An overview of Malaysia’s healthcare system. A miracle or a disaster?

An overview of Malaysia’s healthcare system. A miracle or a disaster?

Part III of III – The Professionals and a Conclusion
Having discussed patients’ attitudes and the balancing act between the public and private healthcare sector, I imagine the next obvious discussion lies in the attitude and professionalism of the healthcare workers themselves. Before I go on, I wish to share my experience to readers, as an insider to the system:

“A young man, was admitted into the Intensive Care Unit (ICU) for a fatal overdose of paraquat (a type of herbicide); an obvious suicide attempt. With the patient critically ill, the family waited nervously outside the ward. The Medical Officer (MO) briefed the freshly graduated House Officer (HO) of what the priorities are in regards of treating the patient, before she left him to deal with this tremendous but seemly impossible task of treating this patient. Shortly afterwards, the patient arrests, and the HO attempts to resuscitate him, and calls for help from the available medical staff in the ward. In that instance, the nurses and an attendant immediately came to support the HO. Meanwhile, the patient’s family, who realised the sudden urgency in the medical staff, sensed that something was going horribly wrong, tried to force their way into the ward. The nurses and attendant, restrained them from entering the ward, and told them that they were only getting in the way of the medical team. So the nervous family, were forced to wait outside, and their only comprehension of the scenario, was the little they could see through the tiny window that connects the ward to the outside.

In ICU, the HO is tiring from performing the cardiac massage whilst the other nurses who crowd the ICU are discouraging the HO in what they believe is a futile attempt. I was in utter disbelief when a nurse muttered these exact words,

“Cukup la doktor, dia sudah mati! (That’s enough doctor, he’s already dead).”

I understand that given the scenario, the survival of a patient who had consumed a fatal dose of paraquat is practically zilch. But nowhere along my medical training have I encountered calling a living man, dead, and staff discouraging the efforts of another staff to attempt to save him, regardless of the odds.

The HO ignoring these comments persevered but eventually exhausted, requests for a nurse to take over. She reluctantly takes over, but with minimal regard and effort for the technique required for the cardiac massage, she ultimately renders the procedure useless. The HO pushes her aside to continue with the cardiac massage, whilst the attendant (who is also trained for the procedure) comments, that he would feel obliged to help only if he were paid to do so. The HO, losing the battle of resuscitating the patient, recognises the need for an urgent inotropic drug administration asks the nurse to titre the required dose. But at that moment, the HO realises, all the nurses had left, save one who was a student nurse and inexperienced and even she had to call for the other more senior nurses to help prepare the required drug.

Finally, the patient dies. The HO walks over to the family to break the news. They cried in disbelief as they hear the difficult and shocking news, but they were well within earshot when the MO yells in background from across the ward, calling for the HO hurry up with his ‘time wasting’ and carry on to complete his wards rounds because she could not be bothered to wait any longer.”

This actual event took place in a district government hospital in Malaysia during my attachment as a pre-medical student. In my brief time there, there were uncountable accounts of unprofessional behaviour ranging across all levels of medical staff. Doctor-patient relationship goes no further than the extent of providing a drug to cure the disease. Nurses constantly complain of having to deal with both the patients’ and doctors’ attitudes, yet demonstrate little ability in completing their chores at an acceptable standard. These problems that I have highlighted are merely the tip of the iceberg of hugely unprofessional behaviour amongst medical staff in public healthcare service. Having experienced the public healthcare sector from varying perspectives, I have enough reason to believe that anyone would be discouraged from seeking healthcare services from the public healthcare services, if one could afford the more professional private healthcare service.

And if readers realised, I have yet to even discuss the competency of the medical staff in delivering a healthcare service that consumers require and demand. We have reason to believe that medical malpractice and negligence in government hospitals happens, which is indicated by the number of legal suits that have been filed, many of which reputedly have been settled out of courts. With the furore surrounding the de-recognization of Crimea Medical State University and other medical schools from Ukraine, the Malaysia Medical Association (MMA) stated that it places the highest importance in standards of doctors which are allowed to practice in Malaysia, a claim that is used to support their move. However, there have been numerous rebuttals from various groups demanding that Malaysia Medical Association (MMA) reveal and standardize the criteria which are used to ‘recognize’ medical degrees issued from all universities, yet it fell on deaf ears. The inconsistency that MMA portrays is worrying, with medical graduates pouring into the country from various institutions worldwide. How are we to know if they really are qualified to practice in Malaysia? The MMA solution to the question is a separate qualifying examination, which medical students from non-recognized universities need to pass. I personally wonder how many of our local graduates would actually pass these examinations.

