One of the more difficult and controversial healthcare issues that requires putting politics aside is the need to increase the fees at public hospitals and clinics. — AZHAR MAHFOF/The Star
It is a bit of a cliche by now to say that the Covid-19 pandemic and its aftershocks were unprecedented, that we are still bearing the adverse health and socioeconomic outcomes, even as we attempt to live in a world endemic with the SARS-CoV-2 virus.
It has also been said that the crisis has highlighted the importance of having a robust healthcare system – one that will not only be able to withstand future infectious disease outbreaks, but is also fit-for-purpose as we deal with ever- increasing non-communicable diseases (NCDs) and escalating healthcare-related costs.
The need for change
The Malaysian healthcare system has achieved substantial progress in achieving good outcomes on many health indicators and in providing affordable universal health coverage.
However, what has worked for the past 65 years will unlikely be suitable for the next 65.
This is especially true as there is a focus on curative, rather than preventive measures, while more could be done in tackling and correcting more systemic factors rooted in environmental, socioeconomic and behavioural factors.
The numbers tell a story of some of the challenges we face:
- One in five adults have diabetes.
- One in five children under the age of five suffer from stunting.
- Three in 10 adults have hypertension (high blood pressure).
- Four in 10 adults have high cholesterol levels.
- One in two adults are overweight or obese.
Alongside an increasingly bearish economic outlook that is likely to increase mental ill health, we have to contend with an ageing population – by 2040, those aged 65 and above will rise to 14.5% of Malaysia’s population – who may not have adequate savings to live a comfortable life post-retirement.
Fifty-two percent of the total 12.8 million EPF members aged under 55 have savings of less than RM10,000, with 3.2 million have a very critical savings level of less than RM1,000.
There is a need to address these issues systemically, rather than by intermittent troubleshooting.
In the words of the American rock band Rage Against the Machine: “It has to start somewhere, it has to start sometime.
“What better place than here, what better time than now?”
Our healthcare system will only face increasing demands as our population ages. Increasing the amount of healthcare spending would allow for more resources to be allocated to public clinics, thus allowing more care to be done at the community level and decongesting public hospitals. — Photos: Filepic
From sickness to health
Identifying the issues is the first step.
The next steps involve identifying and implementing changes that need to occur at both organisational and enforcement levels.
This is one of the core purposes of the Health Ministry’s upcoming Health White Paper (HWP), which seeks to address the imbalance in resource allocation, organisation and policy focus between public, primary and secondary care.
In his recent keynote speech at the Health Policy Summit 2022, Health Minister Khairy Jamaluddin highlighted the need to develop primary care services in order to address the burgeoning NCD burden, with a commitment to allocate more resources for primary care services, such as family health teams, that engage communities as equal partners in promoting and maintaining health.
This should start with a doubling of Malaysia’s total public health spending from the current 2.58% of GDP (in 2020) to 5% of GDP as recommended by the World Health Organization (WHO).
While we may not be able to achieve this in Budget 2023 given the prevailing economic and fiscal climate, the Finance Ministry should be committed to a gradual increase over time to alleviate the chronic underfunding of our healthcare services.
This will allow for proper planning; from development of skilled human resources to devolving care from hospitals to the community in an effort to decongest our public facilities and improve waiting times for medical consultations, investigations, treatment and rehabilitative care.
Healthcare above politics
With the 15th General Election being the hottest speculative topic in town, there is understandable concern that efforts such as the HWP are an exercise in futility and that they will not bear fruit.
There is also particular concern among the medical fraternity that priorities may differ depending on who happens to be the incumbent Health Minister.
There is also the question of political will to discuss and work on difficult and controversial issues, such as debating the need to increase charges for access to medical care.
To quote the former European Commission President Jean-Claude Juncker: “We all know what to do, but we don’t know how to get re-elected once we have done it.”
However, there is cross-partisan support for institutional change.
For example, the HWP calls for the establishment of a Health Reform Commission that is answerable to Parliament and not beholden to political masters.
This has been seconded by Bandar Kuching Member of Parliament Dr Kelvin Yii, who is also DAP’s Youth chief and chairman of the Parliamentary Select Committee on Health, Science and Innovation.
He had previously opined that such a commission can act as a vehicle to frame a reformation in essential healthcare areas, including financing systems, manpower resources, healthcare infrastructure, as well as data collection and analysis.
Such a commission could work across political boundaries and act as a platform to ensure that reforms are done in a transparent fashion, while adhering to principles of good governance.
The Commission will last across administrations, and can create long-lasting institutional check-and-balance while independently monitoring, advising and reporting on the progress of reform proposals.
Increasing the amount of healthcare spending would allow for more resources to be allocated to public clinics, thus allowing more care to be done at the community level and decongesting public hospitals.
Stakeholder engagement
In pushing for reform, there is a need to engage with all the key players within the health ecosystem.
Some may be obvious, e.g. ancillary services, the private sector, insurance companies and the pharmaceutical industry.
Some may be less so, e.g. digital tech companies; ministries and agencies involved in our socioeconomic nets, education and environment; as well as institutions such as Bank Negara.
Ultimately, any and all reforms are aimed at improving the lives of the ultimate stakeholder, i.e. the rakyat.
It is important that our voices are heard too.
Efforts will be put in place to organise town halls, and individuals can send feedback and ideas to kertasputih@moh.gov.my.
It is hoped that constructive feedback will help make the reform proposals more robust and enable us to prepare our healthcare system for the inevitable shocks in the future.
Dr Helmy Haja Mydin is a consultant respiratory physician and a member of the Health Ministry’s Health White Paper Advisory Council. For further information, email starhealth@thestar.com.my. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
