IHH Healthcare Malaysia chief executive officer Dr Kamal Amzan’s book, The Future We Choose, is very short for a book written by a CEO at just 145 pages long.
For someone who has practised for around four decades in health care, I expected a far longer book. Donald Trump’s The Art of the Deal, which was published in 1987 before the businessman ran for the United States presidency, is 367 pages long.
The Future We Choose, newly published by Gerakbudaya, illustrates familiar problems in Malaysia’s dual health care system, why some policies fail, and Dr Kamal’s roughly sketched vision for reforms.
An author’s note titillates readers by promising discomfort. The book doesn’t disappoint in that regard, although Dr Kamal still holds back from being brutally honest.
In Malaysia, businessmen across sectors tend to refrain from publicly criticising government policies. Health care is no different, with private-sector critique mostly coming from doctors’ associations instead.
But The Future We Choose openly criticises certain health policies by the Madani government, namely price transparency; Rakan KKM; and an expansion of the sales and service tax (SST) to outsourced hospital services like cleaning, linen management, and imaging and laboratory support.
Private hospitals in Malaysia, which are represented by the Association of Private Hospitals of Malaysia (APHM), did not object to any of these policies when they were proposed and came into effect and even welcomed the drug price display rule that requires private health care facilities to display retail medicine prices.
I didn’t know about the 2025 SST expansion to outsourced hospital services until I read The Future We Choose.
Despite Dr Kamal’s criticisms of these policies, the foreword is written by Health Minister Dzulkefly Ahmad, who also officiated the book’s launch last July.
The Future We Choose describes the Ministry of Health’s (MOH) price transparency policy as “performative” and “signalling virtue”. Ouch.
Dr Kamal says he “argued then” – and continues to believe now – “that transparency alone is insufficient if it is not paired with deeper structural reforms to reimbursement models and insurance coverage.” He points out that although a schedule of charges shows medication costs, it doesn’t explain other “embedded” operational costs of private hospitals, such as the overheads of a 24-hour pharmacy, cross-subsidies to support undercompensated services, and regulatory compliance burdens.
The IHH CEO then complains about how the imposition of SST on outsourced services further squeezes private hospitals that are already under pressure from “regulatory ceilings”, as well as demands from insurers for deeper discounts and faster reimbursement cycles.
Contrary to his remarks, the only private health care costs legally capped under the Private Healthcare Facilities and Services Act 1998 (Act 586) are doctors’ consultation and procedure fees. Everything else, from consumables to medical and surgical supplies, and medicines, aren’t regulated, thus enabling private hospitals to implement cross-subsidies and itemised billing bemoaned by the insurance industry.
Even as Dr Kamal’s book criticises price transparency, while APHM endorsed the policy, associations representing private general practitioners (GPs) and dentists were the ones who managed to get the court to suspend enforcement in their judicial review application.
If Private Hospitals Aren’t The ‘Bad Guy’, Who Is?
The Future We Choose seeks to dispel public perception of private hospitals as profiteering actors born out of “market greed”, arguing that health care is a costly and labour-intensive business because hospitals operate 24/7.
Dr Kamal lists, but doesn’t specify, costs that are invisible to consumers like biohazard waste management, servicing of imaging equipment, licensing fees, cybersecurity systems, inflation in global supply chains, recruitment of skilled labour, and regulatory compliance.
On human resource, Dr Kamal cites the rising costs of recruiting and retaining doctors and nurses beyond salaries, such as continuous medical education, underwriting professional liability insurance, and overtime pay.
As CEO of one of the biggest private hospital groups in Malaysia, I expected Dr Kamal to elaborate on how IHH manages operational costs or how the company marks up consumables, medical supplies, or drugs, for example, to cover the costs of expensive medical equipment or nursing manpower.
The Future We Choose demands an honest confrontation of trade-offs in public health care, but fails to hold the same mirror to private health care.
Even if Dr Kamal was reluctant to specify how much IHH pays its consultants or nurses, the CEO could have written about how his company competes with other private hospitals to aggressively recruit nurses or attracts specialists from the public sector – if only to hammer in the point that skilled health care labour is in short supply in Malaysia.
Or even to simply say that while private hospitals may poach doctors and nurses from the haemorrhaging health service, at least these people remain in our country, which would be a valid if uncomfortable defence.
However, these details are absent from The Future We Choose, found instead in a far more enlightening report by Parliament’s Public Accounts Committee (PAC) on rising health insurance premiums and private hospital charges.
Since Dr Kamal doesn’t explain specific operational costs in IHH, readers who aren’t familiar with health care probably won’t be convinced by his argument that health care is simply very expensive – be it in the private or public sector – especially those who mistakenly believe that increasing patient fees in the MOH from RM1 to RM10 is enough to cover health care costs.
He writes that “private care is indeed more expensive”, which although technically true, may inadvertently mislead laymen, though I’m sure that wasn’t the author’s intention. What Dr Kamal should have said is that even though the price at the point of care vastly differs between public and private hospitals, some costs may be similar, like human resources.
