KUALA LUMPUR, June 25 — Malaysian Medical Association (MMA) president-elect Dr R. Arasu has called for a fundamental shift in health care funding towards preventive and primary care, warning that Malaysia is “spending the most when it’s already too late.”
Dr Arasu said Malaysia’s health system spends heavily on hospital care but neglects early intervention, especially general practice. He urged policymakers to reallocate resources, calling primary care the “best value” for both patient outcomes and long-term sustainability of the health care system.
“The longer we wait, the more we pay – in doing it, in suffering, and in system strain,” Dr Arasu said during his presentation at a health care forum organised by the Universiti Malaya Student Union (UMSU) Faculty of Medicine on May 29.
Drawing on a single slide that illustrated rising health care costs over time and severity of illnesses, Dr Arasu urged the government to invest early in the system where general practitioners (GPs) currently play a crucial, yet underfunded, role.
“If you look at the pre-illness, what do we do? We do preventive and promotive care. Vital signs are being taken. These are basic preventive methods we do, right? And then we do vaccination. We do a lot of lifestyle intervention advice,” Dr Arasu said.
“If you look at social health determinants, 80 per cent of social health determinants have nothing to do with health care – 30 per cent is lifestyle, 40 per cent is social economy, and 10 per cent is physical environment. If you are in the B40 category, you are already at a disadvantage.”
He stressed that early GP engagement is critical for health education and behavioural change, noting that family-based visits give GPs repeated touchpoints with patients.
“Typically, in GP clinics, 60 per cent of patients are family patients or they come in families. So that means if they come to the clinic 12 times in a year – four times maybe as a patient, another eight times maybe to accompany their family – we have the advantage to communicate with them on health education.”
However, Dr Arasu warned that the continuity of care is “slowly fading off” as chronic disease management is increasingly outsourced to third-party administrators (TPAs) and large pharmacy chains.
“So much so, the perception and the narrative being told to the patients is that as long as you take medications, you’re alright. That curve is slowly going up. The GPs will be totally cut off from the management of non-communicable diseases (NCDs). There is no proper follow-up. There is no continuity of care,” he said.
“How do you monitor lifestyle? How do you take HbA1c reading? How do you monitor obesity? You can’t be doing everything online, right? That curve is now shifting towards a transactional party and the patient-doctor relationship is gone.”
‘Health Care Is Not Cheap’
Dr Arasu reiterated that making health care affordable does not mean making it cheap.
“If we are seriously talking about making health care affordable, we must understand health care is not cheap, but we must make it affordable. That is what’s important,” he said. “If you want a sustainable private GP practice, the fee structure must be relevant with time. It must be dynamic.”
Dr Arasu also lamented that GP consultation fees had not been revised for more than three decades. “For over 30 years, we have had to practically beg every government. While I’m talking today, it has yet to be resolved.”
Health Minister Dzulkefly Ahmad told reporters last Monday that the long-delayed review of private GP consultation fees under Schedule 7 of the Private Healthcare Facilities and Services Act 1998 (Act 586) is now in the final stages of scrutiny by a high-level committee chaired by Deputy Prime Minister Ahmad Zahid Hamidi.
At an historic doctors’ rally in Putrajaya last month, 11 medical groups demanded that the government remove the mandatory drug price display requirement from the Price Control and Anti-Profiteering Act 2011 (Act 723), under the Domestic Trade and Cost of Living Ministry (KPDN), and to regulate it under Act 586 instead.
At the rally, doctors also highlighted the issue of stagnant consultation fees, which Dzulkefly pledged to revise before implementing the drug price display policy on May 1.
The government pushed through the mandatory drug price display policy despite resistance from the GP community.
In response to ongoing fee stagnation, doctors’ groups in multiple states have threatened to introduce new clinic charges – including a facility fee, registration fee, regulatory compliance charge, and an optional prescription fee. They argue that these reflect real-world operational and compliance burdens.
The Malaysia Competition Commission (MyCC) has since warned that any collective decision by medical associations to standardise fees may violate the Competition Act 2010, potentially constituting price-fixing and triggering enforcement action.
Health Care Reform Must Start With GPs
While acknowledging various government initiatives – including Selangor’s Skim Peduli Sihat, ProtectHealth’s Peka B40, and the Skim Perubatan Madani – Dr Arasu said these were not enough without structural reform.
“Basically, health care is central policy and local implementation. You have 11,000 clinics. How do you localise all the treatment? And GP is a community-based clinic.”
He emphasised that health reform policy must be co-created with GPs from the beginning, not just during implementation.
“It’s not to say you (the government) decide, then you come to us for implementation. That’s not how policies are being developed. They should get us involved from the start.”
Dr Arasu urged Malaysians to pressure their elected representatives to act: “We should pressure the parliamentarians to do this. If they talk in Parliament, it’s in the Hansard. There must be an action plan. There must be follow-up.”
