This article is written in response to a recent CodeBlue commentary discussing whether private general practitioners (GPs) can help relieve the growing outpatient burden in Malaysia’s public hospitals.
Malaysia’s public hospitals are drowning in outpatient demand. Clinics are overcrowded, waiting times are long, and clinicians are increasingly stretched. The question raised recently whether private GPs can help relieve pressure on public hospitals is important. But it may also be the wrong question asked in my opinion.
Malaysia does not have a private GP shortage problem. Instead, we have a primary care system design problem.
Today, public hospitals manage a disproportionately large share of routine outpatient care. This includes follow-ups for stable chronic diseases, medication refills, hypertension monitoring, diabetes reviews, and preventive screening conditions that in many health systems are primarily handled in community settings, and not to mention the flocking of more T20 and M40 patients back to the public hospitals and clinics.
Hospitals, by design, should focus on complex and specialised care. Primary care should serve as the front line for simple acute minor ailments and long-term disease management. It will be a bonus to provide values on preventive and promotive health care services to the community.
Malaysia has gradually drifted away from that structure due to various factors, including but not limited to health literacy, health-seeking behaviour, and availability of resources.
As a result, specialist clinics in public hospitals are increasingly filled with patients whose conditions could be safely managed in primary care. Meanwhile, thousands of GP clinics across the country operate below their potential capacity.
The issue is not capability. It is alignments of interests and incentives.
Private GPs are fully capable of managing stable chronic conditions, preventive care, and medication titration. These are core functions of primary care.
However, the current financing structure makes the public system the default provider for long-term care. A heavily subsidised consultation fee at government facilities naturally attracts patients, even for routine follow-ups.
Over time, this has created a structural imbalance in which hospitals become the centre of gravity for outpatient care.
Simply asking private GPs to “absorb” some of the load will not solve this problem. Without reforming incentives, patients will continue to gravitate toward the most subsidised pathway.
The real question therefore is not whether private GPs can help.
The real question is how Malaysia chooses to organise primary care and its care pathway with aligned interests and incentives leveraging on technologies and AI in today’s world.
First, payment models need to evolve beyond the current fragmented structure. Fee-for-service encourages episodic visits rather than continuous care.
If Malaysia wants GPs to manage chronic diseases at scale, the system needs mechanisms such as capitation or bundled chronic care payments working towards value-based health care model.
These models reward continuity, prevention, and long-term management rather than volume.
Second, integration between hospitals and GP clinics must improve significantly. At present, clinical information does not move seamlessly between the two sectors. This makes coordinated care difficult and discourages decentralisation. Shared electronic medical records, referral protocols, and digital care coordination are essential if patients are to move safely between hospitals and community providers.
Third, the GP ecosystem itself requires strengthening.
Many clinics operate as single-doctor practices with limited diagnostic capabilities. Expecting them to suddenly absorb large patient loads without structural support would be unrealistic.
Malaysia therefore needs to explore networked primary care models, where independent clinics are supported by shared diagnostics, AI-powered digital frontdoor, teleconsultation access to specialists, procurement systems, and digital platforms.
Such networks allow individual practices to retain independence while benefiting from scale, collaboration, and shared infrastructure.
Finally, policymakers must confront a difficult but necessary reality.
Hospitals should not be the default venue for routine chronic disease management. When hospital outpatient departments are filled with stable hypertension or diabetes cases, specialists spend less time on complex conditions where their expertise is most needed. This represents an inefficient use of scarce clinical resources.
Strengthening primary care is therefore not simply about shifting patients away from hospitals to reduce queues but designing a smart care pathway that works and it is evidence based with safety as the top priority in mind.
In my humble opinion it is about redesigning the health system so that each level of care performs the role it is best suited for. Private GPs should not be treated merely as overflow capacity for an overstretched public system.
They should instead be recognised as a central pillar of Malaysia’s health care architecture.
If Malaysia succeeds in building an integrated, digitally connected, and properly financed primary care network, hospital congestion will ease naturally. But if the system continues to rely on hospitals as the backbone of routine outpatient care, overcrowding will remain a permanent feature of the landscape.
The debate therefore should not be whether GPs can help relieve hospital congestion. The real debate is whether Malaysia is ready to redesign primary care for the realities of modern chronic diseases.
Until that happens, outpatient overload will remain a symptom, not the disease.
Dr Raymond Choy is founder and CEO of Heydoc Health, as well as secretary of the Association of Digital Health Malaysia.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