Attrition of doctors and nurses from the health service is high because they’re grossly underpaid. If they were properly compensated by the government, the cost of emoluments in the MOH would shoot up. Skilled labour is just one example; other hidden costs like capital expenditure aren’t necessarily counted in the health service, unlike private health care facilities.
On how private hospitals dealt with SST on outsourced services, described as a “hidden tax on the sick”, Dr Kamal merely writes that many tried to find a “middle path” between absorbing costs and passing them on to customers. I’m not sure how such middle ground can exist: it’s either one or the other.
Since IHH Healthcare Bhd is publicly listed, Dr Kamal could have plainly stated his company’s profit margins and explained where its profits are invested. This would have strengthened his defence of private hospitals as an ethical player in Malaysia’s health care landscape.
But the author’s bald defence of the hospital industry leaves me hanging. The only convincing argument he makes is that if every patient who seeks private health care were to be diverted to government facilities, the public health care system would be “overwhelmed overnight”. Private hospitals deliver an estimated 30 per cent of all inpatient care nationwide and more than 60 per cent of outpatient specialist consultations, writes Dr Kamal.
Due to widely reported problems of insurance denials and now the revocation of cashless facilities from specialists, besides insurers’ absurd waiting periods for specialists before they can treat insured patients, I initially believed that perhaps the government should restrict private hospitals to medical tourism and double MOH’s annual budget to boost the public health care system.
However, Dr Kamal’s blunt statement gives me pause. But then, it still isn’t a persuasive plea to suddenly cheer on private hospitals as a moral partner that has our best interests in mind.
Even if private hospitals aren’t the “bad guy”, as IHH’s CEO asserts, maybe they’re a necessary evil instead.
The Future We Choose doesn’t paint insurers as the enemy either, lacking anecdotes about specific pressures from insurance and takaful operators (ITOs), if any, on IHH. This is a curious omission, considering that the adversarial relationships and interlinked fates of the insurance and hospital industries have been a major policy issue over the past two years.
The villain in Dr Kamal’s story is poor systemic design. On one hand, it’s probably true, but on the other, just like how a government is made of individuals, so too are businesses.
Poor public policies in health can be attributed to the government of the day and, specifically, the health minister. Even if many policies are crafted by civil servants, the Cabinet and its members hold ultimate responsibility. Similarly, decisions on private hospital charges and operations are made by a CEO and their board of directors.
I would argue that singling out a villain isn’t simply convenient storytelling, but placing accountability where it rightfully belongs, as preached by Dr Kamal in his book.
Preachy About Public Health Care
Surprisingly, for a book written by the CEO of a private hospital operator, The Future We Choose mostly delves into the shortcomings of the public health care system.
Dr Kamal cites a few localised studies, beyond well-reported ones like the National Health and Morbidity Survey, as well as interesting anecdotes on failed pilot projects to show Malaysia’s addiction to shiny new things without creating supporting mechanisms.
One such example is how a district health office visited by the author showed encouraging results in a pilot project that used case managers and structured follow-ups to improve diabetes management. But after funding expired in two years, the nurses who had been seconded to the project returned to their original postings and the case management software subscription wasn’t renewed.
“Pilots feel safe because they are bounded, time-limited, and insulated from the compromises of large-scale implementation. They flatter us with the illusion of progress without requiring us to wrestle with the harder work of designing enduring solutions,” writes Dr Kamal.
The IHH CEO writes about the failure of another MOH-led initiative in 2023 that saw only partial uptake from selected clinics for digital diabetes monitoring. GPs reportedly cited inadequate training, incompatible software platforms, and a lack of incentives to integrate digital tools into their workflows. Some clinics struggled with poor connectivity in rural areas, while others found that patients were reluctant to adopt new devices without personalised support.
These anecdotes provide once-unknown glimpses into the public health care system.
Dr Kamal admits in his book that he has also “seen the same pattern repeat” in his personal experience leading the adoption of digital solutions. However, he stops short of providing specific examples, beyond merely saying, “The result is a cycle of optimism followed by quiet abandonment.”
The IHH CEO criticises the way Malaysia, irrespective of the government of the day, prioritises visible curative over invisible preventive care, because the launch of new hospital wings or advanced medical equipment generates “ribbon-cuttings or front-page headlines”, compared to funding increases for community clinics.
He points out that even though the World Bank estimates that every RM1 invested in high-quality primary care yields RM3 to RM4 in avoided downstream costs, prevention is the most vulnerable to cuts from fiscal pressures.
Dr Kamal makes a convincing argument for Malaysia to shift from the “tyranny of the annual budget cycle” to multi-year funding for public health care, similar to the United Kingdom and Australia.
The IHH CEO further addresses the social determinants of health (SDH) beyond the MOH’s purview, such as the unaffordability of healthy food, lack of green spaces, informal labour, and insecure housing.
“When we focus solely on individual behaviour, we indulge the convenient fiction that illness is a personal failing rather than a predictable outcome of structural neglect. We pretend that health is simply a matter of better choices while ignoring the environments that constrain those choices at every turn.”
