I write as a doctor who has served 25 years in the Ministry of Health (MOH) and another 25 years as a private medical specialist. During that period, I had the opportunity to be the National Malaysian Medical Association (MMA)/Schomos chairman for a year in 1994, and several years later on, as president of the Association of Specialists in Private Medical Practice Malaysia (ASPMP).
The MOH as an institution for the public health care is perhaps at a critical point, where it may make or break, i.e whether it can rise up again to its former glory or gradually sink beyond repair.
During the period of my service with the government, and even until recent times, the World Health Organization (WHO) would often place our Malaysian health service as one of the best in the world in its coverage from primary to tertiary care, with one of the most comprehensive network of health care centres, district hospitals, and general hospitals.
It was an institution that grew over the years, with perhaps the largest workforce of civil servants then. While the whole world watched and admired the Malaysian health care system as it grew into an effective, functioning, affordable dual system of public and private care, it was something that no nation could emulate or copy.
The MOH had the ability to handle all forms of ailments, from basic primary care in the village to more specialist and complex care – something that all Malaysians were proud of then.
The sick, whether citizen or foreigner or immigrant, could walk into the corridors of our health care system and receive amazingly good care for a token fee, with the so-called General Hospitals, and the few University Hospitals for the more complex cases.
Even the National Heart Institute (IJN) became a centre of excellence and learning after its establishment, with televised training beyond our borders to as far as Europe.
Perhaps, over the last decade, the situation has taken a turn for the worse. What is happening here to the MOH in this short span of time is so worrying and serious that something must be done before it is too late.
In recent years, what surprised me is that even senior ministers of the government, senior civil servants – in fact the highest among them, like a retired Ketua Setiausaha Negara – have been seen visiting private medical centres, signifying that something is seriously wrong.
When I began private medical practice in 2000, only about 10 per cent to 20 per cent of patients were covered by personal insurance. Hence, the vast majority of the population sought care from public hospitals, and all was well. Over the last two decades, private hospitals have flourished and so has the private medical insurance industry growing in tandem. Now, the situation has reversed whereby 80 per cent of admissions in private hospitals are covered under insurance.
Could the rise and flourishing of private medical centres cause a decrease in demand for good care in public hospitals, resulting in complacency by the government in maintenance and support – in personnel, finance, and infrastructure?
Everyone should know by now that for good medical care, we must keep in progress with developments, both in equipment and expertise, or we will fall backwards and go downhill. The old ATUR or Nokia phone has to be replaced by the smartphones, just as the old manually operated cars are now all automatic, and soon electric or driverless.
There are three major issues that the MOH now faces: brain drain at the top, with a lagging in training, brain drain at the bottom as trainees and medical officers are driven away to other countries, and thirdly the lack of funds, hence the lack of new infrastructure to support the growing population.
Rather than allowing the public to be distracted with medical insurance premium hikes and the so-called rising cost of private medical care, the MOH must look after its own affairs and continue to have centres of excellence.
For a start, a moratorium of private hospitals is needed, as every new hospital will draw away dozens of much needed experienced specialists from the government sector.
Next, a serious improvement of service conditions, better promotion prospects for specialists, and career prospects and training opportunities for medical officers will stop the outflow of both specialists to the private sector and young doctors from government service or going abroad.
Finally, an old institution badly needs funds to build new hospitals and to keep old hospitals well equipped with new good functioning equipment.
Who can solve these issues? The MOH, the Treasury Department, and parliamentarians are the ones who should wake up to this reality of a sinking institution, instead of imposing rules, regulations, and laws that choke rather than support flourishing private medical institutions.
Reducing insurance premiums and controlling the cost of private health care treatment with Reset policies and diagnosis-related groups (DRG) fees regulation are only temporary measures that allow the middle class to have better care in private medical centres.
Let existing private health care centres flourish and let insurance companies with their capable actuarial consultants and economists work out premiums and adjustments, while the government focuses on providing good public health care.
The MOH needs to seriously plan ahead and seek more funds from the government, with support from Treasury and parliamentarians, rather than target private health care.
Introducing projects like Rakan KKM will only take away whatever remaining good care from the public and the poor.
The author is a specialist based in Kuala Lumpur.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
