Much has been talked about recently about the Rakan KKM initiative. Many criticised it and I also received a request from CodeBlue to offer my opinion on this hotly discussed topic.
The Rakan KKM initiative, in my view, is a beneficial development for Malaysia’s public health care system, which falls under the Ministry of Health (MOH). The concept of offering private services within public institutions is not new; university hospitals have successfully implemented similar models for years without compromising their public service.
Therefore, I believe the term “privatisation” is inaccurate; “private wings within a public hospital” more precisely describes this initiative.
Malaysia is far from alone in adopting this hybrid approach. Numerous advanced countries have successfully integrated private services into their public health care systems.
The NHS in the United Kingdom, a globally recognised publicly funded health care system, has long permitted “Private Patient Units” (PPUs) or “Private Patient Services” within its hospitals. For instance, The Royal Marsden NHS Foundation Trust, renowned for cancer care, generates substantial income from its private patient unit.
This revenue is then reinvested into pioneering cancer research and treatments for both NHS and private patients. Similarly, Moorfields Eye Hospital NHS Foundation Trust’s private patient services contribute significantly to advancements in eye care, benefiting all patients.
Australia operates a mixed public and private health care system. While public hospitals provide free care to all citizens and permanent residents through Medicare, they also allow patients to be admitted as private patients.
This offers patients greater choice and potentially faster access to care, all while utilising the comprehensive facilities and specialist expertise of large public hospitals. Crucially, this model also generates vital revenue for the Australian public hospital system.
Closer to home, nations like Singapore, Thailand, and South Korea run similar schemes. Structured hospitals in Singapore, such as Singapore General Hospital, operate Class A and B1 wards. These are private or semi-private rooms offering enhanced privacy, comfort, and amenities like air-conditioning and attached bathrooms.
Patients opting for these classes are considered “private patients” in terms of billing and may have more choice regarding their attending doctor, albeit at a higher fee.
In Thailand, major university hospitals like Chulalongkorn Hospital and Siriraj Hospital in Bangkok are known for their high quality of care and offer options for private appointments or rooms, generating revenue that supports their broader public services and research.
Similarly, major university hospitals in South Korea, such as Seoul National University Hospital (SNUH) and Asan Medical Center, provide options for private rooms and premium services, catering to patients seeking higher comfort levels.
These international examples clearly demonstrate that offering private services within public hospital settings is a common feature, even in highly developed health care systems. The primary aims of such initiatives typically include:
- Generating additional income to supplement public funding, with proceeds reinvested directly back into the public system.
- Retaining highly skilled medical professionals by offering them opportunities for private practice income within the public hospital setting.
- Providing enhanced amenities, comfort, and sometimes a choice of doctor or faster access to elective procedures for patients who can afford it.
I acknowledge the concerns that Rakan KKM will operate during regular hours, potentially leading to the neglect of public patients. To mitigate this, strict governance is crucial to prevent a recurrence of the flaws seen in the previous government’s Full Paying Patient (FPP) scheme.
Key monitoring parameters, such as the waiting times for public patients, the total number of public patients seen by specialists, and the care quality matrix for public patients, must be meticulously tracked both before and after the implementation of Rakan KKM. Any specialist found to be underperforming in their public service provision should be barred from the Rakan KKM initiative.
The concern that Rakan KKM will further strain an already overstretched human resource in public hospitals seems overstated. Currently, specialists who meet specific criteria are already allowed one day off per week for private practice. I believe this “flexi-day” can be extended to allow them to participate in the Rakan KKM initiative.
Even better, we should consider restricting this flexi-day solely for Rakan KKM participation once the initiative is available in more public hospitals nationwide. This could significantly aid in retaining our specialists, as current “flexi-day” offers them a chance to experience private practice within a public setting before potentially leaving the service entirely—a common career path for many of our specialists.
Under the previous FPP scheme, other health professionals were not adequately remunerated, often only receiving overtime pay for working after hours or on their days off. This sometimes forced paramedics into compulsory overtime to support the FPP initiative.
While Rakan KKM will still allow other public health care professionals to contribute and earn additional income, a key advantage is its ability to hire full-time health care professionals to run its services. This opens up the possibility of tapping into the expertise of our retired health care professionals, who still wish to serve in public facilities but have no intention of practicing in private hospitals.
I do not believe Rakan KKM will “cannibalise” the public health care system. The international examples mentioned earlier clearly demonstrate that public health care systems in other countries have not been cannibalized by similar initiatives.
Furthermore, within Malaysia, private wings in our university hospitals have existed since 1995. Has the initiation of the Universiti Malaya Specialist Centre led to the neglect of the renowned Universiti Malaya Medical Centre? On the contrary, I believe this initiative has been instrumental in retaining top medical talent at Universiti Malaya, such as the late Prof KL Goh, Emeritus Professor Dr Tan Chong Tin, and Prof Emeritus Dr Wan Azman Wan Ahmad.
Our university hospitals have successfully paved the way; it’s now time for the MOH to implement similar strategies to retain its best medical brains while simultaneously using the proceeds from Rakan KKM to further upgrade our MOH hospitals.
Dr Lingeshwaran R. Arunasalam is a member of the Dewan Negara.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
