Restructuring the Malaysian health system: Is there a need?


— Academy of Medicine of Malaysia
The Malaysian Insider
Feb 14, 2012

FEB 14 — We observe with concern and interest the recent discussions by the ‘rakyat’ and explanations by the Ministry of Health Malaysia (MOH) in the print and electronic media regarding the planned National Health System Transformation. We agree that there are deficiencies in the present system that need to be addressed and applaud the Director-General of Health’s pledge to engage the ‘rakyat’ and stakeholders in its planning.

There is no denying that the Malaysia’s Health System is acknowledged internationally as being successful in providing health services to the ‘rakyat’. Notable successes include:

1. Reduction in mortality and morbidity and increased life expectancy, rising from 56 yrs for male in 1957 to 72 years in 2006; and 58 yrs for females to 76 years correspondingly. Infant mortality rate is comparable to developed countries.

2. An equitable public sector and universal access to comprehensive treatment; where everyone has access to medical treatment up to tertiary level at a nominal fee; and for the poor for free.

3. An effective Public Health Service focused on health promotion and disease prevention.

4. An efficient and effective rural health service; this has been used as a model for other developing countries by WHO

All these were achieved with a total health expenditure amounting to 4.8 per cent of GDP; with the government spending less than 3 per cent of GDP. This is way below that recommended by WHO which is 7.6 per cent.

The MOH in its Concept Paper dated 11th August 2009 had proposed a complete restructuring of the Malaysian Health System. The reasons given were:

1. Ensuring that services provided meet clients’ needs

2. Enhancing performance to improve equity of service

3. Providing higher quality care

4. Overcome limited and mismatched health care resources

The question arises whether there is a need for major transformation of the Malaysian Health System to achieve the stated objectives. What is the logic behind public-private integration? Private Hospitals are for profit entities run by private corporations. Should public funds be used to finance such institutions? Why do we need such public-private integration to improve quality and outcome?

It is mind-boggling to think that such an integration will result in such a change without first finding the reason behind such a problem.

The two-tier health system, separate public and private health services, complement each other. The private general practitioners play a vital role in providing primary care to a large portion of Malaysians in urban areas.

We are one of the rare few where private GPs offer 24-hour service. This had helped tremendously to reduce the load of emergency rooms in public hospitals. Primary care for those in the rural community is taken care off by the public health clinics and centres. Secondary and tertiary care are similarly complemented although all the private institutions are concentrated in urban areas.

The MOH had explained that all this is still in its planning stage, with 11 technical working groups discussing the final blue-print. One must understand that these groups are working on the micromanagement of the whole transformation based on the Concept Paper; which is total restructuring of the Health System with a Social Health Insurance Scheme and Public-Private Integration. The path has been fixed from the very beginning; there is no discussion as to the needs to be fixed and how to go about doing it. Since the DG of Health has pledged the he is willing to engage with the ‘rakyat’ regarding this major transformation, we hope that good sense will prevail and the interest of the ‘rakyat’ shall be foremost in everyone’s mind.

  1. #1 by Loh on Tuesday, 14 February 2012 - 9:36 pm

    ///The path has been fixed from the very beginning; there is no discussion as to the needs to be fixed and how to go about doing it.///

    We want discussion on the path. The experts in the 11 technical committees are working as if the path is correct. They might be doing the best for the wrong reasons.

    ///The MOH in its Concept Paper dated 11th August 2009 had proposed a complete restructuring of the Malaysian Health System. The reasons given were:

    1. Ensuring that services provided meet clients’ needs

    2. Enhancing performance to improve equity of service

    3. Providing higher quality care

    4. Overcome limited and mismatched health care resources///

    The MOH can do the mismatch concerning the public sector run on government funds. Resources in the private sector run on profit has nothing to do with MOH with the only exception that they meet the standards of health services management. MOH should not run private healh services.

