I read with disbelief Dr Teh Yik Koon's views on private healthcare. Clearly he is not cognisant with the various issues pertaining especially to why close to 70% of all doctors in this country are in the private sector.

It would be ideal indeed if we had a slick socialist system such as that in Germany or at least the UK. But this is not possible in the environment we function in, especially when money placed with the current custodians of health, MOH (Ministry of Health), has a very high likelihood of being misused.

The problem in Malaysia is two fold. One, healthcare is grossly underfunded. Malaysia spends less than 5% of its GNP on healthcare in direct contrast to even our neighbour Singapore which allocates 14% of its GNP to health. Clearly the current government is least bothered about giving proper healthcare to its citizens.

Teh must remember that if you broke a leg 50 years ago and ended up in a Malayan hospital, definitive treatment would be reduction and a plaster of Paris which would not even cost the government of the day RM1 ringgit. Today with internal fixation, implants, etc, you are looking at more than RM10,000.

Similarly if you had a heart attack, 50 years ago you would be hospitalised, an oxygen tent placed over you, some GTN, aspirin and morphine given, lots of tender loving care, possibly a priest and the rest is left to God. Cost to the government maybe less than RM100. But today with all this angiograms, angioplasties, stenting and bypass surgery, you are looking at nothing less then RM20,000 -70,000 depending on the hospital.

Secondly, how has our Ministry of Health, the custodians of the Malaysian healthcare system, tackled this problem of spending the meager 4.5% allocated to health? Not very well I am afraid. They failed to see the paradigm shift healthcare was undergoing. Hospitals were generally getting smaller and diagnostics were getting more efficient. Because of tremendous technological changes in diagnostics, patients who are put through scanners and lab tests will have their diagnosis in a couple of hours.

Building giant Jurassic Park-style hospitals to admit patients for days on end and have umpteen consultants look at you to arrive at a diagnosis was out. However, the chaps in Block E1 of the MOH either failed to see this or colluded with suppliers and contractors and misled the government.

In the 1980s alone, 13 nucleus hospitals were built with state-of-the-art equipment and sometimes truly at odd places like Sabak Bernam and Slim River at a cost of RM40-70 million each. No one paid attention to manpower. Many of these hospitals with all their sophisticated equipment started to rot. Till this day you will not find a resident specialist at Sabak Bernam. Even contract foreign specialists are running away, let alone Malaysian specialists.

The country again lost billions of ringgit in the 1990s when massive IT-equipped hospitals (Selayang, Putrajaya, Serdang, Sungai Buloh, Pandan Hospital, etc) became the vogue (many of them still not having proper staffing) were built when anyone and everyone in the industry knew that the actual focus had to be investment in health professionals - not mortar and bricks which would be secondary. So suppliers and contractors all went laughing right to the bank leaving Chua Soi Lek wondering how to pay this year's paltry pharmaceutical bill of RM900 million. The arithmetic was just untenable.

However, I do agree with Teh that the private wings created at some of the government hospitals are unbelievably costly. The answer why they are even more expensive then private hospitals is simple. They just don't know their market because they have never stepped out of their ivory towers into the real world and their costing is in all likelihood buttressed by subsidies.

The solution, paradoxically, in our setting is to have more private hospitals not less, and let market forces bring the cost down. The government can then buy services from hospitals that give the best rate. There is no use talking about the UK system, the US system, the Japanese system, etc. Each country must evolve its own system depending on its people, resources, circumstances, etc and so to Malaysia must evolve its own.

It sometimes is worrying when you hear government doctors and even journalists running off at a tangent talking about heart and liver transplants when the money could be better used to treat the ballooning incidence of hypertension, diabetes mellitus and heart disease among young Malaysians who are at the prime of their lives. In a perfect world of infinite resources perhaps we can have everything. But we do not live in a perfect world which means we have to be very careful how we spend our golden health dollar.

Our Asian values and roots are firmly rooted in the nucleus and extended families and as it stands currently, this would be a better insurance and a more cost effective policy for old age. So the demise of non-profit hospitals is indeed sad. Allowing a system that is functioning well without subsidies to wither and die cannot be a good thing.

In the local context at least, it would be better if the powers-that-be in healthcare stopped building hospitals and think of outsourcing acute care medicine leaving only primary health care and emergency services with the government. It would be better for the government to focus on accounts for a change. I think this way, patients in this country would have better care and wastage would be reduced therefore allowing better rationing. We need to get more doctors to think more about accounts. The country cannot afford another MAS, Telekom, TNB bungle.

It would be better if the prime minister did all health professionals and patients alike a favour by appointing someone like Singapore's minister of health who is an engineer by profession but has the mind of an accountant. This before our health system descends into an abyss of no return. A healthcare system that allows as many people as possible get the best care within our limited resources is the way to go.