The right for a healthcare service that meets the patients’ needs is a basic right that all citizens of Malaysia deserve. Anything short of that can only be perceived as an infringement of such a basic right. The earlier parts of my text discussed the growing trend of consumerism behaviour amongst healthcare users worldwide, but more prevalent in the developed country, a trend that is not currently widely observed in Malaysia, which could offer an explanation of the passivity of healthcare users in Malaysia with regards to the service that is being offered. This is a product of the paternalistic doctor-patient relationship, the elevation of the status of the doctor to somewhat mimicking a demigod: a doctor cannot do harm! Unfortunately, this is not true, and patients in Malaysia need to understand this, fast. We can preach about the unprofessional behaviour of the healthcare workers to limitless ends, but unless the patients adopt a new mentality, the arena of medical practice in Malaysia may never change.

Patients need to be more willing to assume a greater share of responsibility in their healthcare; be more willing to learn about the conditions which they suffer from and understand the implications of each treatment options. They need to discard their passive role and be more active with regards to the management of their own health, not merely absorbing the doctors paternalistic views, but instead challenging them to deliver the best of what the healthcare service has to offer. But this evolution will take time, and as for yet, it is impractical to introduce modern aspects of communication in medicine, such as informed consent and shared decision making, as patients are nowhere ready to take responsibility for their own health, and doctors likewise are nowhere ready to relinquish the authority and supremacy that they have been privileged to, all these years.

There are numerous areas in within the healthcare system that I have yet to discuss, such as healthcare delivery within the private sector, measuring patient satisfaction rates, and even expenses within the healthcare system. Also, I have not even approached the issue from the perspective of the medical staff, the limitations they face within the service, obstacles posed by guidelines, protocols and other red tape, inadequate facilities, poor opportunities for training, massive patient loads, horrendous working hours, and the list can go on. Other limitations in my text stemmed from the difficulty in accessing crucial statistics, such as exact figures of patients within each sector, breakdown of expenditure of the Ministry of Health, previous budget allocations, mortality rates, waiting times for patients in out-patients, waiting lists for medical/surgical procedures/investigations and others. Figures from the government allocations into the national budget and the 9MP, are in itself not useful unless we have figures from previous years to compare to and observe trends.

However, despite the numerous problems in the healthcare system that Malaysia faces, all is not lost. On the whole, as Ramesh and Holliday have said, Malaysia is truly a healthcare miracle, a miracle which has been made possible by the government who have created a system that is accessible by the multiple strata of the Malaysian society. For all the complaints, facts and statistics still prove that Malaysia possesses one of the leading healthcare systems in the Southeast Asia region, and a system that is the envy of many other developing countries. Furthermore, we can take some comfort in the recent efforts by the government with plans in place to show that things are definitely moving forward towards providing a better healthcare system for all. It may not be perfect, but it is definitely improving. However, the first step towards improvement lies in the ability to acknowledge the shortcomings within the system, such as some of the ones that I have discussed above. I self admittedly understand that huge chunks of my text have been critical of various parties, purely because I believe that there is much room for improvement.

As to the answer to the question that I put forward, ‘Is Malaysia’s healthcare system a miracle or a disaster?”…I believe that it is a miracle. It is an achievement that no one could have predicted with the numerous inadequacies and flaws at various levels. The existing system in far from being perfect, but it is undoubtedly a miracle that the healthcare system has succeeding in raising the overall standard of health (measured in terms of the variable mentioned above) of the mass population in Malaysia; a performance that deludes the circumstances under which the healthcare system operates on. However, as one who is within the medical profession, I too can appreciate and sympathize with the numerous problems that healthcare providers face: the lack of resources, support and protection. It is simply that, as patient, I would never give another the power to do harm, onto me.

An overview of Malaysia’s healthcare system. A miracle or a disaster?

An overview of Malaysia’s healthcare system. A miracle or a disaster?

Part II of III – Healthcare Economics and How it Affects Us

Statistics from the World Bank and the Harvard Team in 1999 revealed that in 1996, the total expenditure in healthcare services (public and private sector) amounted to only 2.9% of the Malaysia’s GDP of which 1.4% was in the public sector and 1.5% was spent in the private sector. At first glance these statistics may appear to demonstrate that the decentralisation of healthcare services was successful, but upon closer investigation it clearly shows that it the proportion of expenditure is hugely disproportionate relative to the population size these distinct sectors service.