  2. #2 by drngsc on Tuesday, 14 February 2012 - 9:39 pm

    Very well written. We certainly agree with the Academy of Medicine. I am one of those going around talking about 1Care, informing the public about what has not been said by MOH.
    The fact that MOH does not wish to engage with us is not unexpected. They said that they would, but when we invite them to speak to the public about their plans on 12th Feb 2012, they decline, but they still insist that they would like to.
    The other surprise is the silence by the opposition parties. Their silence is deafening. I would have thought that they would come out in support with all guns blazing. But a last, that was not to be. I wonder why. Maybe, like MOH, they think that we are bluffing, although we have release the MOH own 1Care Concept paper.
    I can only assume that the PR has not discussed this issue and so no one dare to step forward to take a stand.
    The rakyat needs to know, how you, PR, see the 1 Care issue? YOUR SILENCE IS DEAFENING.
    Do you agree that MOH should take an average of 9.5% of household income for a reformed social health insurance. Do you like to see rakyat further burdened?
    Do you agree that Healthcare should be privatised? Is it not a government’s social responsibility?
    Would you like to see RM 44.25 Billion dollars collected, and managed by a crony company?
    Please tell us where you stand?

    We need to change the tenant at Putrajaya. GE 13 is coming. Let us get all to register to vote and when GE 13 comes, to vote,

  3. #3 by raven77 on Tuesday, 14 February 2012 - 10:57 pm

    “….We agree that there are deficiencies in the present system that need to be addressed and applaud the Director-General of Health’s pledge to engage the ‘rakyat’ and stakeholders in its planning…..”

    Ball polishing started so early in this article by the “Academy of Medicine”…an association that always knows which side of its bread is being buttered… let the Malaysian rakyat deal with these misfits who want to “revolutionise” healthcare by swiftly removing this government…

  4. #4 by Winston on Wednesday, 15 February 2012 - 9:35 am

    This piece is another one of those “beat around the bush” articles
    that is all too frequent in blogs nowadays.
    It ends by concluding, “Since the DG of Health has pledged the he is willing to engage with the ‘rakyat’ regarding this major transformation, we hope that good sense will prevail and the interest of the ‘rakyat’ shall be foremost in everyone’s mind.”
    The author seems not to realise what sort of government this
    country is having to have said what it said!!!
    For his/her information, this government has the habit of
    ramming through whatever it wants.
    All the seemingly liberal talk of consulting the “rakyat” is just
    that!
    In the end it will have its ways.
    And this is not the first time it happens.
    Malaysians should learn not to continue to be SUCKERS!!!!!!!!!

  5. #5 by Winston on Wednesday, 15 February 2012 - 10:00 am

    Malaysians must realise that they have to fight their
    own government, their very own elected MPs in the BN
    government every step of the way to protect their own interests
    which kept being eroded by one regime after another over the
    decades!
    Doesn’t that speak volumes about the sort of “Caring”
    government that they are having!!!
    Time to wake up!!!

  6. #6 by SENGLANG on Wednesday, 15 February 2012 - 11:40 am

    The health minister is just telling lie by saying all if preliminary and nothing has been committed. we know very well this is how BN implement their big mega project, they will not really studies in depth and they will never engaged people at stake, but it all go underground and just implement base the best interest of the cronies.

    I believe all still fresh from PKFZ, despite such a voluminous and detail discovery by Citizen Nadez, they refused to take action but just going ahead as what they want to get the money and just use it.

    1 care will be second then none another PKFZ in the making. This time they want to do it bigger then ever

  7. #7 by Loh on Friday, 17 February 2012 - 1:17 pm

    The fact that LTL said that nothing is final shows that he is certain that the scheme is not welcomed, and yet he has not the power to stop it. LTL assured people that there is still hope that 1Care would not happen. If he is a real minister with ministerial authority, he should say either he supports the scheme and for the reasons why it was good, or stop the scheme if he is not convinced of its merits. The technical groups work only on the details, and they are not able to turn something we do not want into anything else.

    MCA ministers are only good for window dressing.

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