KUALA LUMPUR, Oct 2 — The Association of Private Hospitals Malaysia (APHM) has told the government to focus reform efforts on the public health care system instead of private health care providers.
In an op-ed for The Edge published yesterday, APHM president Dr Kuljit Singh, who is also an independent director of the Malaysia Healthcare Travel Council (MHTC) board, analysed health care models in Thailand, Singapore, and Indonesia.
“What these Asean case studies make clear is that cost-control measures and efforts to attain universal health care for the entire nation, while necessary, are never without trade-offs,” wrote Dr Kuljit, ahead of Budget 2026 scheduled to be tabled in Parliament on October 10.
“Thailand’s DRG (diagnosis-related groups) model has improved efficiency but faces equity and sustainability issues. Singapore’s market-based framework is financially sound but arguably less inclusive. Indonesia’s vast universal scheme faces real strain under financial challenges.”
Dr Kuljit stressed that health care reform – namely providing sufficient funding and resources – must target the public health care system that serves over 70 per cent of Malaysians.
“As much as it is a low-hanging fruit and may seem like it would effect change, reform simply cannot begin nor end with the private sector because, ultimately, that is not where the tipping point lies,” he said.
“Learning from our neighbouring countries, government efforts must focus on addressing the nation’s health care challenges through the public sector, not the private sector which is significantly smaller in its role to serve at the national level.
“Health care reform at the national level cannot realistically be led by the private sector. If we consider the nature of businesses, they can open or close at any time and operate without a mandate, unlike the government, who has a duty to every Malaysian.
“The health of the nation cannot be entrusted to the uncertainty and volatility of businesses, but must remain the responsibility of the government, which is accountable to taxpayers.”
The government has been heavily touting Bank Negara Malaysia’s Reset framework to reduce private health care costs, but said little about providing the necessary higher allocations for the underfunded, understaffed, and overworked public health care system.
In fact, Finance Minister Anwar Ibrahim, who is also the prime minister, told the Dewan Rakyat last August that the government rejected a request to provide the Ministry of Health (MOH) with an additional RM38 billion allocation, which would raise public health care spending to 5 per cent of the country’s gross domestic product (GDP), because this would breach the government’s self-imposed debt ceiling.
Case Studies: Thailand, Indonesia, Singapore
The APHM president noted that despite over three decades of DRG implementation in Thailand, the system continues to face challenges, such as failure of DRG payments in keeping up with real-world expenses, especially for high-risk or complex cases.
Reimbursement rates in Thai hospitals often lag behind inflation, technological advances, and medical innovation.
“Other persistent problems of the DRG include coding errors, inaccurate medical records, and what is known as ‘DRG creep’, where diagnoses are intentionally misclassified to receive higher reimbursements,” said Dr Kuljit.
“Such distortions lead to reduced hospital stays, premature discharges, or avoidance of costly patients, which are practices that undermine quality of care, and place added pressure on tertiary hospitals.”
As for Singapore, while its health care model is often cited as a global benchmark for sustainability, critics argue that it’s not universally accessible.
Dr Kuljit cited Singapore Deputy Prime Minister Gan Kim Yong as saying that “there is really no such thing as free health care, because someone has to pay for the drugs, the pharmaceuticals, the facilities, the doctors and the nurses, and the health care workers.”
Indonesia – which has one of the world’s biggest national health insurance programmes covering more than 90 per cent of its population – faces financial sustainability problems with its Jaminan Kesehatan Nasional (JKN) that was launched more than a decade ago in 2014.
“It was reported that in 2024, JKN’s projected deficit was approximately 20 trillion rupiah (approximately US$1.25 billion, or RM5.26 billion). In addition, JKN faces a funding gap where many members, particularly informal workers, either delay or stop paying insurance premiums altogether, while continuing to access care,” wrote Dr Kuljit.
Empower GPs To Be Frontliners
Dr Kuljit said the main factors driving a rise in medical costs in Malaysia are a rising NCD burden and ageing population.
“What this calls for is a much greater emphasis on primary healthcare, with general practitioners (GPs) playing a frontline role in the early detection, treatment, and management of NCDs,” he wrote.
“Regular health check-ups should be actively promoted and embedded as part of the national health culture.
“To achieve this, the needs of GPs must be properly understood and supported through responsive policies for them to be the ‘frontliners’, so to speak, in combatting NCDs at an early stage, before patients require hospital intervention.”
As for public hospitals, Dr Kuljit argued for systemic improvements, including upgrading infrastructure and ensuring fair wages for health care workers.
“For this, pricing policies must be reformed to reflect real-world costs, alongside investments in health technology.”