Pharmabiz (an online news service) in a report in 2004 estimated that the private sector in Malaysia only accounted for 20% of the countries hospital beds, yet it employed almost 54% of the doctors in Malaysia. Marzolf (1996), also observed a similar trend in the mid-1990’s, estimated that 75% of beds in the country were provided by government services, yet it only employed 45% of all doctors in the country.

Therefore, self-admittedly by taking a large leap of faith, I assume that it is fair to conclude that almost an equal share of Malaysia’s GDP (if not more spent in the private sector) was spent on approximately 20-25% of all patients in Malaysia, who sought services from private healthcare providers and on 75-80% of all patients in Malaysia, who sought services from the public sector. Clearly no one can deny the huge disparity that exists between private and public healthcare services. It is no surprise that services provided by the private sector in most fields are almost unanimously superior compared to service provided by the public sector. But, surely the huge disparity in quality, standards, workforce and expertise portrays the government’s insensitivity towards the masses and their inept ability to exert control over maintaining the balance between healthcare provisions supplied by the public sector vs. the private sector.

However is it fair to expect taxpayers and consumers of the public healthcare service to accept substandard care from the public services?

In March 2006, the Ministry of Health started a pilot project in Selayang and Putrajaya government hospitals, where these centres will remain open after normal working hours to provide private specialist care for full-paying patients. This project was designed to last for 6 months with the aims to reduce waiting lists for specialist care, with the hope that patients who can afford this option will choose to pay and avoid the long queues. At the end of the 6 months, it will be decided that if deemed successful this project would be expanded to other government hospitals as well. This ‘full-paying patient’ scheme have received mixed responses from various parties. The Coalition Against Health Care Privatisation (GMPKK) which is made up of various NGO’s, political parties and trade unions is amongst the key opposition of this project. Their arguments revolve around the fact that only 30% of specialists in Malaysia are employed by the public healthcare sector and have to deal with about 70% of the patient load in Malaysia. With these specialists burdened with a massive patient load, these extra hours for cash incentives will only over-work them and may affect the quality of care than the non-paying patients will receive. Also, patients may be threatened, pressured or even manipulated into paying for their treatment for ‘better’ care by specialists.

Prior to the introduction of the project, Deputy Health Minister Datuk Dr Abdul Latiff Ahmad said it was introduced to prevent government hospital facilities from being abused by people in higher income groups:

“For example, a patient who can well afford it, only has to pay RM3,000 for surgery as has been set now in government hospitals whereas he is capable of paying up to RM15,000...This will affect the chances of lower income groups from obtaining similar surgery or treatment.”

What I fail to understand is that the public healthcare sector which is funded by the government should cater for all income groups indiscriminately; simply because all income groups are taxed accordingly. Although the government has insisted that this project is only a pilot project, to determine its feasibility, it demonstrates the governments’ inability to continue its funding of its patients requiring specialist care and also insensitivity towards tax payers. This full-paying patient scheme can only be perceived as a system that imposes a ‘double-tax’ on patients who seek quality care from the public healthcare system. However, the project should have ended in September 2006, but what does the verdict say on the feasibility of the ‘full-paying patient scheme’?

As of now, the percentage of GDP spent by Malaysia on healthcare services still stands well below the 5% of GDP recommendation by WHO. Mafauzy M. in an editorial in January 2000 stated that Malaysia’s expenditure in public healthcare services in 1994 was about 2% of the GDP, compared to the US who spent 14% of their GDP and the G-7 who spent between 5-8% of their GDP. Meanwhile Phamabiz projections estimate that Malaysia’s healthcare expenditure may eventually reach 6% of GDP only by the year 2020

N.B I am obliged to inform readers that the statistics from Mafauzy M.’s editorial and Phamabiz did not cite their sources and therefore I caution readers that the inclusion of these statistics in my text is purely to triangulate the various sources in hope to gain a differing perspectives of our healthcare system.

Although these projections seems reasonable, we must understand that in this space of 15 years there will be tremendous changes within the healthcare needs of the Malaysian population, mainly due to changes in the population demographics as a higher proportion of our population will be older, evolution of diseases and medical advances, just to name a few. Furthermore, by consistently spending less than recommended, we can almost be certain that the Malaysian healthcare system will soon fall much further behind other developed countries (who is consistently spending a higher percentage of their GDP) and over this space of 15 years, I can only foresee this gap multiplying itself. By year 2020, which has been earmarked as the time to announce Malaysia as a developed country, I predict our healthcare system to be nowhere closer to one worthy of a developed country.

