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Malaysia’s healthcare system is under growing strain. Healthcare costs are rising, hospitals are increasingly congested, and doctors warn the system is approaching a breaking point. As policymakers debate healthcare financing and service delivery, questions are growing about whether Malaysia’s healthcare system is optimised for prevention and quality primary care. On this episode of #ConsiderThis Melisa Idris speaks with Datuk Dr Thirunavukarasu Rajoo, President of the Malaysian Medical Association, which is the main representative body for all registered medical practitioners in Malaysia.
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00:00.
00:10Hello and good evening. I'm Melissa Idris. Welcome to Consider This.
00:15This is the show where we want you to consider and then reconsider what you know of the news of the day.
00:19As I'm sure you know, Malaysia's healthcare system is under growing strain.
00:24Healthcare costs are rising. Hospitals are increasingly congested.
00:29And doctors warn that the system is approaching a breaking point.
00:33As policy makers debate healthcare financing and service delivery.
00:39Questions are now growing about whether Malaysia's healthcare system is optimised for...
00:43Prevention and quality primary care.
00:47So joining me on the show to discuss...
00:49All of this further is Datuk Dr. Tirunavu Karasu Raju.
00:53Who is the president of the Malaysian Medical Association.
00:58Which is the main representative body for all...
01:03Unregistered Medical Practitioners in Malaysia.
01:07Dr. Raju, welcome to the show.
01:08It's good of you.
01:08Thank you to join me.
01:09Thank you so much for being here today.
01:11I want...
01:12I know there's so much for us to cover...
01:13But I really am quite curious to know your assessment...
01:16Your diagnosis of the...
01:18How do you see the current state of Malaysia's...
01:23Healthcare system currently?
01:25I think the reason why I'm asking is that a lot of people are characterised...
01:28This as being in a state of crisis...
01:31Reaching a breaking point.
01:33Do you agree with that assessment?
01:35First of all, thanks Melissa and also Estorawani for having me.
01:38You asked a very, very important question but...
01:43I have to answer it very carefully because the word crisis may give a different...
01:48connotation to the public as well but one thing we need to acknowledge...
01:53If we are not careful, definitely we will go into a crisis.
01:58At the cusp of it, are we approaching that worrying level?
02:01We are at the worrying level.
02:02We are at the worrying level.
02:03Because one thing we must understand is that the system has delivered a great...
02:08deal for relatively modest spending all these years because if you look...
02:13at the system historically in the 60s and 70s, we had different issues.
02:18Maternal mortality and infant mortality.
02:20Mothers are dying after birth and babies are...
02:23dying, right?
02:24So, we managed to address those issues very well in the early 80s...
02:2890s and 70s.
02:29Okay.
02:30So, it has served the purpose.
02:31So, now the question is that...
02:33the system that was supposed to serve that purpose has served.
02:36Can the same matter...
02:38technology can be used for the current disease burden technology...
02:43ageing population, the complication of NCDs.
02:46Okay.
02:47So, now the...
02:48funding.
02:49There are contemporary problems that the healthcare system may...
02:53not be optimized to deal with.
02:56Let's talk...
02:58Let's talk about the...
02:59one of the key issues is the rising cost of healthcare.
03:03cost pressures.
03:04Where do you see...
03:06or what do you see?
03:08as the key drivers behind rising costs.
03:11Okay.
03:12If you look at the rising cost, right...
03:13number one...
03:14we have to look at the disease burden.
03:15That means the types of diseases currently we are facing.
03:17We have...
03:18seen that...
03:19the non-communicabilities like diabetes, hypertension and cholesterol is on the rise.
03:23obesity is on the rise.
03:24We know Malaysia is number one leading in Southeast Asia, right?
03:26Right.
03:27And then we can...
03:28see the number of diabetes on the rise even for...
03:30even among children.
03:31And then...
03:33if you don't take care of yourself...
03:35from...
03:36pre-illness...
03:37you become illness.
03:38and then you don't take care...
03:39you go into complication.
03:40That's where the cost is...
03:41shoots up.
