Healthcare System in Malaysia
The healthcare sector has seen robust growth over the past decade and this sector has one of the highest multipliers in the economy in Malaysia. Changing demographics, a more affluent society and more health-conscious lifestyles have led to the creation of a robust domestic industry. The health care system in Malaysia provides universal access to all its residents by dual system involving stakeholders from the public and private sector. Both systems provide health care through conventional or traditional and complementary medicine. The Ministry of Health (MOH), as the lead agency for health has been assigned to provide a more efficient and effective health system that ensures universal access to quality healthcare. According to official portal of Ministry of Health Malaysia, there are currently 141 public hospitals and 1039 public health clinics. Government also provide 254 1Malaysia clinics which are strategically located in various housing area. There are between three and four such clinics available at each State at the moment. On the other hand, there are 214 licensed private hospitals and 6801 registered private medical clinics excluded private dental clinics. The country now enjoys a fairly comprehensive range of health services from health promotion, illness prevention as well as curative and rehabilitative care provided by this dual system.
In recent years, the government has taken the initiative to increase funding for the healthcare sector to compensate for a large ageing demographic in Malaysia as well as an overall increase in population. Also, the government aims to further grow health care sector by encouraging more private investments in areas such as manufacturing of pharmaceutical products, medical devices, clinical research, aged-care services and supporting collaborative efforts between public and private healthcare providers. At 2014, Government allocated RM 22 billions for operating and development of health care system in Malaysia. 40 healthcare projects announced under Healthcare NKEA are projected to create 26,966 jobs and generate an income of RM6.59 billion, as well as RM4.96 billion in new investments by 2020. Collectively, government had put much effort in improving health care system in many ways such as 1Malaysia clinics which are strategically located in various housing area, Medical Devices Entry Point Projects which will leverage the country’s cost advantage, capabilities in the large electronics and electrical industry, strong intellectual property (IP) protection framework and accessibility throughout Asia to develop the medical devices industry further.
The Malaysian government appears to be very committed to providing access to high-quality healthcare to everyone in Malaysia, which the Ministry of Health provides through clinics and hospitals nationwide. Although medical care and public and private institutions are abundantly available, there is still a shortage of quality healthcare centres in remote parts of the country. The farther away you move from urban districts, the more difficult it is to find sufficient medical clinics. When patients are transferred from the health centres to the hospitals for further treatment, this not only incurs inconvenience to the patients and their family but also increases the cost to the health care system. Tele primary care is one of the tools to overcome this problem. The doctors in the remote clinics are able to discuss the problem cases through teleconsultation with the doctors and specialist in the hospitals using an audio-visual system to provide better care in the health centres without transferring the patients to the hospitals. Only the essential and needy patients are referred to the hospitals. This has not only reduced the number of patients referred to the hospitals but it has reduced the cost to the health care system. It has also provided a more comprehensive care to the patients in the health centres. The doctors in the health centres are also provided training and are also updated on the latest in medicine. This method of training has made doctors in the health centres more efficient and satisfied.
To supplement a lack of facilities for public healthcare in rural areas, teleconsultations take place between doctors in the isolated location with doctors in other hospitals for better access to treatment and information (Yadav & Lin 2001). MyHEALTHPortal was developed by the Ministry of Health under the Multimedia Super Corridor (MSC) Telehealth Flagship Application. Through this portal the public will be able to access current health information and health advice easily via the internet.
Malaysia has become a destination for medical tourism, attracting foreigners looking for safe, reliable surgery or treatment for a variety of ailments(Organization 2012). Almost every doctor in Malaysia can speak English, and many have studied medicine in western universities.8 Expat Arrivals. Healthcare in Malaysia; Medical facilities in Malaysia. http://www.expatarrivals.com/malaysia/healthcare-in-malaysia.
Equity and accessibility to healthcare services has always been the commitment given by the government. The public sector delivery system subsidizes nearly 95% of the patients’ cost of treatment for nearly 90% of the population that has access to some form of care. However, long queues for outpatient services, diagnostic procedures like CT- scan examinations, treatment modalities like endoscopic surgery and rationing of drugs for chronic diseases is a form of inequity. This inequity also relates to the doctor-population ratio whereby the population in urban areas like Klang Valley has more accessibility to doctors compared to the population in Sabah and Sarawak. All these may due to an imbalance in the distribution of resources and workload with the public sector shouldering a greater workload in terms of complexity and number of patients, particularly in-patients (Noh 2011). The problem of doctors in particular the more experienced specialist opting for the more lucrative private sector, resulting in shortages in the public sector. Both sectors provide excellent specialists and equipment. Yet due to the high number of public sector patients, public institutions struggle with long waiting hours and a lack of personal attention from the doctors whereas private insurance tends to be too expensive. Public healthcare may be the much cheaper option, but private healthcare options do have their advantages, such as faster services as a result of more doctors in the sector who are attracted to the higher salaries and better working conditions.
