Malaysiakini Letter

1Care: Unhealhy lack of public engagement

Dr Helmy Haja Mydin
Published:  |  Modified:

One of the essential features of a successful healthcare system is the presence of a well-organised primary care service that provides comprehensive services to the public that it serves.

Primary care services are usually delivered by a general practitioner(GP) and should ideally deal with a wide range of healthcare issues, from dealing with minor acute ailments to keeping a lid on the development of chronic illnesses.

In Malaysia, we tend to only visit our GPs if we are plagued by a sore throat or any other common acute illnesses. We also have a tendency to move around and not stick to a single practitioner; we tend to be satisfied as long as the costs are covered by a ‘panel doctor’ that is recognised by our insurance company or employer.

This is obviously disadvantageous, as a key characteristic of primary care is continuity - the GP is meant to act as the gatekeeper to secondary care services, and also plays the role of the family physician.

There is reason to believe that the Ministry of Health has plans to reconfigure the primary care landscape. There will be focus on a number of areas, namely policy development and program direction, comprehensive primary care services and benefit packages, quality assurance and performance indicators and last, but not least, human resource development and training.

With the latter issue, it is worth noting that there are less than 400 qualified GPs who are registered with the National Specialty Register, with another approximately 8,000 practitioners who will need to be trained in a recognised postgraduate course.

This contrasts with the situation in the United Kingdom, where primary care services are provided by around 36,000 GPs in approximately 8,200 practices for a population that is roughly double that of Malaysia.

These GPs carry out over 300 million patient consultations a year, and play a significant role in not only improving the lives of their patients, but also ensure that financial and human resources for secondary and tertiary services are not overwhelmed.

An integrated service would also be beneficial in helping identify areas of medicine for which more emphasis should be given or those that could be improved upon. It would also prove to be an invaluable research tool, one that will allow us to target our population appropriately, as we have a unique ethnic mix that is not replicable elsewhere in the world.  

It is understandable that the government intends to restructure of our healthcare system and it will be laudable should they devolve power to the periphery. By transferring authority and emphasising the greater role of primary care, the centre of decision-making is shifted towards that of the patient, who is ultimately the main stakeholder in any shift in healthcare provision.

Unfortunately, negotiations are currently being made behind closed doors without any engagement with the public.

In tandem with this conversation, we should also place more efforts on the education of the public, as most users of the Malaysian healthcare service are not aware of their rights and access to healthcare, nor of the important role of primary care.

There is also a troubling lack of emphasis in highlighting issues pertaining to healthcare issues, as evidenced by the lack of constructive debates regarding healthcare policies.

It is therefore our hope that the government will be more forthcoming with regards to the upcoming changes in our healthcare system. For too long we have allowed our primary care services to languish in the shadows. With sufficient public support and political will, the necessary changes made will lead to a more comprehensive and accessible service for all of the rakyat.

Dr Helmy Haja Mydin is a fellow at the Institute for Democracy and Economic Affairs

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