KUALA LUMPUR, Feb 23 — Senator Dr RA Lingeshwaran today proposed tax breaks and car duty exemptions to attract health workers to Sabah and Sarawak, as persistent staffing shortages in East Malaysia continue to strain public health services.
Dr Lingeshwaran said “out of the box or maybe without the box” financial incentives beyond existing federal pay structures may be needed to recruit and retain doctors, specialists, and allied health personnel in the two states.
“I propose that health workers who choose to serve in Sabah and Sarawak be granted special excise duty exemptions for car purchases if they serve for a specified period. They could also be considered for special income tax relief if they serve for a reasonable duration,” he said during his debate on the motion of thanks on the royal address in the Dewan Negara.
The DAP lawmaker also suggested that the Ministry of Health (MOH) work with the Sabah and Sarawak state governments to establish additional incentives funded at the state level.
Dr Lingeshwaran acknowledged constraints within the Public Service Department (JPA) pay structure but urged policymakers to consider alternative approaches to address longstanding staffing gaps in East Malaysia.
His proposal comes amid ongoing concerns about the effectiveness of existing incentives like the Bayaran Insentif Wilayah (BIW), which was changed under the Public Service Remuneration System (SSPA) from a progressive, salary-linked rate to a fixed monthly allowance.
Under the revised scheme, newly appointed officers receive between RM270 and RM960 monthly, with medical officers in the management and professional group receiving about RM360.
Professional groups have warned that the shift reduces incentives for postings in Sabah and Sarawak, with some doctors and pharmacists reporting losses of thousands of ringgit annually compared to the previous structure.
The Malaysian Medical Association (MMA) estimated that restoring the progressive BIW structure would cost about RM4.2 million annually, based on around 700 new medical officers posted each year.
In a written Dewan Negara reply last December, Health Minister Dzulkefly Ahmad revealed a 43 per cent no-show rate among 764 contract medical officers reporting for duty for permanent placements in Sarawak last year, as of November.
Dzulkefly is now planning to phase out the contract system for medical officers, but the high number of no-shows for permanent appointments, at least in East Malaysia, indicates that permanent positions alone may no longer be sufficient to retain doctors in the public health service.
Why Are Nurses, PPP Not Paid For Passive On-Call, Unlike Doctors
Dr Lingeshwaran said shortages among nurses, assistant medical officers (PPP), and allied health professionals are already affecting service delivery and patient safety.
Malaysia’s nurse-to-population ratio stands at 2.5 per 1,000 people, far below the Organisation for Economic Co-operation and Development (OECD) average of 9 per 1,000.
“When a nurse is forced to care for 15 to 20 patients in a single shift, the risk of clinical errors increases. This is not merely a welfare issue for nurses – this is a patient safety issue that must be addressed immediately,” Dr Lingeshwaran said.
He added that the resignation rate of post-basic trained nurses in the MOH has nearly doubled, with many leaving for the private sector or overseas, including Singapore and the Middle East, where salaries are three to four times higher.
The senator cited a 2025 MOH workforce study showing an 18 per cent shortfall in allied health positions nationwide. “The consequence? Patients are forced to wait three to six months for physiotherapy appointments or MRI scans.”
Dr Lingeshwaran also questioned why non-physician health workers are not paid for passive on-call duties, unlike doctors.
“Another issue frequently brought to my attention is unpaid on-call duties carried out by support staff categories 1 and 2, including nurses, community nurses, PPP, ambulance drivers in health clinics, and others,” he said. “For a long time, these groups have been instructed to be on-call without any payment if they are not called back to the facility.”
Dr Lingeshwaran, who is a former director of Sungai Bakap Hospital, said the arrangement restricts workers’ movement despite no compensation.
“In reality, once they are scheduled for on-call duty, they cannot travel far and must be ready to return immediately if activated. For medical officers or specialists, in the same scenario, they are paid a passive on-call allowance – so why are support staff categories 1 and 2 not given this facility?”
He asked the MOH to justify the policy and state whether it will be reviewed.
MHIT Cap May Leave Patients Underinsured
On health financing, Dr Lingeshwaran warned that the proposed Base Medical and Health Insurance/Takaful (MHIT) Plan may not provide adequate coverage for high-cost conditions.
“Data shows cancer treatment costs can exceed RM200,000 per year. If the MHIT basic plan only has an annual limit of RM100,000, patients may exhaust coverage midway and eventually return to burden the public system,” he said.
CodeBlue’s search previously found at least five comparably priced or even cheaper health insurance products that provide 10 to 50 times more coverage than the base MHIT product designed by Putrajaya. Five and three existing medical plans in the market for the 31-35 and 61-65 age groups respectively offer better value and protection than the Base MHIT Plan.
Dr Lingeshwaran also raised concerns about rising premiums.
“We must ensure MHIT premiums do not increase sharply each year. Medical inflation in Malaysia has reached 15 per cent, among the highest in the region. MHIT must be people first, profit second,” he said.