03:42Okay.
03:43You got...
03:43multiple organs are affected.
03:45So, the cost shoots up.
03:46That's one thing.
03:47And then we also...
03:48have ageing population.
03:49So, when you have people who fall sick early...
03:53when they age...
03:55to maintain yourself...
03:57in terms of your...
03:58health system...
03:59your body is also going to be expensive.
04:01And plus...
04:02technologies...
04:03on the rise...
04:04right.
04:05So, all these things are compounding factors.
04:06Why the cost is...
04:08going up?
04:09So, there is one other question...
04:10and we are also understanding.
04:12Okay.
04:13So, you're talking about the fact that...
04:16demand on healthcare services...
04:18has been increasing.
04:20Yes.
04:21Where do you see the...
04:22Where do you see the...
04:23the drivers for cost pressures on the...
04:28supply side?
04:29Okay.
04:30If you look at the supply side...
04:32of course...
04:33who is delivering the care?
04:35Right?
04:36Number one, you need a facility.
04:38and then from the facility...
04:39you have equipment...
04:40to manage...
04:41to deliver the care.
04:42Okay.
04:43you have workforce...
04:44manpower...
04:45Okay.
04:46We are understaffed...
04:47we are overworked...
04:48public sector.
04:49I am talking about the public sector.
04:50Public sector.
04:51Yes.
04:52Public sector.
04:53So, definitely...
04:53so...
04:54people who are providing the services also lot of stress.
04:57So...
04:58definitely...
04:59you need to...
05:00you need to manage it holistically.
05:01So...
05:02the key...
05:03while the cost has gone up...
05:04but the key...
05:05people who are managing the...
05:07healthcare system.
05:08the healthcare workforce.
05:09Okay.
05:10We really have to take care of them.
05:13We have to take care of the people...
05:15the workforce...
05:16who is taking care of the nation.
05:18So...
05:19that is very very important.
05:20What are your members telling you?
05:21So...
05:22you are...
05:23you represent...
05:24your...
05:23the main representative body of all...
05:25of medical...
05:26professionals.
05:27What are they...
05:28telling you?
05:29What are you hearing...
05:30about...
05:31how best...
05:33to take care of them?
05:34Okay.
05:35How best to take care of them...
05:37is a very good question.
05:38Okay.
05:39Number one.
05:40Of course...
05:41there is a work-life balance as well.
05:42Okay.
05:43If you are talking about...
05:43healthcare overall...
05:44we have doctors...
05:45we have medical assistants...
05:46we have nurses...
05:47we even have those...
05:48hospital assistants...
05:49and even ambulance drivers...
05:50right?
05:51Yeah.
05:52So basically...
05:53Number one.
05:53So...
05:54remuneration is definitely...
05:55one of the important factors.
05:56Okay.
05:57And we must understand...
05:58what are the...
05:58areas of the push factor...
06:00more than the pull factor...
06:01the push factor is very important.
06:03One is remuneration.
06:04We may not be able to give...
06:05SI in Singapore.
06:06Fine.
06:07It is okay.
06:08But...
06:08to be giving...
06:09enough for what...
06:10they are delivering.
06:11That is number one.
06:12Number two.
06:13Is there a very...
06:13clear carrier pathway.
06:14If a doctor...
06:15enters a housemanship...
06:16and goes to medical officer...
06:17he or she...
06:18are they very clear...
06:20where...
06:21where...
06:22where can they apply?
06:23What do they get?
06:24Career pathway is very...
06:25very important.
06:26And number three.
06:27promotion.
06:28Okay.
06:29If they get promoted...
06:30if you are from a specialist...
06:31you know they have...
06:32the gridding...
06:33the government system...
06:34and then you go up the ladder.
06:35So it must be very...
06:36very clearly defined.
06:37There must be transparency...
06:38in that part.
06:39Including posting.
06:40There are certain things...
06:41the government has come out...
06:42posting.
06:43If they are married...
06:44and suddenly they get posted...
06:45in other place.
06:46So these are...
06:47the basic things...
