The Galen Centre for Health and Social Policy supports Sarawak Deputy Premier Dr Sim Kui Hian’s reminder that while public health care is subsidised, it is not free and certainly not costless.
Every bed, scan, medicine and staff hour is and needs to be accounted for and paid for. It comes with real and often substantial opportunity costs if there is under-investment.
Calls for “cheaper” or “state-owned private” hospitals must be grounded in the full financial and operational realities of running a health care facility: capital outlays, multi-year operating costs, sufficient skilled staffing, and reliable supply chains.
Believing otherwise risks creating unfunded promises, longer waiting times, and poorer outcomes, especially outside urban centres. Health care does not cost RM1 or RM5.
At the same time, we urge state governments, especially those with available resources and means, to assume a larger role in health and to include investment in health care for their citizens as part of state obligations. Sarawak and Selangor are good examples of this in action.
Despite health being under the Federal List in the Malaysian Constitution, the burden of health cannot simply be left to the Federal Government, for Putrajaya to decide. They cannot shoulder the burden alone.
Health is about caring for citizens, families and communities in your own state, not merely a federal line item. Greater state leadership and defined health autonomy in areas like infrastructure planning, service delivery, and workforce deployment are consistent with long-standing proposals to narrow inequities and accelerate reforms closer to where needs are greatest.
The states are best suited to answer that question. Investing in quality and effective health care will result in better outcomes and returns for the state.
There are a few opportunities for state governments to consider:
- Co-Fund State Hospital Development Plans: States could co-design and co-fund multi-year hospital and clinic pipelines, aligning capital builds with realistic five to ten-year operating budgets (staffing, equipment, maintenance).
- Joint Workforce Strategies: States such as Sarawak could provide financial incentives (e.g. bonuses and allowances) for posts in critical specialties, rural rotations, and paired with transparent posting tailored to local realities. This could attract talent and create competition to fill those positions.
Malaysia’s public health care is a matter of national pride. Keeping it strong demands fiscal honesty and smart federal and state burden sharing.
We can and should debate models, but we must stop pretending that quality care can be expanded on political slogans rather than real budgets and sound governance.
On this, Dr Sim is right: do the homework, count the true costs, and let states shoulder more responsibility where it improves care for their people.
Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
