FMT asked the Malaysian Medical Association (MMA) to give a doctor’s perspective on areas in need, not only as the country begins to rebound from the health crisis but also as it looks to build a more sustainable healthcare ecosystem.
Gaps in access
MMA president Dr Koh Kar Chai said one thing that’s apparent is the affordability gap between public healthcare and the private sector.
“The reason why we have very affordable public healthcare services is because it is heavily subsidised by the government, hence it can’t be compared ‘apple to apple’ with private healthcare,” he told FMT.
He said that to narrow this, the government must look at reforms like a national health financing scheme, which had been proposed in the past but never materialised.
Unequal distribution is also an issue, with some areas lacking full-range health services at a reasonable cost or the services entirely, forcing some patients to travel in order to get the care they need.
Manpower and crowding
One of the most glaring issues, Koh said, is a lack of manpower across the board, particularly in the public sector. A problem even before the pandemic, the increased strain caused by the virus has only illuminated the issue.
“It is obvious that most of the population opt for government healthcare because it is affordable and free in some instances, hence we see a high number of patients going to public clinics and hospitals.
One patient, who chose to deliver her second child at a private hospital, told FMT the number of patients at government facilities was one of the biggest motivating factors for moving away from public facilities.
“That isn’t to say the services offered at government hospitals are bad, but with the overwhelming number of patients they have to treat each day, they can hardly give special attention the way private hospitals do,” Aqilah Hairudin said.
“The waiting time is shorter with faster access to specialists, with a more comfortable and private environment.
She said that while government healthcare is by no means substandard, “you can expect a higher quality of service (at private hospitals) that comes with the cost.”
The high ratio of patients-to-staff takes a particularly heavy toll on junior doctors, Koh said, adding that they are often faced with extra hours and double shifts without sufficient manpower to take leave.
However, he said MMA was confident that the health ministry will be quick to address this, with both health minister Khairy Jamaluddin and his director-general Dr Noor Hisham Abdullah recognising the need to boost the number of workers in the medical field and ensure equitable distribution of doctors to improve access to rural healthcare.
Not enough specialists
Separate from the lack of manpower is a dearth of specialists in particular, which can lead to long wait times as patients greatly outnumber the doctors able to treat them.
“Many patients have to wait for months for certain non-elective surgeries due to the high patient count. Better outcomes can be achieved if the wait time can be reduced. The only way to do this is by increasing the number of specialists,” Koh said.
“Proper training pathways and career progression have to be offered to our junior doctors who have yet to obtain clarification on their specialisation pathway,” he said, but added that he is confident that Khairy will be able to find a solution.
Next Steps
First, he said the country should be looking to spend more on healthcare. Currently, healthcare expenditure is around 3% of the GDP, but a figure closer to 5% is needed if a system that provides universal access to healthcare is to be achieved.
However, Koh said that in developing infrastructure and human capital, the government must be prudent in ensuring wastage is minimised and money isn’t spent where it isn’t needed, which would require optimising private participation.
“There needs to be more public-private collaboration. The healthcare system must be seen as consisting of both public and private healthcare functioning as one.”