Healing the healthcare system

MALAYSIA’S public healthcare has always been regarded as one of the best in the world for affordability and accessibility.

After all, few countries can offer their citizens gold standard quality care and medicines for a minimal fee of RM1 or RM5.

But the system in Malaysia is now “wounded” and needs “nursing” itself.

This month alone, several hospitals were forced to restructure their services due to manpower shortages. Among them were the facilities in Segamat, Lahad Datu, Pekan and the Duchess of Kent Hospital in Sandakan.

At the same time, new healthcare facilities, including the Petaling Jaya hospital, have been announced.

All this is happening as the government tightened its belt by cutting down on expenses, no thanks to the US-Iran conflict.

The only consolation of sorts is probably the clarification by the Health Ministry, dismissing allegations that its budget had been slashed by RM3.06bil.

But it acknowledged that the Finance Ministry had restricted its operating expenditure to RM500mil, describing it as a “technical adjustment” in view of the surplus allocations for vacant positions that cannot be filled this year.

This apparently does not affect the 18,641 posts approved by the Public Service Department (PSD) for the Health Ministry for 2026.

“The restriction does not involve the ministry’s operational allocations or asset procurement,” it said.

Nevertheless, the headlines this month painted a grim picture on the reality of our public hospitals. In essence, they tell us that our healthcare needs rescue.

Yes, new facilities can be built. But what use are they without the healthcare workers and the healing hands to attend to the sick?

One may argue that it takes years to build a hospital and that the requirement for staff is not immediate yet but we have seen examples of understaffed hospitals time and again.

The latest would be the new Hospital Pasir Gudang where the government is still targeting to fill 59% of the vacancies by September.

We must not forget that private healthcare is becoming increasingly unaffordable, too. There have been multiple reports of people, including retirees, giving up their health insurance as they could no longer afford the premiums.

The Parliament’s Public Accounts Committee tabled its reports this week in which the findings were an indication of how private healthcare is becoming out of reach for many.

This means that the demand for public healthcare will only go up even more.

For instance, it said that private hospitals charged patients with Guarantee Letters higher rates than cash-paying patients and those using a pay-and-claim basis.

It also uncovered the practice of “unbundling”, whereby hospitals impose separate charges for basic items that would ordinarily be included in room fees.

Whether these business practices are acceptable or not, private healthcare as an option is becoming increasingly unattainable to the masses.

To be fair, the Health Ministry has been trying to solve its many problems, but some things are just out of its hands.

The deep-rooted problem is rather systemic and cuts across several entities.

One of the solutions to the problem is more funds.

It is also high time to rethink the hiring system. This sector needs autonomy in deciding its workforce needs.

The current recruitment system, which is governed by the PSD and the Public Service Commission, probably works for other sectors of the civil service but it is clearly not helpful when it comes to healthcare.

If there is a lesson the Covid-19 pandemic has taught us, it is that when it comes to healthcare, having a surplus of workers is great.

You can never have too many healthcare workers, especially in a country which is ageing fast.

Perhaps it is time to seriously look into the idea of setting up the Health Service Commission, which would at least provide the ministry with some level of authority to appoint its manpower.

Based on previous estimates, the healthcare sector needs an allocation which is at least 5% of gross domestic product (GDP).

Despite repeated calls each year for the Health Ministry to be given the highest allocation in the national budget, that call has never been heeded.

Traditionally, the highest allocation has been going to education.

There is no doubt that both health and education are among the largest service schemes in the country, if not the largest.

But the Health Ministry’s needs are pressing; governments have come and gone, yet the ministry’s problems are not fully resolved.

It is hoped that despite the austerity drive this year, healthcare will be given the lion’s share of the budget when the government tables its national spending plan for 2027 on Oct 9.

Calling private healthcare workers to serve on a pro bono, honorarium or sessional basis at healthcare facilities may be a temporary solution but it is not the ultimate resolution to staffing woes.

This at most will serve as a band aid and not the cure to the problem.

Health Minister Datuk Seri Dr Dzulkefly Ahmad has indicated that more details on the possible nationwide enlistment of private healthcare workers to support government facilities will be announced in the coming weeks.

These, he said, were among the “noble ideas” to be shared soon.

While we wait for the announcement, let’s not forget that healthcare workers are the pulse of hospitals and clinics.

Without them, these facilities would just be buildings. Before we build more hospitals, let’s staff existing ones first.

Healthcare cannot be a luxury.