Sustaining public healthcare

A version of this article first appeared in theSun here, on 18 January 2018.

IT is said that you get what you pay for. The more expensive the product or service, conventional wisdom assumes that the quality of the product or service is proportionately better. From what we now know about pricing strategies of companies, it is highly arguable whether the premium you pay corresponds proportionately to the quality and capability you get, compared to cheaper products or services. RM1,000 smartphones are not three times less effective than RM3,000 rivals. Nevertheless, the steadfast belief in this so-called rule of thumb prevails.

This is apparent when it comes to healthcare.

For those who can afford it, private healthcare is seen as superior to public healthcare. The perception is that by paying many times more for private healthcare over the equivalent cost in public healthcare, you get higher standards, smaller crowds, shorter waiting times, special attention, and most importantly, less risk. Supposedly.

My personal experience of going through women’s healthcare in both private and public hospitals is contrary to this belief. Yes, private hospitals do have the sheen and shine of being more exclusive. Their nurses and staff are assumed to be friendlier, and more hospitable. However, the encounters I have had thus far of the public healthcare system – in both the Klinik Kesihatan Desa Damansara which provides practically free services and University Malaya Medical Centre’s Women and Children Health Complex – have been nothing but positive.

The quality of medical expertise within this area of healthcare in government hospitals is comparable to what one would find within private hospitals. Doctors and specialists in government hospitals are often just as good as their private counterparts. In fact, it is commonly believed that complications are usually escalated to government hospitals, which are better-equipped to handle these high-risk cases.

So, if government hospitals have equally good medical professionals and equipment, what accounts for the difference? What patients are paying for under private healthcare – and the discrepancy in prices between these two opposing healthcare systems can be astoundingly large – seems to be the perception of more sophisticated bells and whistles: administrative niceties and creature comforts. They would be supposedly paying for the choice of private and more comfortable rooms, more attentive nurses and shorter waiting times.

Yet, it must be said that the occasional anecdotes about nurses and staff in public healthcare who might have been curt and direct have been generalised to the point of tarring all nurses with the same brush. And waiting times might also seem slightly longer, but there are just as many accounts of lengthy and frustrating waiting times at private hospitals.

One needs to add a caveat to these observations, of course, that these are only my personal experiences in one area of public healthcare. Second, the quality of public healthcare may vary significantly across the country. A public hospital in Petaling Jaya or Kuala Lumpur might not be comparable to that in smaller towns.

Which brings me to the more important question of sustainability of the public healthcare system. The current system seems to be working well in terms of providing quality healthcare, but there are early signs that anyone who cares about public policy would be concerned with.

I am no expert in healthcare policy in the country, but a 2016 report by the Harvard TH Chan School of Public Health, which is carrying out a study for the Ministry of Health, states that Malaysia’s health system is at a crossroads, and concludes that “the health system faces new challenges in the face of a rapidly evolving context – characterised by demographic and epidemiological transitions, a shifting socio-cultural environment, technological changes, and rising income levels, which have contributed to a nutritional transition, increasing health risks, and new user expectations.” It also states that the lack of coordination between primary and secondary healthcare results in the overcrowding of government hospitals.

In other words, because of our country’s population growth and rising costs of living, public healthcare will need to be well-funded to adapt to these rapid changes. The report is useful in recommending several proposals, chief of which includes aligning the financing, payment methods and regulation of this sector.

In terms of funding, the Malaysian government already contributes some 9.5% of its annual budget to healthcare, where RM26.58 billion is being allocated this year. This comes up to about 4.75% of the country’s GDP, close to the WHO recommended proportion of 5%, but lower than the OECD average of 9.7%. But if the increase in healthcare spending continues at its current rates – increasing an average of 12-13% per year from 1997 to 2009 – this may not be sustainable in the long run.

People tend to think that private hospitals are better than public hospitals, but this perception does not match the reality, which is that Malaysians are extremely fortunate to have comparably good quality healthcare at affordable prices. However, the government subsidies and funding that will rise exponentially year on year is not sustainable.

Having the choice to go to private hospitals is fair, for those who can afford it. But we should not neglect public hospitals and a solution to keeping their funding sustainable is extremely important. There were previous attempts at introducing a public insurance system called 1Care for 1Malaysia in the past, but this was eventually shelved. It is unclear whether there will be any new proposals for a public insurance system, but one thing is certain – learning from the outcomes of Obamacare in the United States, whatever new policy the Ministry of Health introduces will have to be clearly and transparently communicated with all stakeholders.

This is especially important now, as the costs of living are escalating, and a large proportion of Malaysians continues to depend on the public healthcare system. As all policymakers know, a healthy population is a key prerequisite for a strong economy and peaceful nation.

So, if you care for the people, do not neglect public hospitals and public clinics. Keep them well-funded, well-staffed and well-equipped. There are a good many problems in Malaysia, but public healthcare is not one of them. Not yet.

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