When the cardio-thoracic and cardiology departments were hived off from the Kuala Lumpur Hospital in 1992 and corporatised as a government-owned referral heart centre - Institut Jantung Negara (National Heart Institute) - one of its explicit missions was to provide high quality cardio-thoracic and cardiology services at medium cost to Malaysian citizens.

Civil servants and government pensioners would continue to receive treatment for heart ailments at IJN at government expense, as an employment health benefit.

For Malaysian citizens who are not civil servants, however, patient charges at a corporatised IJN would be increased from the hitherto highly-subsidised rates, and IJN staff would be paid salaries markedly above the corresponding Health Ministry scales.

The IJN, however, would continue to be subsidised by public funds although not to the extent of the 90%-95% as is commonly the case for the regular Health Ministry facilities.

The intention was that IJN should also act as a price bulwark, ie, a fallback option which would serve as a competitive price check against steep price increases in the private healthcare sector (such as the Subang Jaya Medical Center in which Sime Darby has a major stake).

Indeed, going beyond IJN, this is a strategic role that subsidised, publicly-provided healthcare plays in the Malaysian healthcare system, as a price brake against the ever-escalating fees and charges levied by the profit-driven healthcare sector.

It is also the reason why the continued existence of well-funded, widely accessible quality healthcare provided by the public sector is in the interests of all Malaysian citizens, regardless of whether one patronises the public or the private healthcare sector.

In Singapore, the government's polyclinics there offer price competition and help to restrain fee increases imposed by private clinics. In Hong Kong, well-remunerated publicly provided healthcare achieves a similar effect.

It is noteworthy that both territories enjoy among the highest levels of health indices worldwide, at quite modest levels of national health expenditures which bracket Malaysian expenditures when computed as a percentage of gross domestic product.

In Malaysia, an added complexity arises from the fact that government-linked agencies (federal and state), in effect, own and operate three parallel systems of healthcare. They are:

the regular Health Ministry facilities (as well the health facilities of the Defence Ministry)

corporatised hospitals (IJN and university teaching hospitals of UM, UKM, USM)

a huge ‘private wing’: the Pantai chain of hospitals, operated as commercial hospitals with Khazanah Nasional as a controlling shareholder, similarly with the KPJ chain of hospitals, controlled by the Johor government through its corporate arm, the Johor Corporation.

Are the KPJ and Pantai hospitals public? Or private? Is this a ‘nationalisation’ of private enterprise space, or an extension of the logic of capital into strategic adjuncts of the state?

What contending interests and policy conflicts are being engendered, exacerbated, or attenuated by these developments?

At a time when the role of the state in social and economic affairs has re-emerged worldwide as a burning issue of the day, these questions are among the priority concerns that deserve extensive public debate in Malaysia.