The think tank said states should take on a larger role in healthcare by jointly designing and financing multi-year hospital and clinic projects, developing capital for long-term operating budgets for staffing, equipment and maintenance.

In a statement, Galen CEO Azrul Khalib also pointed to Sarawak and Selangor as examples of states that have begun investing in healthcare for their citizens.

“States such as Sarawak could provide financial incentives, like bonuses and allowances, for posts in critical specialties and rural rotations. This could attract talent and create competition to fill those positions,” he said.

On Oct 26, Sarawak DAP chief Chong Chieng Jen suggested that the state government build state-owned private hospitals with public hospital rates for Sarawakians.

Kota Sentosa assemblyman Wilfred Yap criticised the “financially irresponsible” proposal, saying it would shift federal responsibilities onto the state government while straining funds meant for other priorities.

However, Azrul argued that while health is under the Federal List in the constitution, the burden of health cannot simply be left on Putrajaya to carry.

“They cannot shoulder the burden alone. Health is about caring for citizens, families and communities in your own state, not merely a federal line item,” he said.

He also cautioned Chong that calls for state-owned private hospitals must be “grounded in the full financial and operational realities of running a healthcare facility: capital outlays, multi-year operating costs, sufficient skilled staffing, and reliable supply chains”.

“Believing otherwise risks creating unfunded promises, longer waiting times, and poorer outcomes, especially outside urban centres. Healthcare does not cost RM1 or RM5,” he said.