LETTER | Dear prime minister and health minister,
We write to you today as concerned citizens who deeply value our public healthcare system.
Malaysia has long been praised for providing accessible healthcare to the rakyat. However, it is no secret that our public health system is under severe structural and financial strain.
In these challenging economic times, the rakyat understands that maintaining a world-class healthcare system requires shared responsibility.
We are willing to step up and contribute more if it means saving the system that protects us all.
Reforming outpatient fee
The RM1 outpatient fee is an extraordinary legacy codified under the Fees Act (Medical) 1951 and officially gazetted in 1982.
However, maintaining a completely unchanged, 44-year-old fee structure in an era of rapid medical inflation is no longer fiscally sustainable.
Based on Healrh Ministry data, government facilities record approximately 63.5 million outpatient visits annually.
We believe Malaysians are ready to absorb a nominal increase if the system is structured fairly, protecting lower-income and rural areas while utilising the higher economic capacity of major cities.
We urge the ministry to look beyond a flat increase and consider a Progressive Tiered Grading System based on infrastructure and regional economic strength:
Scenario A (RM2 flat fee): Generates an additional RM63.5 million in direct annual revenue.
Scenario B (RM5 flat fee): Yields an additional RM254 million annually for the healthcare budget.
Scenario C (RM500 million tiered framework): Rather than a blanket fee, the government can grade healthcare access into specific tiers:
- Tier 1 major urban centers and general hospitals: A fee of RM10 is introduced in highly developed Tier-A cities (eg Kuala Lumpur, Shah Alam, Penang, Johor Bahru).
- Tier 2 (district hospitals and smaller towns): A fee of RM5 is maintained for smaller municipalities, suburban districts, and rural clinics.
Financial Impact: Assuming an equitable distribution where roughly 60 percent of nationwide outpatient volume flows through major urban general hospitals and 40 percent through secondary district facilities, this structure would generate a total of RM476.25 million annually.
This effectively hits the critical RM500 million target required to fundamentally transform public health funding without placing an unfair burden on rural communities.
Upgrading public dental fees
Our public dental service extracts teeth for RM1 and places fillings for RM2. Meanwhile, the private dental sector routinely charges RM30 to RM100 for basic inspections and RM100 to RM400 for standard composite fillings.
We propose re-pricing public dental fees to a modest RM5 for a dental inspection and RM10 for a standard filling.
Given that public clinics see roughly 11 million dental attendances annually, this adjustment would generate RM77 million in annual dental revenue - representing a net revenue gain of RM66 million over current collections.
This injection of funds is urgently required to upgrade dental chairs, restock high-quality filling materials, and retain our heavily strained oral health officers.
Stemming brain drain
Our public doctors are working under unprecedented duress. The prolonged ambiguity surrounding the contract system leaves our young medical officers and housemen seeing little long-term future within the government sector.
Our medical graduates and housemen are highly sought after and openly welcomed by elite international healthcare frameworks.
Systems in Singapore, Australia, New Zealand, and the United Kingdom actively recruit Malaysian talent due to their high-quality training and adaptability.
We are effectively subsidising the education of brilliant minds only to lose them to neighbouring nations because we cannot offer them stable career progression or competitive compensation.
Utilising the targeted new revenue streams from adjusted outpatient and dental fees to fund permanent positions and improve on-call welfare must be prioritised to halt this systemic brain drain.
Revenue collection from foreign nationals
While we must treat every human life with dignity, the existing legal framework regarding medical fees for non-citizens must be strictly enforced.
Foreign nationals are mandated to pay RM40 for outpatient services and RM120 for specialist consultations.
However, public hospitals continue to face significant financial leaks due to uncollected or bypassed foreign patient bills.
Tightening administrative enforcement and ensuring that standard fees are consistently collected at all points of care will reclaim millions of ringgit that are rightfully meant to sustain public infrastructure.
Smarter medication dispensing
A glaring area of fiscal wastage lies in over-prescription. It is a common occurrence to see patients given a three-month supply of chronic medications all at once, only for large portions to be discarded or left unused if formulas change or patients default.
We respectfully urge the Health Ministry to direct doctors to be more conscious of over-prescribing and to adopt best practices seen in other developed nations.
Doctors can write a prescription valid for three months, but the pharmacy should dispense the medication on a monthly basis.
To ensure this shift does not place an undue physical or financial burden on patients, especially the elderly or immobile, the ministry can aggressively expand and promote the existing medicine sent by post framework.
By utilising the MyUbat app partnered with Pos Malaysia, patients can securely opt to pay a nominal postage fee, such as the RM5.70 rate, to have their monthly refills delivered directly to their doorsteps.
For those who prefer walk-ins, designated fast-track "express refill lanes" can be allocated at local clinics, effectively cutting down both drug waste and pharmacy overcrowding.
Educating and rewarding healthcare workers
Plugging financial leakages requires fostering a culture of internal accountability.
While the Health Ministry has a proud history of promoting grassroots quality improvement through the Anugerah Inovasi KKM and the Kumpulan Inovatif & Kreatif conventions, these programmes historically focus on operational time-savings and clinical outcomes rather than systematic cost-containment.
We recommend expanding these frameworks to actively educate and reward healthcare workers for fiscal efficiency and waste reduction.
By introducing clear key performance indicators regarding asset care and resource utilisation, and backing them up with concrete career progression incentives or financial bonuses for departments that significantly reduce waste, the frontline workforce will be structurally empowered to protect public resources.
Plugging leakage in linen management
Beyond medication, significant capital leakage occurs across institutional logistics.
It remains an open secret within public hospitals that institutional medical scrubs, linens, and utility textiles are frequently taken off-site for personal use or lost permanently due to weak inventory controls.
To help the ministry identify and plug these operational and material drains, I would like to formally offer my professional services to the ministry to conduct a comprehensive, pro bono national healthcare waste audit.
Combining rigorous data analysis with supply chain oversight, this audit will target operational bottlenecks, textile lifecycles, and inventory controls to save the government millions in unnecessary procurement replacement costs.
Brave sustainable reforms
Tough times require courageous, dignified structural reforms. The rakyat does not wish to see our public healthcare flatline, nor do we want to watch our doctors burn out.
By adjusting the nominal citizen fees into a smart tiered system, expanding digital pharmacy logistics, tightening textile inventory pipelines, and protecting our junior talent, we can secure the future of Malaysia’s healthcare.
Thank you for your tireless service to the nation. We look forward to seeing brave, sustainable healthcare reforms implemented for the sake of the country.
The writer is a transformational business leader, board adviser, and digital growth strategist with more than 25 years of executive experience across financial services, futures brokerage, retail, manufacturing, and technology-enabled businesses throughout Southeast Asia and Europe.
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.
