IMPROVING MALAYSIA’S HEALTHCARE SYSTEM TO MEET FUTURE NEEDS

Letter to the Editor, NST from the Director General of Health Malaysia in response to the article titled ‘Affordable Healthcare, Please’ dated 17 June 2015.

Dear Editor,

The Ministry of Health would like to refer to the NST article titled ‘Affordable Healthcare, Please’ dated 17 June 2015. We are happy that the News Straits Times (NST) has raised the issue of healthcare development in Malaysia. Indeed as noted the Malaysian healthcare system has achieved a commendable level, not only in the area of service delivery but also in the area of financial risk protection. The incidence of those becoming poor because of health spending is low comparable to mid-level Organisation for Economic Cooperation & Development (OECD) countries such as Hungary, Sweden and Denmark. This is because of the highly subsidised public healthcare system, which does not even recover the actual cost care delivery from its users. MOH only recovers less than 3 percent (3%) of actual expenditure through various fees collected not only from patient care but also from other fees such as rental of staff quarters and hostels and licensing fees.

Yet, within this highly subsidised public facility structure there are those who do not or cannot pay their fees. For those who cannot pay, they are readily referred to the medical social officers for assessment of fee waiver and assistance from the health fund.

On the other hand, there are also Malaysians who just walk out of the facility without settling their bills regardless of their socio-economic circumstances. Yet majority are of those who default payment are foreigners, who probably also did not contribute into our general tax funded system. Perhaps many do not even reside in Malaysia but enter our borders specifically to access the public healthcare system, at the expense of limited funds for our own population.

Why do we need to transform?

Given these limited measures and big challenges, there is a need to transform the healthcare system more so in preparation of the looming and very real hurdles of ageing population, high prevalence of non-communicable disease (NCD), increasing and expensive medical technology as well as unexpected environmental and communicable threats to health. Becoming a developed nation requires us to ensure a commensurate health system of higher quality and safety that efficiently utilises all available health resources to provide greater access to more effective care corresponding with the needs of Malaysians. Preventive care is the basic principle of future healthcare delivery, which may ensure a healthy population hence reduction in cost for curative care. This is the focus for the health sector in the 11^th Malaysia Plan.

At the same time, the MOH is working with local universities and global experts to comprehensively assess our health system in the aspects of service delivery, organisation and financing of health such as exploring additional sources of public financing including pre-payment method. The Malaysia Health System Research (MHSR) Project will benchmark our system across time as well as against other countries at the same or higher level of development because Malaysia aspires to become developed nation by 2020. Under this project, MOH is studying different healthcare system of other countries including UK, Turkey, Korea, Canada and Australia.

Indeed, the health plan in RMK-11 is very important and the opinion and ideas of various stakeholders will be sought. The cooperation of private and non-government organisations (NGOs) in working together with the public sector and the Government is critical to ensure the success of the RMK-11 plan on healthcare system transformation.

STRENGTHENING PRIMARY HEALTHCARE IS KEY

Primary health services are provided through 2,860 static health clinics and community clinics and 239 mobile health teams. Total attendances for 2014 were 65,796,442, which has shown a 32.7% increase compared to year 2010. Integrated health screening was started in 2008, intended for holistic care of outpatients in the health clinics and ultimately to reduce the disease burden of the community. Health risks are prioritised according to age groups. The strategy is to identify and manage risks early and accordingly in order to prevent progression to disease. It has been targeted that five percent (5%) of each age group population are to be screened. In 2013, 1,038,226 people were screened which comprised 4.3% the estimated Malaysian population aged 10 years and above (24,194,147). In 2014, 1,314,750 or 5.3% population has been screened.

Family Doctor Concept (FDC) is one of the initiatives under the Ministry of Health’s way forward to strengthen primary healthcare service in Malaysia with the aim of ‘One Family One Family Doctor’. The introduction of the Family Doctor Concept (FDC) is a positive step to address the rising burden of diseases in which each family will be assigned to a doctor who will take the responsibility of care from womb to tomb. Being seen by the same provider will create a good patient-doctor relationship, which will enhance the quality, continuity of care and client’s compliance towards the treatment and management provided.

The introduction of FDC will ensure a wider population can be covered by the Primary Health Care services which give more opportunity for early screening, risk identification, risk intervention packages and clinical management of chronic diseases. FDC will provide more opportunity for health promotion and disease prevention for individuals, families and community. The FDC will also strengthen the gatekeeping role that will reduce inappropriate referrals to secondary care and unnecessary costs to the client.

Datuk Dr Noor Hisham Abdullah

Director General of Health Malaysia

22 June 2015