I refer to the letter Citizens literally suffering in pain .

I am afraid Constitutional Malaysian's letter describes a very real situation in our government hospitals. I am an orthopaedic surgeon who has worked in both the public and private sectors in Malaysia.

Malaysia does not have a sufficient financial backing for its struggling public sector hospitals. Due to severe under-funding over many years, our real access to quality healthcare has deteriorated over the last 20 years, in my opinion.

When accident victims with severe fractures are told to wait three weeks (or more) before definitive surgery, when diabetics with limb-threatening infections lie literally festering for want of operating time, when patients with severe back pain and impending paralysis may have to wait weeks for an MRI scan, how can anyone argue differently?

There are only two original models for healthcare: socialised medicine (for example, the British National Health Service [NHS]) or private medicine (such as the US system). Both need sufficient financial input - either from the state, or from the individual - to function effectively.

For example, under the UK's NHS, emergency cases, such as fractured limbs and diabetic complications, are dealt with adequately (it used to be 'excellently', but the British NHS is also now suffering from under-funding), while purely elective operations such as knee and hip replacements are dealt with by having a long waiting list, of up to two years.

The private sector in Britain mainly looks after elective patients who do not wish to, or cannot, wait for their surgery. To have an effective or adequate public health sector in the UK, between 6.5% and 8.5% of the GDP is spent on the NHS, depending on the figures one reads.

In the US, private healthcare in the form of health insurance, bought by the individual, employers, or groups, forms the basis of healthcare. The indigent are cared for by the state via state-funded insurance or by teaching hospitals funded by their own charitable endowments, but this still leaves a large proportion of patients with poor access to healthcare. In the US, some 15% of GDP is spent on healthcare.

In Malaysia, only approximately 3% of GDP is spent on funding healthcare, with plans for up to 6% in the next 15 years. What does this mean in real life?

If you break a limb and need semi-urgent, but not 'emergency' surgery to fix the problem, you can either wait three weeks or more in a government hospital to have surgery done (likely by a junior surgeon) or have it fixed immediately in the private sector by a senior surgeon. Is limited private practice in our university hospitals helping?

A patient who came to me in a private hospital said that the professor who saw him after an accident offered him a three week wait in the normal wards "or I could do it tonight on my private list" at a cost equal to, or even more than, in a fully-fledged private hospital.

Lesson: Buy private healthcare insurance and lobby the government for more funding for our 'safety net' public health sector.