From Dr RA Lingeshwaran

Much has been said recently about the Rakan KKM initiative. Many have criticised it, and I have also received media requests to share my views on this widely discussed topic.

In my view, Rakan KKM is a positive development for Malaysia’s public healthcare system, which is under the health ministry.

The concept of offering private services within public institutions is not new. University hospitals have successfully implemented similar models for years without compromising their public service.

Therefore, I believe calling it “privatisation” is inaccurate – “private wings within public hospitals” is a more precise description of this initiative.

Malaysia is not alone in adopting this hybrid approach. Many developed countries have successfully integrated private services into their public healthcare systems.

For example, the National Health Service (NHS) in the United Kingdom – a globally recognised public-funded healthcare system – has long permitted “Private Patient Units” (PPUs) or “Private Patient Services” within its hospitals.

The Royal Marsden NHS Foundation Trust, renowned for cancer care, generates substantial income from its private patient unit, which is then reinvested into pioneering cancer research and treatment for both NHS and private patients.

Similarly, the private patient services of Moorfields Eye Hospital NHS Foundation Trust significantly contribute to advancements in eye care that benefit all patients.

Australia operates a mixed public-private healthcare model. While public hospitals provide free care to all citizens and permanent residents through Medicare, they also admit patients as private patients.

This offers individuals more choices and potentially faster access to care while leveraging the advanced facilities and specialist expertise of large public hospitals. Importantly, this model also generates vital revenue for the public healthcare system.

Closer to home, countries like Singapore, Thailand, and South Korea follow similar models. Structured hospitals in Singapore, such as Singapore General Hospital, offer Class A and B1 wards – private or semi-private rooms with enhanced privacy, comfort, and amenities such as air-conditioning and attached bathrooms.

Patients in these wards are billed as private patients and may have more say in choosing their doctors, albeit at a higher fee.

In Thailand, major university hospitals such as Chulalongkorn and Siriraj in Bangkok – known for their high-quality care – offer private consultations and rooms, generating revenue that supports broader public services and research.

Similarly, in South Korea, top university hospitals like Seoul National University Hospital (SNUH) and Asan Medical Center offer private rooms and premium services, catering to patients seeking higher levels of comfort.

These international examples clearly demonstrate that offering private services within public hospital settings is common – even in advanced healthcare systems.

The primary objectives of such initiatives typically include:

• Generating additional income to supplement public funding, with proceeds reinvested into the public healthcare system.
• Retaining highly skilled medical professionals by enabling them to earn private practice income within a public hospital setting.
• Providing enhanced amenities, comfort, and sometimes faster access to elective procedures or preferred doctors for those who can afford it.

Strong governance

I acknowledge concerns that Rakan KKM, operating during regular working hours, might lead to neglect of public patients.

To address this, strong governance is crucial to prevent a repeat of the shortcomings seen in the previous Full Paying Patient (FPP) scheme.

Key indicators – public patient waiting times, the number of public patients seen by specialists, and quality-of-care metrics – must be carefully monitored both before and after Rakan KKM’s implementation.

Specialists who underperform in their public service obligations should be barred from participating in Rakan KKM.

The concern that Rakan KKM will further strain already overstretched public hospital human resources is, in my opinion, overstated. Currently, eligible specialists are already granted one day off per week for private practice.

I believe this “flexi-day” could be restructured to accommodate participation in Rakan KKM.

Even better, we should consider restricting this “flexi-day” solely for Rakan KKM participation once the initiative expands to more public hospitals nationwide.

This could help retain our specialists by offering them the experience of private practice within a public setting – an important factor, as many specialists ultimately leave the service entirely in pursuit of this opportunity.

Under the previous FPP scheme, other healthcare professionals were not adequately compensated, often only receiving overtime pay for work after hours or on their days off.

In some cases, paramedics were forced into compulsory overtime to support FPP.

With Rakan KKM, public health professionals can still contribute and earn additional income, but a key advantage is the ability to hire full-time professionals specifically for these services.

This opens the door to leveraging the expertise of retired healthcare professionals who still wish to serve in public facilities but do not intend to work in private hospitals.

I do not believe Rakan KKM will “cannibalise” the public healthcare system. International examples have shown otherwise.

Even within Malaysia, private wings in university hospitals have existed since 1995. Has the creation of the University Malaya Specialist Centre (UMSC) diminished the quality of care at the University Malaya Medical Centre (UMMC)?

On the contrary, I believe it had helped retain top medical talent at Universiti Malaya, such as the late Dr KL Goh, emeritus professor Dr Tan Chong Tin, and emeritus professor Dr Wan Azman Wan Ahmad.

Our university hospitals have successfully paved the way. Now it is time for the health ministry to implement a similar strategy – to retain top-tier medical talent while using revenue from Rakan KKM to enhance our KKM hospitals further.

Dr RA Lingeshwaran is a senator and a former director of the Sungai Bakap Hospital in Penang.

The views expressed are those of the writer and do not necessarily reflect those of FMT.