Excerpt from Minister of Health Malaysia media release on World Health day 7th April 2023
“ 𝘈𝘴 𝘢 𝘴𝘪𝘨𝘯𝘢𝘵𝘰𝘳𝘺 𝘵𝘰 𝘵𝘩𝘦 1978 𝘈𝘭𝘮𝘢 𝘈𝘵𝘢 𝘋𝘦𝘤𝘭𝘢𝘳𝘢𝘵𝘪𝘰𝘯, 𝘔𝘢𝘭𝘢𝘺𝘴𝘪𝘢 𝘢𝘧𝘧𝘪𝘳𝘮𝘦𝘥 𝘩𝘦𝘢𝘭𝘵𝘩 𝘢𝘴 𝘢 𝘧𝘶𝘯𝘥𝘢𝘮𝘦𝘯𝘵𝘢𝘭 𝘩𝘶𝘮𝘢𝘯 𝘳𝘪𝘨𝘩𝘵 𝘢𝘯𝘥 𝘢𝘤𝘩𝘪𝘦𝘷𝘦𝘥 𝘦𝘧𝘧𝘦𝘤𝘵𝘪𝘷𝘦 𝘶𝘯𝘪𝘷𝘦𝘳𝘴𝘢𝘭 𝘩𝘦𝘢𝘭𝘵𝘩 𝘤𝘰𝘷𝘦𝘳𝘢𝘨𝘦 (𝘜𝘏𝘊) 𝘪𝘯 𝘵𝘩𝘦 1980’𝘴. “
Internationally Malaysia is seen by many countries around the world and in the Asia Pacific as a model country with its ability to achieve UHC at relatively low levels of health care investment.
The Alma-Ata Declaration, adopted in 1978, emphasized primary health care (PHC) as the key to achieving health for all, advocating for accessible, affordable, and community-participatory healthcare, and urging nations to invest in PHC as a cornerstone of national health system .
In 2023 , there were 3114 Government Health clinics and 10495 Private General Practitioner ( GP) clinics .
In 2022, Total expenditure on health was Rm78,945 Million with Public expenditure making up 52.2% of the Total .
This chronic underinvestment in healthcare in the government sector leads to long waiting times , shortage of beds , overworked doctors , nurses , paramedical staffs and a hospital system as well as primary care clinics at near breaking points among others .
There is very little if at all investment into the private healthcare system in particular the Private GP clinics in any shape or form for decades .
Yet private healthcare expenditures nearly equals governmental expenditures nationwide and instead private healthcare was and is frequently seen by the government as a compensatory mechanism to the government own underfunding efforts to achieve universal health care .
This is markedly evident by the large numbers of patients seen by the more than 10,000 Private GP clinics nationwide on a daily basis and that if these clinics were to stop services even for 24 hours , the governmental Health clinics would likely collapse.
Instead of enhancing the private GP clinics , assisting in streamlining their cost effectiveness and acknowledging the fact that they are crucial partners in providing UHC , the government had done exactly the opposite for decades .
These are evidence by ignoring GP low stagnating professional fees for decades, constantly piling layers after layers of regulations , some outright illogical but yet requiring high compliance costs and Human Resource allocation all ultimately driving the costs of running GP clinics to a non sustainable level.
Decades ago , it’s nearly unheard of that GP clinics would open and later close down but today , GP clinics being non sustainable and closing down are fairly common occurrence and some unfortunate doctors were even declared bankrupt as a result .
Meanwhile , the lack of permanent positions in governmental healthcare facilities and challenging work conditions for many results in many young doctors leaving the government for private GP clinics but without adequate experience or training to handle the wide spectrum of illness and diseases they encounter often working in silo without any expertise or specialist support , underlining the fact that not only the financial health of GP clinics are constantly under pressure and threats but even quality of care may be constantly eroding .
In the governmental quest to acquire important health data and trying to achieve target health outcomes in women and children for example , GP clinics are required to regularly submit data reports , notifications of diseases , high risk groups and so on , all without any funding reliefs granted but yet expecting all GP clinics to adsorb all costs associated with such activities .
The current medicine price display mandate implementation on GP clinics is another example of totally unnecessary exercise , unlikely to achieve the objectives of lowering healthcare costs but yet requiring enormous human resources with the constant updating & maintenance of the price list , compliance issues and continuing audit .
Ultimately policy makers and the government need to understand deeply that private GP clinics are not set up for the purpose of compensating governmental inadequate healthcare investments and that regulations and directives can’t be implemented endlessly on GP clinics without the consequences of making them unsustainable or lowering the quality of care to survive.
Equally crucial is the need to recognise that GP clinics are indispensable partners in provision of UHC and that sincere efforts must be made to assist , support and even invest in these clinics to truly achieve quality , accessible healthcare for all .
We have a tax funded public healthcare system that is almost free of charge or very low minimal costs to access for every citizen and inability to provide UHC to all doesn’t mean that government should constantly pile pressure and demands on the private healthcare sector as in reality they are complementary but not a replacement for the public system.
Dr John Teo
