Vision 2020 fired the hopes of my generation that Malaysia would reach developed nation status within our lifetimes, and by extension, the population would be served by an accessible, equitable and responsive healthcare delivery system.
The announcement by the Government that the target has been shifted to 2030 is realistic.
It is a fact that most of Malaysia’s health achievements have been in the last century and that the health indicators have stagnated or worsened in this century to date.
There is even debate about whether the healthcare delivery system is en route to the intensive care unit (ICU).
So, what will healthcare in our country be like in 2020?
The incidence of non-communicable diseases (NCDs) will continue to rise with increasing undiagnosed and uncontrolled numbers; and increasing demands on total healthcare expenditure.
This is because there is no coordinated effort to control NCDs.
Communicable diseases will continue to take its toll.
The re-emergence of poliomyelitis and diphtheria in 2019 was shocking as the Health Ministry had reported that immunisation coverage for both conditions in 2018 was 100.22%!
Was the data accurate? Did it include the data of the children of migrant workers who comprise an estimated 9% of the population?
Some previously eradicated diseases like rabies have also made a comeback.
The incidence of dengue in 2019 was the highest since 2015.
It is perhaps time to revisit the issue of the dengue vaccine, which has been licensed in many countries for use in those with previous infection.
New emergent communicable diseases may appear, particularly with the globalisation of travel.
Public trust in modern or allopathic healthcare delivery systems continues to wane.
Healthcare will be increasingly provided by the non-health sectors with tools provided by technology, e.g. home deliveries by unregistered personnel and internet purchases of unlicensed medicines.
Patients’ voices and actions will become louder in 2020 as they become increasingly more informed, particularly from the electronic media, notwithstanding its variable quality of information.
The demand for better patient experiences, patient safety and better quality of care will continue to pressure regulators and payers.
The increased budgetary allocation to the Health Ministry will not assure improved patient safety and quality of care unless wastages, inefficiencies and the role of middlemen are reduced markedly.
The uptake of the PeKaB40 screening and MySalam schemes are unlikely to meet their targets as long as the relevant information is not reaching the B40 population, and the criteria and processes are not user-friendly.
The former will not be a gamechanger unless it is revamped.
Healthcare expenditure will continue to rise because of the ageing population, the double whammy of NCDs and infectious diseases, new technologies, increasing patient demands and the unrestrained role of middlemen in healthcare.
Long-term care and NCD management will increase for the senior population and an increasing number of young adults.
There will be increasing out-of-pocket expenditures in the private and public sectors, particularly with expensive medicines and procedures.
An increasing number of families will face financial ruin if they or their relatives get catastrophic diseases like cancer and heart attack.
Medical inflation will continue to rise unabated.
The deregulation of professional fees will lead to minor adjustments in the short and medium term.
Middlemen will pressure providers to reduce professional fees.
The care provided by those succumbing to these pressures will likely be substandard.
More general practitioner (GP) clinics will close, primarily because of financial unsustainability, and rarely because of retirement.
Private practice for public sector specialists may or may not stem the outflow to the private sector as this outflow is often due to service conditions and not just financial compensation.
There are no published studies on the impact of such private practice on patient safety and quality of care.
There are too many medical schools, too many graduates, and too few House and Medical Officer posts.
Over-production continues, although the public are wiser with decreasing applications to private medical schools, which will lead to mergers, acquisitions and closures of some of these schools.
The crunch came in late 2019 when the contracts of the initial cohort of junior doctors in the Health Ministry ended.
Some were appointed as permanent Medical Officers, others on contract and some have no offers at all.
The rationale for these administrative decisions is unfathomable as the Health Ministry bade “sayonara” to some who have passed the initial post-graduate examinations recognised by the country.
Delays in the appointment of housemen continue to lead to some of our best and brightest training in other countries that provide certainty of appointments.
Training doctors at taxpayers’ expense for other countries is, to say the least, illogical.
New technologies, e.g. smartphones, portable diagnostics, smart drug delivery mechanisms, digital therapeutics, genome sequencing, machine learning, artificial intelligence (AI) etc, increasingly impact on healthcare.
Issues of patients’ confidentiality and security, patient safety, and the successes and failures of the new technologies, are increasingly posing problems.
reported to increase the diagnostic accuracy of breast cancer in a study.AI has been
However, it has also been reported that a computer virus can add fake tumours to medical scan images.
Whilst the potential of new technologies is the focus of attention of a select few, the basics of healthcare are paramount to the general population.
Technology should not be permitted to depersonalise healthcare.
New technologies are just tools. Whether they add to or detract from humane healthcare has to do with how and why it is used.
Discrimination and careful evaluation are essential, not technological exuberance.
Some policies announced in 2019 met with brickbats from the medical profession and the public.
They included different compensation packages for Medical Officers offered permanent and contractual appointments, the deregulation of professional fees and the withdrawal of critical allowance for new staff in 2020.
The Poisons Act Amendment Bill 2019 exemplified a blinkered approach as it was a reflection of the lack of proportionality, understanding and consideration of the legal and ethics matrix of prescribing medicines.
The Health Minister announced that the Sihat Bersama (Health Together) 2030 campaign will be tabled for Cabinet approval soon without providing any details.
Whilst the proposal appears to address health issues at a macro level, the devil will be in the details.
As long as the Health Ministry formulates health policies without genuine consultation with stakeholders, the result will be limited or no success.
Several target dates given by the Health Minister and his deputy have come and gone without any further news, i.e. the inquiry into the Hospital Sultanah Aminah fire in 2016 and deregulation of professional fees.
Such announcements impact on the credibility of the Health Ministry.
The need for healthcare is avoided by staying healthy.
A healthy diet, maintaining an appropriate weight, regular exercise, sufficient rest, safe sexual practices, avoiding smoking, moderate alcohol consumption and keeping vaccinations current are some necessary measures.
This requires effort, smart lifestyle choices and the occasional medical check-up.
Wishing all readers good health in 2020.
Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
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