According to the Human Development Report in 2006 prepared by the United Nations Development Programme (UNDP), Malaysia was ranked 61/177 based on the Human Development Index which takes into account factors involving life expectancy, literacy and standard of living. The report revealed that in 2003 Malaysia also spent 3.8% of the GDP for healthcare services of which 2.2% was allocated to public health expenditure which ranked Malaysia at 124/175 based on percentage of GDP on public health expenditure. Private health expenditure amounted to 1.6% of GDP which ranked Malaysia at 123/175. Therefore I found it surprising that Malaysia ranked 75/175 in terms of total health expenditure (public and private sectors) per capita amounting to US$374 (adjusted for purchasing power parity).

N.B. Health expenditure per capita was adjusted for purchasing power parity (PPP) in US$ to allow a more valid comparison between countries and does not represent the absolute amount of expenditure per capita in RM.

However, there are signs of improvement in recent times. Although during the 1990-2004 period there were only 70 physicians per 100,000 population in Malaysia; ranking Malaysia at 101/175 in the UNDP 2006 Report, trends show that the ratio has improved greatly compared to those released by the World Bank, 1999 that show there were only 14 physicians per 100, 000 people in 1960 and 44 physicians per 100, 000 people in 1995; more than a 60% increase presently, in ratio of physicians to per 100, 000 people since 1995. Another crucial statistic that strengthens the claims of signs of an improving healthcare delivery is the population’s life expectancy since birth. The World Bank, 1999 showed that life expectancy in Malaysia since birth at 1962 and 1997 stood at 55.8 years and 71.6 years respectively. The UNDP 2006 Reports measured Malaysia’s life expectancy since birth at a hugely improved 73.4 years, ranking Malaysia at 58/175!

Ramesh and Holliday, 2001 in their article titled, ‘Healthcare Miracle: East and Southeast Asia’ applauded Malaysia (amongst Hong Kong and Singapore) for having achieved a remarkable health care status are a modest cost. The paper argued that the financing of the healthcare system is not the key factor for the performance, but rather concentrating the provisions on in-patient care, an expensive component but of considerable efficiency. Whereas on the whole, there was less importance placed on out-patient care; a feature common to the three healthcare system discussed. However, the paper was exact in recognizing its limitations and acknowledging that the improved markers of health status in Malaysia are not solely attributed to the contributions of the healthcare delivery system. On a separate note, I also believe it is worthy of mention that the paper also recognize and warn that with increasing efforts to privatisation, it will increase inflation and the cost of healthcare to the society as a whole, as discussed above earlier. In summary, Ramesh and Holliday marvelled at the manner how Malaysia continued to demonstrate improved health status markers despite contributing well below the 5% of GDP recommended by WHO.

The governments’ stand and approach to the future of the healthcare system in Malaysia also shows greater intent towards improving the healthcare system than previously. Mafauzy M. claims that the government allocates approximately 5% of the national budget to the Ministry of Health amounting to approximately RM2.6 billion, which I presume was true at the time her editorial was published. However, the Federal Government Budget in 2006 through the Operating expenditure Estimates by the Treasury Department of the Ministry of Finance, revealed that approximately RM7.4 billion was allocated to the Ministry of Health, which amounts to almost 7.3% of the entire budget. Of which, RM1.3 billion is allocated purely for development expenditure amongst which RM85 million to complete construction of hospitals in Alor Setar and Cameron Highlands, RM 229 million for building and upgrading clinics nationwide, and RM 131 million for upgrading hospital laboratories and equipment.

Also the Ninth Malaysia Plan 2006-2010 (Rancangan Malaysia Ke-sembilan) states that the Ministry of Health will continue to be the leading agency and main provider of health services and together with other healthcare service provides and NGO’s will receive an allocated 5.4% of the budget amounting to almost RM10.2 billion, of which RM3.3 billion will go into public health care, RM5.4 billion into patient care services, which includes building new hospitals and renovation and RM1.4 billion into other healthcare services, which includes training of staff. The 9MP also outlines a broad plan to cover areas of weakness within the existing system such as greater efforts into development, primary and secondary prevention, and improving the efficiency of the delivery. Also it shows greater sensitivity towards a more equal distribution of healthcare services and with aims to improve healthcare services delivery to rural areas.

