The recent Public Accounts Committee (PAC) report on escalating medical insurance premiums, rising private hospital charges, and their impact on public health care should serve as a national wake-up call.
It is not merely another technical report on health financing, but a reflection of a health care system that risks drifting away from the very values upon which the medical profession was built.
Perhaps equally significant was what followed in Parliament. Members from both sides of the political divide — government and opposition alike — expressed rare bipartisan concern over the growing burden borne by ordinary Malaysians.
In today’s increasingly polarised political environment, such agreement is unusual. Yet on this issue, there appeared to be a common understanding that health care affordability has reached a critical point.
For readers of CodeBlue, the PAC’s findings will sound familiar. Earlier this year, in Base MHIT: Who Really Bears The Cost Of Growing Old?, we questioned whether private medical insurance could continue serving as a reliable safety net for an ageing population.
More recently, Growing Old Without Growing Poor highlighted the growing danger that health care expenditure could become one of the greatest threats to financial security in later life.
Parliament recently validated many of these concerns. After extensive hearings involving the Ministry of Health, Ministry of Finance, Bank Negara Malaysia, insurers, private hospitals, academics and civil society, the PAC has identified systemic weaknesses throughout Malaysia’s health care financing ecosystem.
These include sharp premium increases, “closed pool” insurance practices that disadvantage long-standing policyholders, opaque hospital billing structures, excessive mark-ups on medicines and consumables, creative itemisation of routine charges, and a worrying exodus of patients from private care back into an already overstretched public health care system.
These are not merely financial or administrative problems. They are ethical ones. Medicine has always occupied a unique position in society.
Unlike most professions, doctors and health care providers are entrusted with people’s lives, fears and hopes. Patients seek care not as consumers purchasing luxury goods, but as vulnerable human beings, often during the most difficult moments of their lives.
For centuries, that trust has rested upon a moral contract. The Hippocratic tradition reminds physicians to place the welfare of patients above all else.
Modern medical ethics similarly rests upon the principles of beneficence, non-maleficence, justice and respect for human dignity. Compassion, empathy and altruism are not optional virtues. They are the very foundations of professional medicine.
These principles should not become secondary simply because health care is delivered in the private sector or because hospitals operate within competitive markets.
Private health care undoubtedly plays an indispensable role in Malaysia.
It provides highly specialised services, introduces innovation, reduces pressure on government hospitals, and contributes significantly to the nation’s economy.
Thousands of dedicated doctors, nurses, pharmacists and allied health professionals continue to serve their patients with exceptional professionalism and compassion every day.
This article is therefore not an indictment of private health care. Rather, it raises a more uncomfortable question: have we gradually allowed commercial incentives to overshadow the humanitarian purpose of medicine?
Health care institutions, like any organisation, must remain financially sustainable. Staff deserve fair remuneration, hospitals require modern technology, and investors understandably expect reasonable returns.
Yet there is an important distinction between financial sustainability and the relentless pursuit of profit.
When health care systems begin rewarding higher volumes of procedures, increasingly complex billing structures, aggressive mark-ups, and continual revenue growth, society is justified in asking whether the balance has shifted too far. The PAC’s findings suggest precisely this concern.
No group feels these consequences more acutely than older persons. Ironically, those who require health care most are frequently those least able to afford it.
The PAC noted that steep increases in medical insurance premiums have forced many policyholders aged over 60 to discontinue their insurance precisely when they need protection the most. This is neither economically sensible nor morally defensible.
Patients do not simply disappear because they can no longer afford private health care. They return to public hospitals. The consequences are entirely predictable:
- Longer waiting times.
- Overcrowded emergency departments.
- Delayed elective surgeries.
- Greater workload for health care professionals.
- Accelerating burnout and brain drain.
- Higher government expenditure.
Ultimately, every Malaysian pays the price.
The PAC itself describes this as a domino effect, where patients priced out of private health care migrate into government facilities, creating severe operational and fiscal pressures. This reinforces a reality that public health practitioners have long understood.
Malaysia does not have two separate health care systems. It has one interconnected health care ecosystem. When one side becomes unaffordable, the other inevitably becomes overwhelmed.
Yet even if every recommendation made by the PAC were implemented tomorrow, Malaysia would still face rising health care expenditure unless we address the greatest driver of all — the growing burden of preventable chronic diseases such as diabetes, hypertension, heart disease, stroke, kidney failure, cancer, and obesity.
These conditions account for much of the health care utilisation among older Malaysians and are major contributors to escalating medical costs across both public and private sectors.
Many are preventable, or at least substantially delayable. The most affordable bypass surgery is the one that is never required. The least expensive dialysis treatment is the one that prevention made unnecessary. The cheapest hospital admission is the one that never occurs.
This is precisely why health promotion and disease prevention deserve far greater national priority than they currently receive.
For decades, Malaysia has invested in curative health care with considerable success. However, health promotion has too often been misunderstood as merely conducting campaigns or disseminating health education.
Genuine health promotion is far broader. It creates environments, policies and communities that enable people to live healthier lives throughout the life course.
Healthy ageing does not begin at retirement. It begins in childhood. Every investment in healthier lifestyles, behavioural change, community wellness, physical activity, healthier nutrition, tobacco control, mental well-being, and preventive care represents an investment in reducing future health care costs.
In many ways, prevention is Malaysia’s most powerful health financing strategy.
The PAC report should therefore not be remembered simply as an investigation into insurance premiums or private hospital charges. It should mark the beginning of a deeper national reflection.
Health care is unlike any other sector because it depends upon trust. Patients trust doctors with their lives. Families trust hospitals with those they love. Society grants health care professionals extraordinary respect because it believes they will always place patients before profit.
That trust must never be taken for granted. Malaysia’s health care system will always require financial sustainability. But it should never come at the expense of compassion, justice and humanity.
The PAC has given Malaysia an opportunity not merely to regulate hospital charges, but to fundamentally rethink how health care is financed.
Reforming the Base Medical and Health Insurance/Takaful (Base MHIT) in line with the committee’s recommendations — through greater transparency, value-based purchasing, smarter provider payment mechanisms, and stronger investment in preventive care — would be an important step towards a more sustainable and equitable health system.
Before proceeding with the planned pilot, the government should urgently revisit the design of Base MHIT. While comprehensive reform of the broader private health insurance market may require time, there is no reason why Base MHIT itself cannot set a higher standard.
It should become a model of affordability, equity, transparency and lifelong protection by adopting community-rated premiums rather than age and health-based risk rating, providing predictable and incremental premium adjustments throughout the policyholder’s lifetime, and ensuring that premium schedules stated in policy contracts are legally binding rather than merely illustrative.
Ultimately, the success of a health system should not be measured by the profits it generates or the sophistication of its technology, but by its ability to protect those who need it most.
As Malaysia moves towards becoming an aged nation, our greatest measure of success will be whether every citizen — regardless of age, health status or income — can continue to access affordable, high-quality care with dignity and confidence. That is not merely an economic necessity; it is a moral obligation.
Dr Zarihah Zain is a public health physician who retired from the Ministry of Health in 2012 and is now a part-time lecturer in community medicine and medical ethics. Assoc Prof Norashidah Mohamed Nor is an academic fellow at the School of Business and Economics, Universiti Putra Malaysia.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
