I have absolutely no idea how difficult it must be to sit in as a policymaker trying to manage a country with a debt-to-GDP ratio of around 60 per cent, alongside significant fiscal pressures from subsidies, public sector wages, and pension obligations.
I assume that a government bearing such a burden would have no choice but to commit to fiscal consolidation and cutbacks. As economists might put it, finding ways to “thin down the fat man.”
Balancing austerity with social welfare is an extremely delicate task. Regrettably, in my opinion, some of the policies currently being pursued are heading in the absolutely wrong direction.
To align with the Madani Economic Framework, social sustainability must be a priority. Our greatest strength is our young and growing population, which offers us demographic dividends—but only if we nurture our people and prioritise human capital.
I would argue that human capital is our most precious resource for sustainable growth and a positive economic future. Not location. Not natural resources. Not agriculture.
Unfortunately, current policies suggest a clear neglect of human capital. The lack of foresight among policymakers is apparent, with the most aggressive fiscal cutbacks targeting the public health care system.
Health care is the pillar that supports human capital. In fact, it is the backbone of every aspect of our society. Given the persistent urban-rural divide and high-income inequality, socialised health care is not just an ideal—it is a necessity.
Health care is about more than just access (and even by that metric, we might be failing given the arduous task it is for some to reach decent health care); on the same side of the coin of access is quality. Focusing on just one will be a determent. And for both aspects, it is about the people who keep the system running.
Health care workers are the lifeblood of this system, and respecting and valuing them is crucial for a virtuous cycle of benefits. Fair wages and decent working conditions for public health care workers will, in turn, ensure a healthy, robust population that contributes to national wealth and economic strength.
Current policies reflect a significant lack of insight into the deficiencies of our health care system.
The blatant exploitation, overstretching, underpaying, and undervaluing of health care professionals invite a vicious cycle that could lead to systemic collapse. The attrition and exodus of health care professionals—driven by current policies—is undeniable. Yet, this ongoing brain drain has been met with little to no concern.
Does the Ministry of Health (MOH) truly believe doctors should be grateful for a supposed “cushy, rewarding, comfortable, government job”?
The reality: Overcrowded clinics, never-ending patient lists, and endless administrative workload—all under relentless pressure, little rest, and zero room for error.
Truly, it can be a thankless job.
One might assume that fair wages would justify the sacrifice. But they do not. I know that there will be calls from parties to be realistic with doctor’s salaries and argue that they are actually paid more than enough to justify cutbacks.
The less known reality is that Malaysian public sector doctors actually earn significantly less than their counterparts in other socialised health care systems or the private sector.
Even after corrected for cost-of-living indices and purchasing power, our salaries are still far lower than neighbouring countries. With backbreaking demands, frequent placement insecurities and inadequate compensation, what is left to inspire loyalty?
When I say that doctors deserve better remunerations and we should aspire to improve dismal working conditions of our health care workers, I am not saying it out of self-pity. I am saying it because if we don’t, other parties will happily take our doctors with open arms.
Doctors will naturally be drawn towards greener pastures. It is our country and its people who will then have to suffer the dreadful fact that our best minds will leave. The indifference shown towards potential loss of these assets thus far is disheartening.
Such neglect and disregard lead one to suspect that there is an active effort to severely cut back on socialized health care while pushing aggressively toward privatization. If true, this would be a penny-wise, pound-foolish approach.
It is easy to look to nations like Singapore as models of health care success. However, it is crucial to recognise that Singapore’s economic base and historical context are fundamentally different from Malaysia’s.
A sudden and complete shift toward privatised health care in a moderate- to low-GDP country like Malaysia—without addressing massive income inequality—would be catastrophic. It would only widen social divides and exacerbate inequality.
Equal opportunity for our young and growing population must include equal access to health care. Anyone failing to foresee the widening health care access and quality gap under the current policies is severely lacking in insight.
There cannot be a discrepancy of a cancer diagnosis of six months between one who can afford private health and another who cannot. Neither can there be a delay of months, weeks or even days for a PCI or a trauma surgery when required.
Hospitals—regardless of their facilities—cannot function without skilled professionals.
The greatest factor for survival outcomes in this country will not be million-dollar breakthrough drugs. It will be patients’ access to healthy, capable, and motivated doctors.
A mere 10 per cent decrease in patient access to doctors could potentially result in approximately 300,000 Quality Adjusted Life Years (QALYs) lost annually in Malaysia, with cancer and cardiovascular diseases contributing the most significant losses.
This may convert to an annual GDP loss of approximately RM 10.8 billion and a 20-year NPV loss of almost RM 160 billion, underscoring the economic value of patient’s access to doctors.
Numbers published in the public domain of doctors leaving until 2023 were alarming enough with an average of three doctors leaving per day and I suspect numbers last year as well as predicted for this year will make those numbers in 2023 pale in comparison.
The number of new registering doctors have also halved in the recent years compared to previous years. The policy cutbacks targeting doctors are not worth it.
My suggestion is that we take a step back and explore alternative ways to enhance fiscal sustainability. If improvements are impossible, at least, do not add further insult to injury.
Do not gamble with our health care system, its dedicated workforce, and our human capital as disposable assets to be sacrificed at a whim.
The prosperity and wealth of a nation lie in the opposite direction of policies that place the health care system on the chopping block and treat health care professionals as mere sacrificial lambs.
CodeBlue is providing the authors anonymity because civil servants are prohibited from writing to the press.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