Dr Kamal urges various ministries and agencies to work together rather than in silos, including the Ministry of Education for health literacy and local councils, besides employers and civil society organisations.
All of his arguments are valid, if not well-trodden ground. But The Future We Choose sometimes comes across as preachy, especially when its author doesn’t similarly moralise to the private health care sector.
I also feel that while SDH can be partially blamed for someone’s poor state of health, personal choice and responsibility shouldn’t be completely discounted. Government doctors complain about low patient compliance and wastage of expensive medication, whereas private clinicians criticise patients’ willingness to spend thousands of ringgit on alternative medicine while refusing to see a qualified doctor until it’s too late.
Foreigners are amazed at how Malaysians eat and drink as if insulin is free. Why don’t consumers drink cheap plain water instead of costlier “kaki potong” sugary garbage? So, Dr Kamal comes off as sounding a little woke. French philosopher Jean-Paul Sartre says, “Man is condemned to be free.”
Dr Kamal argues against our tunnel vision of chasing a reduction in private health care costs but to look at value instead. At the same time, he questions the definition of value-based care and how it can replace the fee-for-service model as an alternative. Even though IHH’s own annual report says the hospital group has delivered value-based care since 2022, Dr Kamal’s book doesn’t explain how this works on the ground.
Based on previous news reports, value-based care in private hospitals, including IHH, includes switching certain drugs to generic versions. It would have been helpful for Dr Kamal to cite this as an example and defend it. As an insured consumer with a medical plan, I personally oppose private hospitals’ shift to generics because I’m paying for my care.
What Is Kamal Amzan’s Leadership Style?
One of the reasons why I picked up a copy of The Future We Choose was because it’s written by a CEO. I think CEOs can impart valuable lessons. Trump’s The Art of the Deal, which I’m currently reading, contains fascinating stories.
A chapter on leadership, culture, and the human heart of health care in The Future We Choose is disappointingly shallow, without a single anecdote about how Kamal Amzan, CEO of IHH Healthcare Malaysia, manages people.
As many private hospitals in Malaysia are led by non-doctor CEOs with qualifications in health care administration or management, I had high anticipation for Dr Kamal, who is a clinician, to relate his personal leadership style in his book.
But The Future We Choose spouts truisms like “culture eats policy for breakfast”, while lecturing public and private providers to respectively fund adequate staffing and to measure success beyond financial sustainability or throughput.
“I have sat in meetings where the conversation revolved entirely around bed occupancy, revenue growth, or efficiency metrics, and felt an uneasy awareness that we were ignoring the most important truth: that none of those numbers matter if our people are hollowed out in the process,” writes Dr Kamal, teasing the reader but leaving her unsatisfied.
He dispels the “myth of heroism” that allows policymakers and the public to justify exploitation in Malaysia’s health care system, saying health care workers “are not heroes” but “human beings” who need decent working conditions and support systems. While true, this is again another reprimand of the MOH.
I would think that the situation in private health care is different: nursing ratios in private hospitals are legislated and the health care labour market is fluid. Dr Kamal doesn’t say if an expectation for doctors to “sacrifice indefinitely” also exists in private hospitals.
Even if private hospitals don’t face the same challenges as government hospitals with staff shortages and huge patient loads, hospital groups probably have unique problems with work culture or interference with a clinician’s practice of medicine, whether it’s budget constraints, insurer demands, or patient expectations. But this is just an assumption because the author doesn’t delve into these issues.
Conclusion: Recommended For Everyone
I recommend The Future We Choose to everyone, whether it’s people who are unfamiliar with health policies or those working in the sector.
Dr Kamal’s critique of certain government policies is refreshing. He specifies various problems in Malaysia’s health care system and challenges policymakers to be honest about the allocation of finite resources, although his opinions about how things should change aren’t fleshed out as much as I’d like them to be.
For example, on the issue of staff shortages and excessive work burdens in the health service, I would have liked Dr Kamal to suggest his preferred trade-offs for policymakers to make. It’s easy to say that health workers should be given adequate rest, but how is that possible when some district hospitals in Sabah like Ranau are being run by just eight medical officers? Should we shut down certain services or facilities, hire foreign doctors and nurses, or impose a moratorium on new private hospitals to reduce health worker attrition from government?
There is no right answer. It depends on what different stakeholders are willing to stomach. However, the author doesn’t tell us what he wants.
The Future We Choose has substance, but Gerakbudaya editors should have been much more stringent.
I put the book down many times, thin as it is, because I was put off by the word “quiet” that appears uncountable times, sometimes more than once in a single paragraph. The book would have been much better without a single mention of the word “quiet”.
Repetition of words in one sentence, such as “It appears in every policy document, every conference speech, every ministerial statement”, shows very poor copy-editing. What kind of sentence is this? It should be written as: “It appears in every policy document, conference speech, and ministerial statement.”
Overall, Dr Kamal presents a utopian vision of health care as the future he chooses for Malaysia. But beyond nice-sounding principles, which may be hard to practise in reality without compromises along the way, he doesn’t quite lay out a yellow brick road for policymakers, providers, or the public to follow.