However, before we marvel at statistics that have led to Ramesh and Holliday lauding Malaysia as ‘Southeast Asia’s Healthcare Miracle’, we must be aware that the healthcare system in Malaysia, as previously mentioned, focuses mainly on in-patient care, or tertiary care. Therefore by implication, it means areas of medicine such as primary care, primary and secondary prevention which often utilises out-patient services are less pronounced and less successful in terms of implementation. These areas of medicine usually involves long term management dealing with numerous chronic medical conditions, as opposed to the in-patient setting which can only deal with acute conditions.

Therefore, patients who suffer from conditions that are more often prevented or controlled via careful long-term monitoring which is not plausible within the in-patient setting, often are left to manage their own conditions, until an acute event which requires hospitalisation occurs. This often leads to a drastic disruption to the patients’ life, and can also lead to a poorer quality of life following recovery after the acute episode of the disease. Furthermore, cost-benefit analysis of numerous conditions have demonstrated that long-term management of chronic conditions with primary and secondary prevention methods are often more cost-efficient than treating the acute complications of these diseases within the in-patient setting. By failing to control these chronic diseases, numerous hospital beds are unnecessarily occupied and unavailable to other patients who might need them. The management of such acute-on-chronic conditions are mostly otherwise preventable, and avoids unnecessary incurred costs of treating them within in-patients.

The most successful form of primary care in Malaysia relies heavily on private general practitioners (GP) clinics that have mushroomed throughout the country. These are easily accessible in most parts of the country by anybody at all, requiring only a quick registration process and the GP is at your service. Unfortunately, the GP service is ultimately a privately owned business that provides out-patient care for anyone willing to pay. These clinics by large, are poorly regulated with huge amounts of ongoing concealed malpractice, out-dated medical practice, unprofessional behaviour, and conflicting interest between doctor and patient. Therefore, it is shocking that these privately own GP clinics are the only form of out-patient healthcare service that ‘reliably’ provides a long-term management of chronic conditions with the concept of continuity of care, allowing the patients and doctor to forge a relationship that allows the doctor to appreciate the individual needs of the patients and cater for them in a manner that the public healthcare service is unable to do. Although, this is not necessarily guaranteed because with the increasing competition amongst private healthcare providers, there is also a huge disparity within the standards of service provided by GP clinics, and consequently a shift of patients from one GP to another for better service and value for their money. Unfortunately, this disrupts the concept of continuity of care and thereby the most valuable service provided by the GP itself.

(to be cont.: Part III of III – The Professionals and a Conclusion

An overview of Malaysia’s healthcare system. A miracle or a disaster?

An overview of Malaysia’s healthcare system. A miracle or a disaster?

Part I of III – Consumerism and a Dual Health Care System

“…First do no harm. What is implicit in this simple precept of medicine? An awesome power. The power to do harm. Who gives you this power? The patient…because he trusts you. He trusts you the way a child trusts. He trusts you to do no harm…”

~Dean Walcott; Patch Adams, the movie~

The 1998 movie, Patch Adams (based on a true story) which was set in the early 1970’s accurately captured the paternalistic relationship between a doctor and his patient. Historically, for many years, doctors and other medical staff alike have imposed their thoughts, ideas, and beliefs onto their patients in a paternalistic manner under the guise of maintaining professional distance, preventing transference and a superiority complex stemming from specialised inside medical knowledge. These elements have been deemed necessary to deliver the most appropriate and unbiased healthcare service to the patient.

But the medical profession is no longer as untouchable as it once was before. Patients in the developed countries, in the wake of consumerism are currently rejecting these traditionalistic approaches by healthcare providers.

Over the years numerous medical scandals have shook the foundations of a once unquestionable medical practice; the distribution of Creutzfeldt-Jakob disease (CJD) contaminated growth hormones in France (1985), the Apotex Drug Trial scandal in Toronto (1995) are amongst two scandals which have received wide media attention. More recently are the tragedy of Dr Shipman and the horrifying truth about the Bristol hospital scandal, the two most recent medical disasters in the UK which has contributed tremendously to the tarnished reputation of the formerly sacred profession and consequently lead to an increased medical awareness and consumerism amongst patients in the UK.

Patients worldwide are slowly but surely beginning to gain awareness of their rights as consumers with regards to healthcare services, and especially with the severely inflated costs that is being incurred by these healthcare providers. There is an increasing demand amongst patients from their healthcare providers for better overall services apart from a simple prescription to cure the disease; patients are demanding to be more informed regarding the disease itself, treatment options, and psychosocial problems stemming from the impact of the disease on the patients.

