Some key areas to examine to enhance healthcare

Health policy analyst Dr Chan Chee Khoon

THE Pakatan Harapan manifesto has committed to raise public expenditure on healthcare to 4% of the Gross Domestic Product.

“If they keep their promise, despite their tight budget, this will channel more resources to the ministry, on top of potential gains from more competitive bidding and reduced leakages,” says health policy analyst Dr Chan Chee Khoon (pic).

With the additional public funding, he adds, “A decent job can be done.”

Dr Chan highlights some key areas for the new Government to look into to enhance Malaysia’s healthcare delivery.

Q: What are some of the areas that the Health Ministry needs to look into?

A: The ministry should prioritise comprehensive primary healthcare, community-based services and gaps in tertiary care (such as paediatric sub-specialties, trauma and burns, oncology).

With the added resources, the Government could offer terms of employment attractive enough to retain more of its senior, experienced staff. You can’t match the remuneration of the private sector, but if you attend to the principal grouses such as training opportunities, promotions, career prospects, you could reduce the outflow of skilled professionals to the point that an expanded and subsidised public sector can offer affordable, accessible, no-frills but good quality care for all.

> Governments in the world are having difficulties sustaining the cost of healthcare. Even with increased public spending by 4% for Malaysia, it may still not be enough in the long run especially with the increasing costs of drugs, medical devices and new technologies. Should we continue with the tax-based system or consider a national health insurance to meet the needs?

If you can reform and improve the tax-based public healthcare system in the manner described above (with increased allocations from more progressive taxation regimes), why build up an additional parallel system of national health insurance with all its administrative and logistical outlays, for collections, tracking of beneficiaries, eligibilities, and entitlements, and payments?

At the moment we have a system that is beautiful in its simplicity. Any Malaysian citizen with a MyKad can walk into any government health facility and expect highly subsidised care limited only by the geographical distribution of those facilities and the treatments and competencies on offer.

The tax-based system entails minimal, additional administrative costs, and allows for expanded allocations to the public healthcare sector funded by a more progressive taxation regime.

> The Government’s investment arm Khazanah Nasional Bhd is the majority stakeholder in IHH Healthcare Bhd while the Permodalan Nasional Bhd owns the Ramsay Sime Darby chain of hospitals. The Johor state government’s investment arm Johor Corporation owns the KPJ Healthcare list of specialist hospitals while Terengganu state government’s TDM Bhd own five affordable hospitals and the Tabung Haji, Pusrawi Hospital. What do you think of the Government having a stake in private healthcare?

The Federal Government is the major provider of public sector healthcare, it is the regulator and government-linked companies (GLCs) at both federal and state levels are massively invested in commercial healthcare (controlling more than 50% of commercial hospitals beds). Clearly, there are conflicts of interest.

If they do a good job reinforcing the public sector for instance, as a provider of affordable and reliable healthcare, that may not be good for the private sector. Has there been a benign neglect of the public sector?

On the other hand, the fact that GLCs own or control such a big chunk of the private healthcare sector may allow them to exercise ownership prerogatives to bring those private health facilities more in line with national healthcare needs and priorities.

> Should the Government encourage non-profit hospitals?

From my understanding, non-profit hospitals in Malaysia currently mean that the owners of the hospitals do not distribute the hospital’s profits as dividends to shareholders. How is the non-profit hospital otherwise different from the private for-profit hospital?

Lam Wah Ee Hospital fees are only a bit lower than market rate but not that much lower. The hospital earns profits but this may be re-invested into the hospital, and it may have some kind of welfare fund for poorer patients. They have social workers who also assess applications for fee waivers or discounts depending on family circumstances.

In terms of the fee charges, currently, there is no regulation on hospital charges. There should be one if they are getting benefits as non-profit hospitals such as tax exemption or discounted tax rate.

> What else can the new Government do to improve our healthcare?

My hope is that with the additional public funding, plugging of leakages, adopting good staff management and building more health facilities, we can do a decent job without the frills. What people really want is a good, competently run healthcare.