK2 (Finance Minister II). I know it is always about opportunity cost,” Dzulkefly said.
He reportedly expressed hesitance in asking for more money for health care because Malaysia’s tax revenue to GDP ratio has remained in the low teens.
“So unless we get to have a more broad-based taxation system, we will not be able to enhance our tax revenue. In this scenario, I cannot be asking for more and more. Getting RM45.27 billion, the second highest [allocation to ministries under Budget 2025] is good enough.”
Dzulkefly touted the Rakan KKM programme and the Hospital Services Outsourcing Programme (HSOP), in which the latter enabled the MOH to make “a lot of savings.”
He also said the MOH is working with the Ministry of Finance (MOF) to set up a National Health Trust Fund that aims to pool various funding sources, including general tax revenue, sin taxes, and funds from insurance companies, individuals, zakat, wakaf, and endowments.
Rakan KKM To See First Patient By Mid-2025, Four Hospitals Shortlisted
The Edge reported that Rakan KKM – the so-called “premium economy” wing of selected MOH hospitals – is expected to see its first patient in the middle of this year. Four hospitals in Selangor have been shortlisted: Cyberjaya, Sultan Idris Shah Serdang, the National Cancer Institute (IKN), and Putrajaya.The fifth hospital is being identified.
Dzulkefly claimed that some government hospitals, such as Cyberjaya Hospital, have “a lot of excess or underutilised facilities.”
“Cyberjaya has about 100-plus beds. So we are taking only 20 beds that are not currently used. We’ll prove to them that it is viable, sustainable and can generate good, modest income. We hope to grow to about 500 beds in the course of two years,” said the health minister.
Rakan KKM has secured RM25 million in seed capital from the MOF, besides getting investments from government-linked investment companies (GLICs). The Edge reported that there will be a revenue-sharing model to ensure an adequate return on investment.
“We are getting an encouraging response from GLICs. Since the investors are not the private sector, any allegation that this is an attempt at backdoor privatisation is unfounded,” said Dzulkefly.
The health minister did not elaborate much on Rakan KKM, such as what kind of services will be provided, how the programme will be able to source for manpower given existing shortages, how much the “entire health care team” beyond lead specialists will be paid, or charges for patients that he simply said would be “a lot cheaper” than the private sector.
“I can understand the anxiety, ‘hey, the public facilities are already congested, so how are you going to do it?’ But you know that [some public hospitals are already catering to] full-paying patients. That alone is evidence that there is room for this,” said Dzulkefly.
CodeBlue reported last October that the MOH’s full-paying patient (FPP) service was severely downscaled after the Covid-19 pandemic, as three of 10 hospitals initially listed with FPP have closed the service: Pulau Pinang Hospital, Sultanah Aminah Johor Bahru Hospital, and Sultan Ismail Hospital.
‘Mini-DRG’ For Hospital Services Outsourcing Programme
The Edge reported that the MOH has outsourced 22,773 cases to private health care facilities via HSOP, costing the government RM66.5 million. There are 94 registered hospitals under the programme that covers nephrology, cardiology, cardiothoracic, and radiology and imaging.
CodeBlue previously reported that RM144 million has been allocated for HSOP that targets at least 30,000 outsourced patients from the MOH to private hospitals.
In his interview with The Edge, Dzulkefly described the bundled payments under HSOP as a “mini-DRG”, based on expected costs for a clinically defined episode of care in a diagnostic-related groups (DRG) reimbursement model.
“The way we do it is that we issue a request for proposal, or RFP, for a procedure. We go for the best value for money. For those who exceed our acceptable range, we give them a choice: if you want to get on board, your services have to be more affordable. You may not get a favourable margin, but you will get consistent volume,” Dzulkefly said.
Contrary to Dzulkefly’s comments, private hospitals do not see HSOP as a source of business, but merely as a corporate social responsibility (CSR).
Association of Private Hospitals Malaysia (APHM) president Dr Kuljit Singh told a January 9 town hall organised by the MOH on DRG that private hospitals empanelled with HSOP actually incurred losses from the programme over the last one year.
“The private hospitals are absorbing it; we’re doing it like CSR, but we’re willing to do it to help the government,” he said.
Dr Kuljit also said HSOP doesn’t use DRG because the “calculation wasn’t exactly correct”, adding that HSOP must be reviewed as it isn’t sustainable.
