Restructuring the Malaysian health system: Is there a need? — Academy of Medicine of Malaysia

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

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.