COMMENT | The Malaysian healthcare system has made tremendous progress since Merdeka. However, in the past decade, it has lagged behind the other Asian Tigers and other regional countries have caught up.
Disturbing reports have raised questions on how far the healthcare system is on its way to the 'intensive care unit.'
Since 2000, some of the health indicators have not improved to the same extent as other regional countries. An example is the maternal mortality ratio (MMR) which did not achieve its millennium development goal of 11 per 100,000 live births by 2015 ().
Sri Lanka, which together with Malaysia had previously been held up by the World Bank as an example to learn from had the same MMR as Malaysia in 2000, but its MMR was lower than Malaysia’s in 2015.
A Universiti Malaya team, who studied anonymised mortality data of the Statistics Department from 1998 to 2006, found that socially disadvantaged districts had worse mortality outcomes compared to more advantaged districts.
The mortality outcomes within ethnic groups were less favourable among the poor, and premature mortality was concentrated among the poor of every ethnic group.
A Health Ministry and Universiti Malaya team surveyed primary care clinics from June 2011 to February 2012 and reported that “Within the public sector, the distribution of health services and resources was unequal and strongly favoured the urban clinics.”
A multi-institutional team, who studied current health coverage in catastrophic illnesses which inevitably incur catastrophic health spending, found that the coverage was “practically none for HCV, stroke, psoriasis and epilepsy surgery.
"Coverage of targeted therapies for solid cancers, knee replacement surgery, anti-TNF for arthritis and coagulation factors for haemophilia were poor while iron chelation for thalassemia, coronary revascularisation, epoetin and anti-retrovirals were barely adequate.”
An Asean study found that the proportion of previously solvent patients who experienced economic hardship following a cancer diagnosis was highest in Malaysia (45 percent) and Indonesia (42 percent) and lowest in Thailand (16 percent).
The most recent indictment came from a Unicef study, which reported that children residing in Kuala Lumpur’s low-cost flats had a “relative poverty rate of almost 100 percent.”
They reported that “12 in 100 children had less than three meals a day; of the children under five years, 15 in 100 were underweight; 22 in 100 were stunted; 20 in 100 were wasted; and 23 in 100 were overweight or obese.
“Malnourishment is a major concern in Malaysia – one in five are stunted and one in 10 are underweight… In terms of stunting, Malaysian children perform worse than Ghana, despite Malaysia's GDP per capita being six times higher.”
Data and policies
Whilst the Health Ministry espouses evidence-based policy and decision-making, much of the data in the public domain are outdated.
There is no national data on medical errors, which is one of the commonest cause of mortality (3rd in the United States) and morbidity in many countries.
Six patients lost their lives and others were injured in the Sultanah Aminah Hospital fire in 2016. The Dewan Rakyat was informed in March 2017 that the Health Ministry requested additional expenditure of RM345 million to upgrade 78 hospitals and change the wiring systems for 95 hospitals. That there has been no further news is deafening.
Non-communicable diseases (NCDs) which are responsible for 73 percent of deaths, with 17.5, 30.3 and 47.7 and 47.7 in 100 people affected by diabetes, high blood pressure, high cholesterol and overweight/obese respectively in 2015, are a huge drain on resources.
Yet the Health Ministry’s target for 2025 is that there be no increase in the prevalence of hypercholesterolaemia from the 47.7 percent in 2015. Whilst the reduction of the prevalence of hypercholesterolaemia may appear daunting, the consequences of not even trying are incomprehensible.
A study of 12 Health Ministry primary care clinics in 2007, in which 81 percent of the patient encounters were with medical assistants, reported 57.2 percent medical errors of which 93 percent were deemed preventable.
Despite the report, the 1Malaysia clinics were launched and expanded with no doctors in attendance in the vast majority.
Middlemen in healthcare continue to take a share of the healthcare ringgit despite no published data that patients have benefited. Reports of drug unavailability and shortages, as well as interference with clinical care of patients, are common.
There are too many medical schools and graduates with the waiting period for a housemanship training post varying from six to twelve months. What happened to manpower planning?
The current situation is well summarised by the Harvard TH Chan School of Public Health’s March 2016 report “…Malaysia demonstrates a classic case of asymmetric transition, where the rapid transitions in context have not been matched with a corresponding transition in the health system to better address the current and future needs of the population.”
A government doctor’s statement on April 9 is illuminating: “…Drastic action is needed with regards to hospital maintenance and administration. Forget the newfangled programmes, strategies and what-not if even simple things like fixing a lamp can't be
Royal commission on healthcare
The healthcare system is encountering considerable complex challenges. As healthcare involves everyone, its strategies and solutions require the involvement of all stakeholders and not just policymakers.
This is vital to achieving universal health coverage that supports the UN Sustainable Development Goals, the theme of the 11th Malaysia Plan.
Malaysia subscribes to the World Health Organisation’s priority objective of universal health coverage which is “ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.” Whether Malaysia still has universal health coverage has to be revisited.
There is a strong case for the establishment of a royal commission on healthcare to inquire into and report upon the existing and future need for safe and quality healthcare services and the resources to provide such services; and to recommend the necessary measures to ensure that everyone stay healthy, continue to have access to universal health coverage and that no one is left out.
DR MILTON LUM is a past president of the Federation of Private Medical Practitioners Associations Malaysia and the Malaysian Medical Association.
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.