Simply put, patients now expect a healthcare service that is centred around the patient and his/her life rather than traditional practices where it revolved primarily around the disease, an idea which Dr Patch Adams brought forth and startled many at the time. It is no longer acceptable for a medical practitioner to merely provide a cure for the disease, but instead is expected to investigate the patients’ symptoms to form a definite diagnosis and offer the patient a number of treatment options in which the patient can choose by means of making an ‘informed consent’ and a ‘shared decision making process’ of the best treatment for the symptoms the patient experiences in view of the particular patients’ lifestyle, taking into account of the psychological and social impact the disease process and its treatment has on the patient, his/her lifestyle and social circle. Not to mention that all this has to be achieved in confidence between the medical practitioner and the patient with the ultimate goal of improving the patients’ quality of life or to regain as much function as prior to their morbidity.

How much of all these are actually practiced by healthcare providers in Malaysia?

It is difficult to appreciate the effectiveness of the healthcare system in Malaysia due to its complex structuring, which can be (at simplest terms) described as dominated by the public sector with increasing decentralisation to the private sector.

As a former colony of the UK, it is no surprise that Malaysia’s public sector is loosely based on the highly successful National Health Services (NHS) which forms the backbone of the public healthcare services of the UK. However, with the increasing burden of disease, patients’ expectations, patient load and financial constraints, the public healthcare system in Malaysia now faces a struggle to deliver healthcare services to the public and seeks to lighten its burden by the process of decentralisation; increasing privatization of healthcare services to mainly to reduce the patient load in the public sector. Whilst the actual intention of the government to promote the private sector is genuine to improve the delivery of healthcare services to the masses, it underestimated the waves of repercussions produced by the blossoming of private healthcare providers.

The initial push towards promoting private healthcare providers was intended to offload the burden from the public sector, in hope with increasing privatization, the standards of healthcare services delivery will improve tremendously. This indeed proved true, but at the cost of severely inflated medical costs causing many to revert back to seeking services from the public sector whose costs by large were relatively unaffected by the inflation that beset the private sector, and thereby still managing to sustain its services at minimal costs. However, the shift of patients from the private sector into the public sector proved that the governments’ actions were made redundant as the decentralization efforts failed to create the impact they had hoped for and consequently the public sector were once again beleaguered by the same problems they faced prior to the promotion of healthcare privatisation.

There is no doubt that the increasing competition within the private healthcare sector has led to a tremendous improvement in the delivery of services which ties in nicely with the patients’ consumerism. Areas which has benefited largely with this improvement in delivery are things such as, improved doctor-patient relationship, better communication, shorter waiting-lists for investigations allowing prompt diagnoses, more generous time allocation per patient, more comfortable stays at hospitals and better patient adherence to treatment, just to mention a few.

But what shadows all the benefits that I had mentioned above is the concomitant inflation that accompanied privatisation has lead to it being a highly lucrative business. Facing stiff competition, private sectors seek to hire the best medical practitioners and expertise in their respective fields to improve their own standards, and do not hesitate to offer irresistible salaries to those who they deem as valuable assets to their service [business]. Although this improves the ability of private healthcare providers to deliver better services, it regrettably forces a brain-drain of expertise from the public sector to the private sector. It does not take a genius to understand that the public sector is by no means able to compete with the private sector in terms of offering better financial wages, benefits and working environments; whilst appreciating the priority of the government: to provide a sustainable public healthcare service at an acceptable standard to the masses and attempting to keep the bill down to a minimum.

Unfortunately, as the masses revert back to the public healthcare services, many find themselves dissatisfied and wanting for better services having experienced the luxuries of the private sector. The demands of modern medicine and consumerism of patients impose a significant pressure on institutionalised healthcare services such as the public healthcare service in Malaysia to deliver. However it is vital to understand that from the governments’ standpoint, the aim of the public sector is to provide a healthcare service that is accessible to the majority population and often this is only possible by compromising the quality of individual services to cater for a larger population. Thereby this creates a disproportion between the actual needs of the patient, the demands of the patients (or perceived needs), and the delivery of the healthcare service by the public sector; rendering patients to deem the public sector as unsuccessful, ineffective and seek better services from the private sector.

Ultimately, this dual healthcare system consisting of a public sector employing efforts of decentralisation via promoting the privatisation of healthcare services has lead to a gaping inequality between the two sectors. This is characterised by the huge swing of patients, especially those belonging to the middle-class between the public sector and the private sector, having left with the difficult choice of choosing between a much higher quality of healthcare service or settling for the cheaper option.

(to be cont.: Part II of III – Healthcare Economics and How it Affects Us)