A recent article titled “Building More Hospitals Won’t Solve Waiting Times” warrants a more comprehensive and balanced evaluation.
While certain arguments presented are valid, it would be overly simplistic to dismiss the expansion of hospital infrastructure as part of the broader solution to reducing waiting times.
Any meaningful analysis must consider Malaysia’s demographic distribution, health care demand patterns, and structural capacity constraints.
The central proposition of the article — that the government should outsource primary care services to individual or network-based general practitioner (GP) clinics — is not new.
This policy direction has been discussed for more than 15 years within health care reform circles. Although there are indications that the government may be inclined toward such a model, implementation has been constrained by political considerations, fiscal realities, and logistical complexities.
Context And Data Considerations
According to data tabled by the Ministry of Health (MOH) in the Dewan Rakyat on August 27, 2025 under the Proposal to Form a Health Service Commission, total patient visits to public health care facilities reached 68.2 million in 2023, reflecting an 18 per cent increase over the three-year period from 2020.
Public hospitals accounted for approximately 67 per cent of total hospital admissions, with 2.7 million admissions compared to 1.4 million in private hospitals.
In the outpatient segment, public facilities managed 83 per cent of total visits (19.6 million), nearly five times the volume handled by private hospitals.
These figures highlight the overwhelming reliance on the public health care system. Any proposal to shift outpatient or follow-up specialist care to the private sector must therefore be evaluated against the scale of existing demand.
Strategic And Policy Implications
Several key considerations arise from the data presented:
Absorptive Capacity: To what extent can private facilities realistically absorb a meaningful share of outpatient demand without significant investment or restructuring?
Cost Efficiency: Would outsourcing primary and follow-up care to private GP clinics result in net fiscal savings for the government, particularly when private sector fee structures differ materially from subsidised public rates?
Clinical Scope and Competency: Are private GPs adequately equipped to manage the complexity of outpatient treatments currently delivered by specialist clinics in public hospitals?
Upskilling Requirements: If expanded responsibilities are envisaged — including areas such as maternity and child health care — would systematic retraining and accreditation reforms be necessary?
The data suggests that outsourcing cannot be treated as a standalone solution. A carefully phased and strategically designed transition would be required, including clear referral pathways, integrated digital medical records, reimbursement mechanisms, and structured capability development for GPs.
Absorptive Capacity
A significant proportion of GP clinics function as small, single-practitioner operations, often with limited diagnostic facilities, a relatively narrow scope of services, and restricted consultation hours.
As a result, their capacity to manage chronic diseases, undertake specialist follow-up care, or provide comprehensive maternal and child health services at scale remains constrained without meaningful capital and structural investment.
Operating in solo practice also reduces opportunities for peer consultation and multidisciplinary discussion, which can be critical when managing complex or high-risk cases.
These limitations are further magnified in rural settings, where professional isolation and resource gaps are more pronounced.
Strengthening absorptive capacity in rural areas would therefore require deliberate policy intervention.
This may include targeted financial incentives, strategic redistribution of health personnel, integration of telemedicine platforms to support clinical decision-making, and structured government-backed reimbursement frameworks to ensure both long-term financial sustainability and equitable access to care.
A potential solution is to establish a structured corporate network of GP clinics built on a partnership model between medical practitioners and a corporatised entity.
Under such a framework, the corporate partner would provide initial capital for the establishment of the clinic, centralised procurement, and logistics support.
At the same time, the doctor retains responsibility for managing day-to-day operations, staffing, and clinical delivery at the local level.
Compensation could be structured on a per-case or service-based fee arrangement, aligning incentives with service volume and quality.
The practitioner would assume operational expenses but retain the flexibility to generate additional revenue through participation in external panel arrangements or third-party health care programmes.
This model could combine the efficiency and scale advantages of a coordinated network with the autonomy and entrepreneurial drive of individual practitioners, potentially strengthening service delivery capacity while maintaining professional independence.
Existing GP clinics could be incorporated into the proposed network, subject to meeting clearly defined minimum standards and operational requirements.
Cost Efficiency
Outsourcing primary and follow-up care to private GP clinics in Malaysia can generate net fiscal savings—but only under carefully structured payment models. Public clinics benefit from heavy subsidies, low consultation charges, and salaried staff structures.
On paper, shifting patients to private GPs — who operate on fee-for-service models with higher consultation rates — appears more expensive per visit. However, the fiscal question is not the headline fee, but the total cost of care delivery.
Private GPs already bear capital expenditure (premises, equipment), staffing costs, and operational overheads. Government payments would therefore cover service delivery without additional infrastructure spending.
If reimbursement rates are negotiated at scale—through capitation, bundled payments, or chronic-care packages—the government could reduce congestion in public facilities, shorten waiting times, and redirect hospital resources toward complex cases.
The key determinant is pricing discipline. If private tariffs are reimbursed at open-market rates, fiscal leakage may occur. But if payments are benchmarked against public marginal costs rather than subsidised charges, outsourcing could be cost-efficient.
Ultimately, savings depend less on sector differences and more on contract design, patient volume, and the efficiency of care coordination.
Clinical Scope And Competency
Private GPs in Malaysia are well-positioned to manage a substantial portion of outpatient care. However, their adequacy depends on the complexity of cases transferred and the support structures in place.
Most GP clinics are designed for primary care—acute illnesses, stable chronic disease follow-ups, preventive screening, and medication titration.
Many operate as small, single-doctor practices with limited diagnostic equipment and minimal access to multidisciplinary teams.
This constrains their ability to independently manage complex, multi-morbid patients or cases requiring specialist procedures, advanced imaging, or close subspecialty oversight.
However, not all specialist outpatient visits are inherently complex. A significant share involves routine follow-ups for stable diabetes, hypertension, asthma, or post-discharge monitoring — care that trained GPs can competently deliver if supported by clear clinical pathways, shared electronic records, teleconsultation access to specialists, and defined escalation protocols.
The competency gap is therefore less about knowledge and more about infrastructure, diagnostics, and coordinated referral systems.
With structured accreditation, continuing medical education, and bundled chronic care frameworks, private GPs could safely absorb lower-acuity specialist workloads while hospitals focus on higher-complexity care.
Upskilling Requirements
If private GPs are expected to assume expanded responsibilities — particularly in maternity and child health care — systematic retraining and accreditation reforms would be essential to ensure safety, standardisation, and public confidence.
While many Malaysian GPs possess foundational competencies in antenatal screening, immunisation, and basic paediatrics, comprehensive maternity care involves risk stratification, early detection of obstetric complications, neonatal assessment, and timely referral pathways.
These require structured clinical updates, simulation-based training, and clearer scope-of-practice definitions. Without uniform standards, service quality would vary significantly across clinics.
Accreditation reforms would also be necessary to formalise tiers of capability. For example, clinics could be classified based on equipment readiness (foetal dopplers, CTG access), emergency preparedness, vaccination cold-chain compliance, and data reporting integration with public health systems.
Participation in shared electronic medical records and mandatory reporting frameworks would further strengthen oversight.
Importantly, retraining must be paired with financial alignment. Expanded scope increases medico-legal exposure and operating costs; reimbursement models must reflect this risk.
Therefore, scaling GP responsibilities is feasible, but only with coordinated training pathways, regulatory recalibration, and performance-based contracting to maintain clinical governance standards nationwide.
Dr Mohamed Rafick Khan is a trained physician with 12 years of experience in military medical services and over 22 years of experience in the assurance industry. He retired as the CEO of a multinational reinsurance company in 2019 and remains active as an independent international assurance industry consultant.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
