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)