Malaysia’s public health care system has passed the Code Blue stage.
After the absence or failure of emergency interventions by the government, our health care system has now entered a new phase of service closures or disruptions – or a stage of selecting which service to save and which to let go of – due to health worker shortages.
In just two weeks, six government hospitals across Johor, Sabah, Kelantan, and Selangor issued press statements about various issues, mostly on shortages of doctors.
Yesterday, the Pahang state health department announced that a few hospitals in the state were facing shortages of medical officers.
Segamat Hospital in Johor has already made plans to close its obstetrics and gynaecology (O&G) specialist clinic, while anaesthesiology and critical care services at Lahad Datu Hospital in Sabah have been disrupted and risk suspension.
In a third case, CodeBlue reported earlier today a “drastic restructuring” of cardiology services at Raja Permaisuri Bainun Hospital (HRPB) in Ipoh, Perak, due to doctor shortages, that involved giving all referrals to the state hospital’s cardiology clinic one-year appointment dates, except for pregnant women with heart disease that may receive urgent referrals.
Yet, the Madani government has made the irresponsible decision to prioritise cheap petrol over health care by cutting health spending in order to continue funding soaring fuel subsidies.
Last June 1, the Ministry of Health (MOH) implemented 10 cost-cutting measures on an underfunded, understaffed, and overworked health care system. This is akin to cutting off the remaining three legs of a stool that was already missing one leg.
A hiring freeze, along with steep budget cuts of up to 10 per cent for services and supplies and another 10 per cent for assets, will accelerate the deterioration of the health service.
We will likely see more disruptions or closures of specialist clinics, services, or departments that can no longer be prevented by staff transfers or gali lubang tutup lubang.
MOH Putrajaya’s directive for tighter controls over allowance claims, medicine usage, and laboratory investigations will likely be translated down on the ground, across individual departments and facilities, as blunt denials or quotas.
Not all drugs have generic equivalents, especially newer and more effective therapies. From a budget perspective, a generic-first or generic-only policy may be based on a faulty assumption that generics are always cheaper than innovators. This isn’t necessarily true.
Even in previous years, the public health care system regularly couldn’t meet demand, with medicine supplies typically running out towards the end of the year.
Health care workers – be they doctors, nurses, paramedics, or ambulance drivers – will likely see increased rejections of whatever allowance claims, while patients may not get the drugs or tests that they need.
This inevitably creates toxic work conditions in an already stressed health service, as angry patients lash out at attending staff and health care professionals feel frustrated with poor compensation for increasingly unrewarding labour.
Attrition of doctors and nurses will rise, triggering a vicious cycle when those who stay may also quit later on because of heavier work burdens from fewer staff and sicker patients, whose conditions worsened as a result of less effective treatment or late presentation due to delayed diagnostics.
Austerity measures like postponing conferences, seminars, or workshops, or restricting domestic travel, may sound reasonable to a bureaucrat. However, doctors attend conferences for continuous professional development.
Public health programmes require going down to the community, especially crucial in a society that generally doesn’t take preventive health seriously.
Covid-19 illustrated the importance of the health care system. Prime Minister Anwar Ibrahim’s administration – which came into power in November 2022 after the acute phase of the pandemic – had the perfect opportunity to bolster the health service, but did nothing to fix systemic issues.
Instead, the Madani government under two different health ministers – Dr Zaliha Mustafa and Dzulkefly Ahmad – allowed problems to fester over the past three and half years until health workers resigned in droves and services began closing.
Budget cuts mark the point of no return for our health care system.
It’s far easier to retain an experienced worker and keep a service running than it is to hire a new person or reopen a service after it’s closed. Fewer junior doctors entering the service as housemen means fewer medical officers and fewer specialists.
Left untreated, patients get sicker and return to the health care system with complications that are harder and more expensive to treat.
Cuts to current-year spending and the upcoming Budget 2027 will also hamper the 13th Malaysia Plan (RMK13) that includes various hospital projects. A public hospital for Petaling Jaya (which isn’t even listed in RMK13) will just remain an election campaign promise.
Austerity is a bitter pill to swallow (no pun intended) when the prime minister and other ministers continue to travel overseas.
Spending cuts across ministries are now unavoidable because the federal government may have already blown its entire RM15 billion approved allocation for subsidies this year in just the first five months of 2026.
According to Finance Minister II Amir Hamzah Azizan, the cost of fuel subsidies amounted to RM700 million a month in January and February, RM5 billion in March, and RM7.5 billion in April, totalling RM13.9 billion.
So even if the cost of fuel subsidies were to drop to the government’s original RM700 million monthly estimate, there is no money left for this – much less if the fuel subsidy bill remains in the billions of ringgit every month until the end of the year.
Fighting resumed in the Persian Gulf conflict over the past few days, placing a fragile ceasefire on the brink of collapse. The Strait of Hormuz is once again “completely” closed, Iran reportedly announced yesterday.
The government cannot maintain the RON95 petrol pump price at RM1.99 per litre. A decision should have been made as early as March to restructure the Budi95 subsidy programme through a fixed subsidy (i.e. the government pays a fixed rate close to what it paid in January 2026, say 60 sen per litre, while consumers pay the remaining balance of the market price).
So if RON95 petrol retails at RM3.72 per litre, then we pay RM3.12 while the government covers 60 sen.
But if this is too much to stomach, the subsidised RON95 petrol price should at least go up to more than RM2. Whatever the case, RM1.99 is unsustainable.
Targeted cash assistance can be provided to the lower-income, as opposed to the current situation where fuel subsidies disproportionately benefit the rich and owners of large vehicles.
Putrajaya can also mandate a work-from-home (WFH) policy in the private sector by using an emergency order as a legislative tool, like during Covid days, if necessary.
Of course paying close to market rates for petrol will be painful for everyone, but it’s simply impossible for Malaysia to continue operating in an artificial market. RM1,700 of public funds are drained every second just for driving on the road.
Fuel allowances and drivers for MPs and high-ranked civil servants should be cut, along with multiple existing pensions for retired ministers and lawmakers so that these retired politicians only receive their highest pension.
Politics are about the allocation of resources. We argue that choosing fuel subsidies over health care will devastate the public health care system.
We respectfully disagree with PM Anwar’s contention that “every single ministry is important”. The Health Ministry is more important than all other ministries because our national health service deals with matters of life and death.
Some ministries can even be eliminated because they’re unnecessary, such as the National Unity Ministry; the Department of Museums or National Archives can be transferred to the Tourism, Arts and Culture Ministry.
Budget cuts should target all other ministries, departments, or agencies except service-oriented bodies like the MOH, police, fire and rescue, Social Welfare Department (JKM), as well as regulators across various ministries.
But, in any case, Malaysia cannot maintain fuel subsidies at the cost of public services, especially health care. If the government either ends or substantially reduces fuel subsidies, then no ministry needs to face spending cuts.
If the Madani government pushes through with health spending cuts, then it will be responsible for devastation of the health service that may take years to recover.
Editorials represent the views of CodeBlue as an institution, as determined through debate in the newsroom. CodeBlue’s Editorial Board comprises editor-in-chief Boo Su-Lyn, senior health writer Alifah Zainuddin, and sub-editor Chua Chern Toong.
