- 5 months ago
- #considerthis
On one hand, long queues at public hospitals, on the other, astronomical bills at private ones. For many Malaysians, there’s no good option. That’s the gap Rakan KKM claims to fill: offering fee-based, expedited care for non-emergency procedures inside public hospitals. Is this a pragmatic ‘third lane’ between the extremes of unaffordable private care and overstretched public hospitals? or does it risk deepening inequality by allowing those who can pay to skip the queue? On this episode of #ConsiderThis Melisa Idris speaks with Azrul Mohd Khalib, CEO of the Galen Centre for Health and Social Policy.
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00:00hello and good evening i'm melissa idris welcome to consider this this is the show where we want
00:15you to consider and then reconsider what you know of the news of the day on one hand long queues at
00:21public hospitals and on the other astronomical bills at private ones so for many malaysians
00:27there's really no good option that's the gap that rakan kkm claims to fill by offering fee-based
00:36expedited care for non-emergency procedures inside public hospitals now is this a pragmatic third
00:44lane between the extremes of unaffordable private care and overstretched public hospitals or does it
00:51risk uh deepening inequality by allowing those who can pay to skip the queue well joining me now on
00:59the show today help me think this through is azrael muhammad kalib who's the ceo of ellen center for
01:04health and social policy as well thank you so much for being on the show so we've only been reading
01:08bits and pieces about the on the articulated vision of what rakan kkm is meant to be but um for someone
01:17who is watching the industry what what have you heard what have you what do you understand about
01:22what rakan kkm is meant to look like in practice well melissa rakan kkm as far as we understand it is
01:31actually the uh ministry of health and specifically the minister of health response to the emphasis to
01:40uh the ministry of health that they can't go back to the ministry of finance each year asking for more
01:46money uh it does become a little bit like oliver twist please sir can i have some more uh and it is
01:54so much that it is only so much that the government is able to provide uh for health uh each year and
02:01even though we see there is a few billion that increases there is unfortunately a limit as to how much
02:09will uh be able to be afforded to healthcare each year considering the fact that the development
02:15budget also needs to compete with and accommodate other uh concerns such as social welfare social
02:23economic issues education so forth so rakan kkm is really intended to generate revenue supplementary
02:32revenue to complement the existing budget allocation that is provided under the federal budget
02:38and this is something that is very important for people to understand it's it's first and foremost
02:43intended to generate that revenue and it tends to do so uh by providing a pathway for expedited
02:52healthcare services that are you know not so much like the private healthcare services that we see but
02:59definitely better than we see right now in public service and it will focus on elective procedures i think you
03:06mentioned and diagnostics uh so you know emergency services won't be a factor or be involved in this
03:12and it will provide a standard of care that's going to be very familiar uh to those who are accessing
03:18private hospitals right now but it's at much reduced rate so uh on paper the revenue generated from uh the the
03:27fees uh charged onto patients who are accessing rakan kkm is is actually intended to feedback uh and supplement
03:36and provide support for the public health care services and provide support for the public health care services
03:40and also uh sort of provide a little bit of more compensation for some of the medical professionals
03:47specialists doctors and even nurses and medical assistants uh at that that point uh in which uh they are
03:54involved so rakan kkm is now rakan kkm sindan bahad so it's actually a company uh that is owned wholly by the
04:05ministry of finance incorporated so a lot of people will be very familiar with this kind of model which is
04:11similar to what we see with the institute jantung negaro national heart institute which is a lot of people
04:18felt and thought was very much 100 under the government but it actually was a cinema in itself
04:24and you know they are able to to generate their own revenue and also develop and expand all right okay
04:30so so i mean um even though i think there's been quite a lot of debate around whether or not rakan kkm
04:38is the model is perfect or imperfect at least this is a an attempt to rethink how we fund and deliver
04:45healthcare in malaysia can i ask you then azro what would be the obstacles in achieving this this vision
04:53well even from what i'm saying to you right now melissa there are a lot of obstacles uh rakan kkm is
05:00is not ideal uh it is basically uh i would argue a band-aid solution to a much more long-term
05:08institutional issue which is uh insufficient uh funding and investment in health for which today
05:15we are having to address the consequences of which is a sicker population but also uh services that
05:22are struggling to keep up with the demand of more more people needing uh healthcare for diabetes
05:31uh cardiovascular disease respiratory tract infections and even when we saw during kubit we saw
05:38a fair amount of that having to struggle and provide the kind of care but we were able to do that
05:44only because a lot of issues were able to be uh you know bypassed or overlooked for the purposes of
05:53the national interest having said that for rakan kkm one of the key obstacles that it needs to address
05:59is really about manpower and this is something that we've spoken about uh for quite a long time now you
06:05know in which we are saying that for example we have not enough specialists from all uh fields and and we are
06:14currently if we look at the gap between what we should have and what we have the gap is around 11 000
06:20specialists both in public and private sector uh so the thinking here uh is that maybe rakan kkm can make use of
06:31surplus or excess capacity uh just isn't really there because even nurses melissa we're short on nurses
06:39too and these are the the gaps in nurses is uh in in 20 and 30 000 when we look at both in terms of
06:47public and private so there is a situation here where the obvious question that is going to be asked is
06:54how is the government going to be able to provide the manpower that's going to be necessary to set up
