THE post-Covid 19 years have exposed and exacerbated deep-seated issues within the Malaysian public healthcare system, many of which are inherited from political and bureaucratic predecessors. Budget 2026 presents significant opportunities to address these critical issues and bring solutions to break the vicious cycle within Malaysia’s public healthcare sector.
But we must first acknowledge and recognise the underlying issues.
1. High attrition of healthcare workers (HCWs): Our public sector is an excellent training ground, churning out top-class specialists, doctors and nurses. Unfortunately, unsupportive and unfriendly policies, such as the contract doctor system, job insecurity, lack of permanent posts and limited specialist training opportunities, drive them to greener pastures.
2. Critically low morale: Severe understaffing forces remaining HCWs to handle unsustainable patient loads, leading to exhaustion, burnout and mental health crises. HCWs feel undervalued and unheard, and their sacrifices during the pandemic and beyond are not compensated by tangible improvements in their welfare, pay or working conditions.
3. Severe overcrowding and capacity strain: Patients are often stuck in emergency departments due to lack of inpatient beds. This phenomenon, known as "boarding", compromises care and demoralises staff. Outpatient appointments and elective surgeries face waits of months or even years, forcing patients to seek costly private care or suffer in pain.
4. Impractical initiatives and communication: The Rakan KKM programme to enhance public hospitals and clinics for all Malaysians faces criticism from medical professionals, experts
and public advocacy groups for creating a two-tier system with operational and legal ambiguities and further burdening overlooked and burnt-out HCWs.
Additionally, the DRG (Diagnosis-Related Group) for the private sector appears to pit the public and private sectors against each other without a clear and detailed implementation plan.
5. Isolating primary care and the private sector: Consultation fees of GPs, crucial primary care providers, have stayed at RM35 for 33 years (since 1992). Despite multiple attempts, the fee revision remained an unfulfilled promise. Similarly, the private sector is often framed as the "problem" behind medical inflation without acknowledging the public sector's capacity limitations that drive patients to private care.
Budget 2026 Fixes
The Malaysian Medical Association (MMA) recommended focusing on workforce retention, system overcrowding and fostering public-private collaboration. The MMA proposals go beyond isolated quick fixes and aim to create a more sustainable and resilient public healthcare system. Utilising a People, Process, Technology (PPT) methodology helps to provide structure towards enhancing organisational effectiveness.
People: Absorbing all contract doctors into permanent positions and increasing on-call allowances directly tackles the root causes of brain drain and low morale. This has been acknowledged by our honorable Health Minister, who recently said, “investing in our healthcare workers is as vital as upgrading infrastructure because without a motivated and well-supported workforce, quality care cannot be achieved.”
Adopting GPs as the Health Ministry's essential partners and frontliners in managing non-communicable diseases (NCDs) is important. This allows the outsourcing of national programmes such as health screenings and vaccinations as preventive health measures. Successful public-private partnerships (PPP) during the Covid-19 vaccination campaign shows this model can work to reduce the burden on public hospitals and clinics.
Process: The Health Ministry must learn from global multinational corporations when it comes to manpower distribution, akin to the uncompromising safety culture of the airline industry. It starts with an all-of-ministry effort, where every Health Ministry personnel work hand in hand with the Minister in mitigating the sky-rocketing dissatisfaction index and attrition rates of the healthcare human capital.
Dissent in the ranks results in resistance to change. One example is the Pertukaran Suka Sama Suka (P3S) package mooted in early 2025, which received lukewarm response. Within six days of its launch, the P3S portal attracted 37,373 visits (input indicator), 2,256 profiles (process indicator) and 21 matches (output indicator).
This positive start, however, came to a screeching halt at the Unit Sumber Manusia (USM) with zero jumlah pertukaran (outcome indicator). What would typically take one to 14 days to approve is now at a standstill for reasons unknown.
This P3S is a major breakthrough in HCW human resource planning designed in-house by the truly selfless, innovative and resilient Health Performance Unit (HPU) team at virtually no cost.
Other ministries and private healthcare institutions are actually watching P3S closely as a potential game changer in HR management.
Technology: In January 2024, we offered insights on addressing the issue of maldistribution
of the healthcare workforce. A national dashboard for transparent workforce mapping is a strategic tool for long term, data driven HR planning. This AI-driven dashboard provides better forecast and allocation of manpower needs, hence minimising discrimination and maldistribution. The dashboard has already been designed by the HPU and is awaiting the green light for rollout.
The fundamental foundation to real reforms are to increase healthcare spending to 5% of GDP, and adopt a collaborative approach. As the Association of Private Hospitals Malaysia (APHM) emphasises, reform must target the public sector that serves over 70% of Malaysians as it is the system's "tipping point".
This involves unpopular but necessary moves such as increasing the registration fees (excluding the B40) of public health facilities, that would help in the healthcare facility’s upkeep and maintenance.
Longer-term strategies such as a permanent council with equal representation from the Health Ministry, GP groups, Association of Specialists in Private Medical Practice Malaysia (ASPMP), APHM and other major healthcare stakeholders needs to be initiated. This council can co-design all major reforms, from DRG to primary care networks.
For a start, the Council can frame DRG as the necessary data-driven foundation for a future National Health Insurance scheme, instead of a cost-cutting exercise for the private sector. This will ultimately benefit the public system with more sustainable funding.
Enough of "Pi Mai Pi Mai Tang Tu"
The public sector's struggles with attrition, morale and overcrowding are not isolated problems; they indicate a system that has been underfunded and under-appreciated for too long. The solutions require political courage and significant investment in the following order of priority: first, stabilise the workforce with immediate financial and career rewards; second, decongest facilities by strategically partnering with and funding the primary care network; and last but not least, rebuild trust through inclusive governance and transparent communication.
Fixing the public health sector would prove Malaysia’s genuine commitment to Universal Health Coverage, thereby creating a more balanced and resilient overall health system. May Budget 2026 bring us one step closer to this worthy goal.
DR MUSA MOHD NORDIN
Paediatrician
CHAN Li JIN
Health Activist
and PROF THIYAGAR NADARAJAW
Paediatrician
