Go back to the basics for a resilient healthcare system

I REFER to the letter “Need to invest more in healthcare” (The Star, July 7).

Healthcare issues are seldom highlighted or get the attention they deserve. And when such issues are brought up, we normally hear complaints about congestion in public hospitals and long queues for clinic appointments.

But the Covid-19 pandemic has changed all that. While cost, quality and access were the crux of discussions about the healthcare

system before this, now it’s whether it would be resilient to massive surges for public health needs such as during a pandemic or fluctuating public expenditure in the sector.

The truth is there is no perfect healthcare system in the world. The cry for the national healthcare budget to be increased to 4% of GDP is perhaps a rather simplistic view or nice political promise.

Will mere financial increments lead to improvement? Healthcare costs a lot, but more money does not necessarily translate into better care for more people. We all know it requires more than that.

The United States has the highest GDP spending on its healthcare at 18%. But what we are seeing are very costly yet unequal healthcare access and now a surreal surge in Covid-19 at tens of thousands of cases daily nationwide.

We may argue over whether the US style of capitalism and market-driven healthcare or the British sort of National Health Service (NHS) welfare system works better. These systems are at polar opposite of one another but they are still suffering tragically in the face of Covid-19.

The World Health Organisation (WHO) defines a health system as comprising all organisations, institutions and resources devoted to producing actions whose primary intent is to improve health. So, a health system’s primary objective is not to create and deliver healthcare services but rather to produce good health in individuals and the population at large.

Based on this principle, the vast increment in health gain in the 20th century is actually due to advances in public health, for example improvement in sanitation, safer and healthier foods, vaccinations, workplace and motor vehicle safety, and healthier mothers and babies but not more facilities like hospitals or modern medical technologies such as heart stents.

And yet for the past few decades, healthcare planning has struggled to mitigate the explosive rise of lifestyle-related, non-communicable diseases such as diabetes, hypertension and the health effects of smoking.

We cannot run away from Covid-19 with its massive disruption to the economy and society. It is an emergency crisis needing an urgent public health, healthcare system and personal-social behaviour response. The virus has to be factored in all our healthcare planning for now and the future.

So how can our healthcare system be improved? The needs of health and the economy would have to be recalibrated. We are

still far from knowing the aftermath of this pandemic but what we do know is that the current healthcare system cannot remain at the current status quo.

Policymakers may need to have a long hard look at the fundamental questions of polity, policy and governance. Are we responsive and resilient enough? It is up to us. We have to find our own way.

CHEAH CHUN FAI , Ipoh