07:03this third stream if you want to call it that you know third pathway to provide these services within the
07:10uh government setting uh for which it will be a sort of a private wing so there's four hospitals that
07:18have been identified uh for involvement in rakan kegam the hospital serdang hospital uh putscher jaya
07:25cyber jaya and the institute uh cancer negara the national cancer institute so these four hospitals have
07:31been designated and at the same time these are also hospitals that are seeing huge number of patients
07:36accessing services especially in serdang and putscher jaya so uh where are we going to get the manpower
07:43uh how are we going to isolate you know in that the needs for this right as well talking about the
07:49specialist shortfall in the public sector what it's well documented as you said the brain drain among
07:55public health care workers into private so is there an argument to be made that rakan kkm will actually
08:01allow for or provide a much-needed incentive structure a way for the specialists and the nursing staff
08:07for instance to earn more without actually leaving the system entirely well this is not a
08:13new concept melissa we've seen from the uh the full paying patient scheme uh the fpp
08:21which has been around for i think more than 15 years uh and it has been something that that has
08:27been implemented uh and we are able to learn from the lessons of the fpp program to see what worked
08:34and what didn't in that particular case they had 10 hospitals involved and they were able to collectively
08:41uh in through 2017 the uh the last time it was documented in terms of how much revenue they were
08:48able to bring in it was around 20 million so they were able to bring 20 million out of 10 hospitals
08:54involved for which is average of 2 million per hospital now that sounds like a lot until you realize
09:00that it's not our our actual amount of of of need is actually in the billions not you know single
09:09digit millions or or double digit million so the the issue here is that have we learned enough from the
09:15fpp program and we realized that when it started off with 10 hospitals it decreased in number because
09:21more and more specialists were leaving anyway uh the service because it wasn't enough to keep them
09:28in their post because the private sector is a competition other countries are also competitions
09:34singapore uk australia new zealand they're all looking at our uh specialists our healthcare professionals
09:41because they're good quality expert individuals some of them are world-class so of course they want to
09:47bring them in so unfortunately the fpp program today is actually very much diminished and it really is
09:54only for specific services so if you are a pregnant expecting mother uh you're wanting ong services yes
10:03you can go fpp because the one thing that seems to be consistent for many of the hospitals participating fpp
10:09is that i have a obstetric and gynecology service for which a lot of people are accessing and that's very
10:15important to realize when we saw when we talk about rakan kkm it doesn't mean that every single service
10:22that involves elective surgeries procedures is going to be available it's not it's going to be very
10:26specific maybe one or two services and specific procedures now if that comes back to the other issue
10:34concerning um the uh obstacles and that is you know these are the same um uh services that are going to be
10:43dependent on the same equipment same expertise same labs when is when it when is this going to happen
10:50you know like when when is the rakan kkm needs going to be addressed if they are also competing with the
10:56public uh patients that are happening at the same time now i've seen a lot of responses uh that seem to be
11:03cavalier in suggesting that the rakan kkm specialists will work at night after office hours so they will do all
11:11their public patients first after office hours then they go to rakan kkm and and do the diagnostic
11:18tests they do the consults and so forth which is very bad when you consider that rakan kkm is supposed
11:24to you know be this premium service where you're supposed to be able to get the attention of the
11:29consultants that you want when you want it and get it quicker but if these guys are supposed to do it
11:35after they finish all the public service then when are they going to do it who's going to do an
11:39mri or ct scan in the middle of the night for example and this is where the same equipment is
11:45is going to be utilized we need to see uh where is it that we can have the benefits of of that uh and
11:52most importantly what kind of revenue charges are going to be expected from rakan kkm and this comes
11:57to the third issue melissa which is is there enough money that's going to be generated from rakan kkm
12:04that it's going to be able to go back into the system to build investments to uh uh build new
12:13hospitals pay our private uh wing better in terms of medical professionals the the specialists the
12:21nurses modernized equipment digital health modern infrastructure is there going to be enough because
12:28the last time i checked the most profitable private hospital uh in malaysia was kpj healthcare
12:37and they made around 957 million in the first quarter of this year in terms of revenue out of which 57
12:48million was profit if i'm not mistaken so you made a lot of money but what feeds back into the profit is is
12:55this much so in order for rakan kkm to be able to uh to demonstrate the kind of outcomes or outputs
13:04that we're expecting they have to make a lot of money they have to make it very soon and most
13:10importantly they have to charge probably higher much much higher than what we're talking about right
13:15now to maybe the point similar to a private hospital so you know this this thinking that private
13:21paying patients who are going to be willing to be charged and pay higher rates uh is true but only
13:27to a certain extent right so how do you attract patients it's going to be a competition between
13:32private hospitals and rakan kkm and you have to be able to provide the most important pull factor
13:38which is time will it provide quicker service will it provide better service but also will it mean that
13:45you have timely and effective access to uh treatment that works for you as well thank you so much for
13:52flagging some of those issues as we appreciate your time as well mamak khalib ceo of the galen center for
13:57health and social policy we're going to take a quick break here and consider this we'll be back with more
14:01stay tuned
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