COMMENT In my last article, I commented on the surplus of house officers and many who opt to change their profession.

The Malaysian health services has achieved remarkable progress in reducing maternal and infant mortality rate.

We have succeeded in providing basic healthcare which are easily accessible even in rural areas.

More commendable is that it is highly subsidised by the government - nearly 98 percent of the healthcare in the public health services is subsidised.

However, looking at the rapid expansion both in manpower and services in the health sector plus the changing pattern of diseases, there is a need to re-look at our health services.

Health has never been a major political issue in Malaysia as compared to the developed nations such as the US or the UK.

However, today we see more problems cropping up and if they are not addressed, it will definitely be an issue in future.

Hence, within the medical fraternity, many feel that there is a need to set up a Malaysia Medical Commission to re-look into the total health services in Malaysia for the next 20 years.

1. Medical education and over supply of doctors

The World Health Organisation (WHO) has set a doctor:population ratio of 1:1,600 for Malaysia. In 2010, we had a ratio of 1:800, with 33,000 doctors. Looking at current production, we would achieve a doctor:population ratio of 1:600 by 2015, with 50,000 doctors serving a population of just over 30 million.

The United Kingdom, with a population of 63 million, has 32 medical schools. Australia, with a population of 23 million has 18 medical schools and Canada with a population of 34 million has 17 medical schools.

In 2009, the number of medical graduates/100,000 population in the UK was 9.3 (5,600 graduates); Australia had a figure of 10.8 (2,500 graduates) and Canada 7 (2,400 graduates).

Malaysia with a population of 29 million has currently a whopping 33 medical schools (11 public and 22 private). In 2009, the number of medical graduates per 100,000 population was 11.2 and in the year 2012, it was 14.6 (4,067 graduates).

So are we producing more doctors than the developed countries? Are we compromising quality in order to get the quantity we think we need?

With this rate, we expect Malaysia (local and overseas) will be producing a total of 6,000 graduates per year.

2. Housemanship

Presently, we have more housemen than patients in a lot of hospitals. Housemen do not have adequate training.

Some housemen see only one to three patients per day when they should clock more than 10 patients per day in order to get adequate training.

I n the long run we will be producing half-baked doctors.

Presently, the Health Ministry has 132 hospitals and the total number of hospital beds in the public sector is 38,394. Currently we are short of 15,000 public hospital beds.

Hence, there is a need to relook into a more holistic solution of medical education, housemanship training and expansion of public hospitals especially in semi-urban areas.

If we delay, we will soon have unemployed doctors and inadequately trained medical officers.

3. Training for specialists and sub-specialists

The training for specialists and sub-specialists should be planned in a more coordinated manner to meet the needs of the nation for the next 20 years.

For the last few years, we have seen a significant shift of disease patterns as Malaysia develops towards a high-income nation.

We are seeing more and more non-communicable diseases e.g. hypertension, heart disease, diabetes, cancer, etc.

Hence, the distribution of public hospital beds, allocation of budget and manpower needs to be reviewed.

Presently, we are training more than enough doctors and medical officers but we are acutely short of specialists and sub-specialists.

Semi-urban and rural areas are inadequately serviced by specialists and sub-specialists.

This may be a hot political issue that will find traction with the rakyat.

4. Ensuring quality of care and standards of medical services

With the mushrooming of private hospitals and their emphasis on bottom line, there is a need to ensure proper supervision of doctors and patient safety in private hospitals.

5. Changing role of allied health professional especially nurses

There is a need to replace diploma with degree programmes in nursing following the world trend. Presently it is estimated there are more than 15,000 unemployed nurses.

The present group of nurses should be further trained for added value e.g. advanced diploma/post-basic in specific areas such as diabetic foot, emergency care, coronary care, etc.

The training can be carried out in six months and can be conducted in private universities as public universities or the health ministry are unable to cope.

There is a need to introduce and support a proper career structure and pathway for allied health professionals.

6. Healthcare financing

Presently, this can be a very sensitive issue but we should not be in denial.

Malaysia is one of the few countries in the world without some form of national health financing mechanism. Ninety-eight percent of the

cost of the treatment in public hospitals are subsidised by the government and it is not sustainable.

We should revisit this issue before it is too late.

7. Health tourism

Health tourism should be promoted and involved by not only the private hospitals but some selected public hospitals as well. We should consider:

  • Hospitals involved should strive for international accreditation,

 

  • Revamp the National Health Travel Council,

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  • Credentialing of specialists vital to avoid mishaps,

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  • Record keeping to keep track progress and performance.
    • Right now we are getting increased number of patients but not the money since a lot of them come for low cost treatment, e.g. cosmetic and dentistry.

    8. Integrating the public health sector with the private

    • Begin with primary care: integrated outpatient services,

     

  • Decrease waiting time with integrated health care system.
    • 9. Pharmaceuticals

    To promote local pharmaceutical manufacturer to produce generic drugs which are more affordable and good quality. These may include:

    • Contract manufacturing: branded drugs manufactured in Malaysia and ensure good quality generic drugs and to be exported,

     

  • Create jobs, transfer of technology and research,

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  • Facilitate development of bio-similar drugs.
    • It takes many years to train a competent health worker.

    If we are not committed to address these issues now, we may be overwhelmed by them.

    DR CHUA SOI LEK is a former MCA president. This article was first posted on his blog .