COMMENT | Malaysia is sick. If not financially, due to the gargantuan national debt, then collectively, as a nation that is most vulnerable to lifestyle illnesses like diabetes, hypertension, stress and heart-related problems. But what makes Malaysia sicker is the healthcare system.

The private sector can provide good medical services but often at a bomb. Prices are high, and out of reach of perhaps as many as 92 percent of the people in the country. Statistics show that up to 92 percent of the people are earning less than RM6,000 a month.

Since a partial withdrawal of EPF in one's second account does not happen until one reaches 50, many Malaysians are exposed to the risk of not having enough money to get the best medical healthcare for themselves and their loved ones.

Of course, private insurance can kick in to save the day. But when basic salaries are low, and family sizes are big, there is no telling if each parent or each child can benefit from extensive – and expensive – personal insurance coverage.

The whole healthcare system in Malaysia is broken, too. How is this the case when an e-tender system was introduced as early as 2003 to do away with corruption and collusion? When it was first conceptualised and introduced, the e-tender system in the Ministry of Health would allow various pharmaceutical companies to offer the best terms and services to the relevant government agencies.

The goal of the e-tender was to prevent any manipulation by the middle person. When prices are below or beyond a certain threshold, the e-tender system would automatically eliminate the tenders that were neither serious nor capable of offering the appropriate medicine, medical hardware, etc. to the public hospitals.

In Seremban, there is an upstanding wholesaler and retailer of pharmaceutical products who has been in business for close to 27 years. Yet, the company often finds its tenders rejected by the e-procurement system in Seremban.

Even a letter of endorsement from members of the Negeri Sembilan royal household, who have had the benefit of receiving good medical products from the company, cannot satisfy the decision-makers involved in the e-tender system.

The e-tender system was introduced by Dr Mahathir Mohammad prior to his retirement in 2004 to help four stakeholders - small and medium businesses that want to supply medical goods to public hospitals; the local businesses; the legitimate bumiputera companies and the non-bumiputera companies.

Pharmaceutical operators with the best intentions, services and pricing, are often knocked out by companies with good connections to the political-linked companies which prior to May 9, were Umno and entities connected to BN.

When companies close to Umno kept getting the contracts despite the overpricing and sub-par services, then the general quality of the public hospitals are bound to decline. Doctors who are hired on permanent contracts after one-year of housemanship in the public hospitals tend to take the patients for granted, too. Warning letters and patients' reprimands are often looked askance, indeed, with total indifference.

The results are a double whammy. On the supply side, the medicine and hardware to cure and prevent lifestyle diseases in Malaysia are often lacking and lagging, in public hospitals across the country. On the human side, dedicated doctors are far and few between.

The Ministry of Health now comes under the remit of Dzulkefly Ahmad, a well-trained toxicologist. He has the best of intentions to reform the medical sector. However, he cannot focus single-mindedly on Pharmaniaga alone. Tales of overpricing, monopolistic practices, indeed, inferior after-sales services, are often the backdrop that forms the entire medical corporate narrative.

Some serious nefarious corporate practices with ties to the former ruling parties seem to have proliferated in the medical sector. They have coalesced into something akin to a strong network with cabal-like features that dominate the supply chain, without being accountable to the supply chain.

Macabre and scary stories

But the disparaging nature of the health care system does not begin or end there. Well-intentioned endeavours like the 1Malaysia clinics seem to want to provide affordable health care. But when the doctors resort to prescribing generic drugs that are cheap and potentially ineffective, patients who should be going to general practitioners end up believing that one trip to a 1Malaysia clinics is enough.

What are the policy outcomes? The businesses of general practitioners (GPs) get a huge hit. Doctors in the public hospitals also become risk-averse.

Instead of working as GPs in the private sector to gain more experience, they recoil and sit back on their permanent contracts in the public hospitals. Difficult and hard-to-diagnose medical problems are not extensively researched. The government has to set up special centres like Institut Jantung Negara (IJN) to cater to one kind of illness alone.

While there is nothing wrong with the provision of such services, IJN has become overly specialised, and the public welfare of the Malaysian population is often overlooked until it is way too late.

The Ministry of Health has another function, one that should be looked into by Dzulkefly Ahmad: the pharmacy board. The latter decides on the list of medicines that can be sold over the counter by any retailer. But the pharmacy board may also insist that certain prices be disclosed in various medicines.

Take Coversyl, for instance. It is produced in France by Servier Incorporated. It is meant as a course of treatment for hypertension. Public hospitals display price tags of RM5 per strip. In the private sector, the general practitioner is able to sell it for RM35.

In the pharmacy, the prices range from RM50 to RM 70. How did something that can be sold in the government hospitals at RM5 shoot up by the multiples in the private sector?

The answer may lie in the lack of general oversight and regulation from the Ministry of Health. Indeed, if the Ministry of Health has any elements in the upper management that are in collusion with the politically connected pharmaceutical companies, it is almost certain that the prices may vary widely, leading to wild cases of profiteering.

Regardless of the macabre and scary stories of the health sector of Malaysia, the corruption and collusion in the public sector have to stop. The Ministry of Health has to do its own clean-up first, perhaps purge a few top individuals to get the slate clean. If there is no such political courage, it does not matter if Dzulkefly Ahmad is assisted by a deputy minister who is a cardiologist.

When one is admitted to a private hospital, for example, one can already see the total absence of basic health ethics. The moment the doctors know the patients come from a well-to-do family, or, are insured, they will jack up the cost of the health care services.

A walk-in from a physiotherapist, if one cares to look at the itemised bill at the end of each stay in a private room, can go up to RM350 per visit of less than five minutes, with the doctor barely doing anything to the patient, let alone touching him or her to know if there is a fever. This has happened in many private hospitals.

If the public hospitals are just as bad, then the much-lauded medical tourism fancied by Malaysia as a top revenue earner would just be a well-organised scam, especially to feed off on the wealth of the patients from the Middle East, or, China, or, even South Korea. Is this the new Malaysia post-May 9 that Malaysians want to show the world? The answer is a clear no.

Thus it is now up to the Minister of Health to consult widely and carefully from the ground up. Making a policy announcement on a national medical audit alone is not enough.

A call for feedback from patients and pharmaceutical firms that have been hurt by the vested interests of Umno and BN is now a must, in order to prevent Harapan from falling into the same trap of greed. That's greed earned at the expense of the average citizen's pocket and physical pain.

PHAR KIM BENG is a Harvard/Cambridge Commonwealth Fellow, a former Monbusho scholar at the University of Tokyo and visiting scholar at Waseda University.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.