Last Friday, October 10, 2025, saw the presentation of Budget 2026 by Prime Minister Anwar Ibrahim. I am a specialist at a tertiary-level private hospital, and I feel compelled to comment on one aspect of the budget in relation to health care, which is of great importance, namely, the recognition of the important role played by the general practitioner (GP) as part of the national health care agenda.
The announcement that the government will revise consultation fees for the first time since 2006 from between RM10 and RM35 to between RM10 and RM80 was, as expected, met with mixed responses, ranging from elation to dejection, depending on who you speak to.
On the surface, it does appear like a windfall to the general public. But only those in the know realise the significance of the announcement, and why it truly matters to my GP colleagues out there.
To give some context, this issue has been debated in multiple townhalls and meetings with many previous governments acknowledging the issue but choosing to sidestep it and remaining silent. There was no acknowledgement whatsoever from anyone with regard to why such a travesty took more than 10 years to rectify.
I have personally seen many of my colleagues from various GP associations attending meeting after meeting to address this issue that should have been addressed way back in 2013 itself, when the amended fees were submitted by the doctors’ representatives for consideration and adoption.
The merry-go-round rhyme might have been amusing as a nursery rhyme, but it was hardly comical to us. This debacle had not only incurred lost productive hours at work, but significant mental and financial strain, especially on the doctors leading the discussions.
I think most of us will look at that period now as a dark episode for our profession, where we literally had to knock on the doors of various leaders from the past and present governments, as well as senior bureaucrats and civil service administrators for a favourable outcome.
To this end, I applaud the political will exhibited by Anwar and Health Minister Dzulkefly Ahmad, as well as the leadership of the health Director-General Dr Mahathar Wahab, and many others behind the scenes for the work put in that led to this announcement.
I look forward to hearing further positive news once the proposed fees are gazetted. It is also prudent that while the legislation is being written, a clause for regular reviews of the fees at set intervals are made so that it is consistent with the cost of running the GP practice which is exposed to yearly inflationary pressures as well.
Over 60 per cent of patients now come through third party administrators (TPAs) who negotiate the consultation fees with doctors. The Malaysian Medical Association (MMA) and many others have asked that the minimum consultation fee to be set at RM50, and no longer at RM10.
Now that the government has agreed to give a range of fees with a ceiling of RM80, which is a bit more reasonable than the previous ceiling of RM35, it is hoped that the large majority of responsible TPAs will continue to acknowledge the role played by the GPs and work towards setting reasonable consultation fees that will commensurate with the professional services rendered by the GPs.
Too low of a fee set would risks GPs going back and forth in endless debates with TPAs on the appropriate fees to charge which would just take valuable time away from the provision of quality health care services to the rakyat.
I sincerely hope that all TPAs acknowledge that the doctors are professionals who are entitled to a decent fee for the work that is done and agree to the proposed fees by the doctors’ associations.
The work put in by GPs, especially in managing non-communicable diseases (NCDs), will ensure that many patients will stay away from developing end-stage organ damage like kidney or heart failure that will require much more expenditure in the long run.
The idea that somehow GPs will burden the poor by charging excessive fees is far from the reality. Speak to any GP in your neighbourhood, and he would know who are the patients who need help, and more often than not, his fees will be reduced or waived. Many do that quietly without any fanfare.
If there are cutthroat GPs who have no sympathy and are callous with their attitudes, the word will spread and market forces will eventually determine the future existence of their practices.
Let’s not be misled by the opportunistic few who do injustice to the large majority of GPs who provide care and compassion to the community at large.
Another item touched upon in the Budget was the Skim Perubatan Madani. Although the allocation has been reduced by 50 per cent to RM50 million, the scheme serves as an example of how a collaboration between the public and private sectors may look like.
The scheme helped to reduce overcrowding at government hospitals and assist the B40 group in obtaining acute primary care services or outpatient treatment at private clinics.
More than 700,000 households benefited from treatments for fever, flu, acute gastroenteritis, sprains, headaches, and mild trauma, with an allocation of RM250 per household.
As the infrastructure and database of patients are already in place, the collaboration could be studied in depth to further accommodate the management of NCDs such as asthma, diabetes, and hypertension.
Private clinics in designated clusters could potentially manage stable patients, while referring the more complex patients to be co-managed with Family Medicine Specialists based at the main Klinik Kesihatan, similar to how GP practices are run in most developed countries.
In Budget 2026, about RM30 million was allocated to enhance specialist services at government health clinics. I hope that in the near future, a holistic public-private partnership in primary health care can eventually be achieved.
As of October 2025, there are about 1,138 Family Medicine Specialists registered on the National Specialist Registry. Based on statistics from the 2023 Ministry of Health Annual Report, there are about 1,095 Klinik Kesihatan, 1,716 rural clinics (Klinik Desa), 80 maternal and child health clinics, and 228 community clinics.
Together with close to 10,000 private GPs all over the country, this collaboration will be a meaningful partnership. Instead of spending millions building new Klinik Kesihatan, especially in urban areas, the availability of many of these GP clinics, literally at the doorsteps of the rakyat, can reduce the current workload experienced by many of these public facilities which are operating beyond their capacity. This is a potential game charger for the country. All it needs is a bit of investment that will see significant returns in the long run.
The current explosion of mental health-related issues is also something that GPs can be roped in to help tackle. As the wait time in many public facilities is still a concern. which reduces meaningful consultation times, GPs can offer more individualised care to their patients, especially when continuity of care for mental health-related issues is vital.
Most GPs are almost like family members to the patients, and the trust factor is crucial to help better manage their conditions.
In summary, I sincerely hope that the proposed announcements in Budget 2026 will be enhanced, incorporating some of the items highlighted by the stakeholders.
There are other constructive engagements that still need to take place, such as Diagnosis Related Groups and National Healthcare Financing, but with the right mindset, both GPs and specialists in private practice can do their best to be meaningful partners of the Madani government in ensuring the health and welfare of the rakyat.
Dr Gunalan Palari Arumugam is a consultant anaesthesiologist at a leading private hospital in Klang Valley as well as a consultant for a US-based third-party administrator. He is a member of a few medical associations and has been heavily involved in various discussions with both government and non-governmental organisations on matters concerning the health care landscape in Malaysia.
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