Also, public medical facilities are overbooked, while private hospitals are attracting more doctors. Even with the Malaysian government’s subsidies and investment attraction initiatives, overall spending on public hospitals in recent years has lowered.10 This means that more doctors are leaving the public sector for a better income working in private practices. Unfortunately, the cost of private medical facilities are rising, which means residents are increasingly visiting public clinics instead. The result is that public healthcare facilities have more patients than ever before, but fewer doctors available to treat them.
The health system has some control over the supply for health services but not much on the demand for healthcare services. Consequences include inequity in access to health services, inappropriate interventions and treatments as demanded by patients or induced by providers, varying quality and standards of care and costs that cannot always be effectively controlled.
Given the health system’s inadequate regulations and/or enforcements over health professionals and hospitals especially in the private sector, it is not surprising that the quality of care varies markedly. First, research has repeatedly shown that outcomes are better when the centres and doctors responsible for procedures undertake large numbers of them. Many of the private hospitals and specialists cannot achieve the necessary scale. Second, Malaysia’s specialty credentialing and privileging is in place but implementation is still weak as doctors receive their medical licenses for life, with no requirement for renewal or recertification, except for the annual practicing certificate issuance, and in many cases the requirements or criteria are much less stringent than they are in many of the developed countries. Third, the system lacks incentives to improve the quality of care and productivity. Further, unlike in the public sector, the private sector does not have a systematic collection of treatment or outcome data, like the National Indicator Approach in the Quality Assurance Program in Ministry of Health (MOH) hospitals, and therefore has no means of implementing mechanisms promoting best-practice care, such as pay-for-performance programs. Similarly, it has no way to enable hospitals or physicians to compare outcomes or for patients to compare providers when deciding where to seek treatment. Finally, quality of care suffers from delays in the introduction of new treatments. Specialists are too often overworked to participate easily in clinical trials or to investigate new therapies. And because the country has few controls over hospitals, it has inadequate mechanism requiring them to adopt improvements in care. Furthermore, the sections responsible for approving effective new drugs and devices is understaffed, which may delay the introduction or wide adoption of some new treatments for several years even after they are approved and adopted in the United States (US) and Western Europe.
Since the Malaysian government does not offer a national medical insurance program, buying private medical and life insurance is a must. Medical insurance is usually provided by employers; however, you may need your own additional health insurance to provide better coverage. Health insurance coverage should cover common ailments, doctor’s consultations, hospital fees, and prescription medication. You can choose a medical insurance policy that protects you and your loved ones with flexible plans that consider rising medical costs throughout your lifetime. Medical insurance covers patients for both public and private hospital visits, meaning whichever you prefer for treatment can be covered. However, private hospitals will still charge more than public ones. So only the portion of the cost stipulated within the insurance can be reimbursed, since private clinics require payments up front. Get health insurance that guarantees easy admission to a large number and variety of hospitals.
Malaysia need to further enhance its policy and regulatory roles over the whole system (public and private) to have better control over matters such as the allocation of medical resources, establish clear targets for providers, and mechanisms to force them to take a more coordinated approach to service delivery, jurisdiction over development of hospital and clinic development, the purchase of very expensive medical equipment in order to prevent or minimize its inappropriate or underutilization.
Addressing rising healthcare cost and increasing resources towards a sustainable health system. Responding to changing demography, ageing and migration, disease burdens and transition. Responding to variations in distribution of delivery (universal access, responsiveness) and quality and standards of care in health services. Increasing capacity and redistributing of health workforce/health professionals. Managing the public–private dichotomy.
Malaysia is fortunate to have a very comprehensive range of healthcare services. The Malaysian government is very committed to its principles of universal access to high-quality healthcare, which the local Ministry of Health offers through a network of nationwide clinics and hospitals. However, there are always pros and cons. To make the right lifestyle choices is the hallmark of a healthy population, there is a need for a comprehensive healthcare system that is equitable, affordable, effective and efficient in terms of delivery and financing, complemented by an environment that empowers individuals and community to practice healthy lifestyle and be responsible for their own health.