06:48that we need to address it.
06:50So that...
06:51so that many of them...
06:52they live to work...
06:53but the environment...
06:54must also be conducive...
06:55the career pathway...
06:56must be very...
06:57very clear.
06:58Promotion must be very clear.
06:59And then...
07:00the fair remuneration...
07:01must be there as well.
07:02You know these are...
07:03long-standing issues...
07:04in the health care...
07:05in the public health care system...
07:07and particularly amongst...
07:08the public health care workforce.
07:11Do you...
07:12are you...
07:13encouraged by...
07:14what you see...
07:15in terms of progress?
07:16Because...
07:17I mean...
07:18I've been doing this show...
07:19for quite some time...
07:20and post-COVID...
07:21we have...
07:22discussed...
07:23multiple times...
07:24what can be done...
07:25to alleviate some of the...
07:26pressures on...
07:27the health care workforce.
07:29Are you seeing...
07:30any progress?
07:31Are you seeing...
07:32any movement...
07:33in improving?
07:34Of course...
07:35to be fair...
07:36of course...
07:37we do see...
07:37some movement...
07:39but the...
07:40the...
07:41the...
07:42the issues that...
07:42rising up...
07:43is...
07:44is...
07:45becoming...
07:46worsening...
07:47compared to...
07:48the progress...
07:49so...
07:50there is...
07:47that's why...
07:48what is important...
07:49for us to understand...
07:50is that...
07:51health care...
07:52is a whole of nation...
07:53and whole of society...
07:52approach...
07:53it is not only the role...
07:54of the ministry of health...
07:55the other ministries...
07:56for example...
07:57if you look at the...
07:58placement of...
07:59staffs...
08:00is under the JPA...
08:01Public Service Department...
08:02right...
08:02under PM...
08:03and then you have...
08:04Ministry of Finance...
08:05also under PM...
08:06so...
08:07definitely the...
08:07prime minister has a...
08:08very important role...
08:09to play...
08:10to ensure...
08:11the sustaining...
08:12the health care system...
08:13so...
08:14it is not fair...
08:15to always...
08:16to push...
08:17the ministry of health...
08:17they are just...
08:18receiving...
08:19and then they have to...
08:20execute...
08:21and the pressure...
08:22everything is...
08:23fingers pointed to the...
08:22Ministry of Health...
08:23yeah...
08:24they do get a lot of...
08:25flack...
08:26don't they?
08:27yes...
08:28so...
08:29to be fair to them...
08:30I think...
08:31we...
08:32we...
08:33we...
08:34we...
08:35we...
08:36we...
08:37we...
08:38we...
08:39we...
08:40we...
08:41we...
08:42we...
08:43we...
08:44we...
08:45we...
08:46we...
08:47we...
08:48we...
08:49we...
08:50we...
08:51we...
08:53I...
08:54saw...
08:54a few...
08:55days ago...
08:56they were...
08:57looking at...
08:5815,000...
08:59healthcare workforce...
09:00by 2030...
09:01we...
09:02can...
09:03see...
09:04the push factor is minimized. How can we make sure that?
09:09I think you need money. Promotion. It must be very clear.
09:14You must be very clear. As a young doctor, at the age of 20, they...
09:19...spend five to six years in medical school, then two years of housemanship.
09:24And then two more years as a medical officer, then they go into specialty.
09:28So, so in...
09:29In a person's life, the 20 to 30 years is a prime time.
09:32Right.
09:33So these...
09:34This generation, this particular witch group, they want to have a very clear mindset.
09:38What is the career path?
09:39Are we providing that clarity in them? Do they know if I want to be a surgeon?
09:44Is my career path which is very clear?
09:46Okay. So that clarity must be there.
09:48And for...
09:49For you to do that, you don't need money.
09:50That's right.
09:51Yeah.
09:52You just need ideas. You just need transparency.
09:53And then the...
09:54The manpower dashboard.
09:55The distribution.
09:56MMA has been asking the ministry to publish it.
09:59The dashboard...
10:00The distribution of workforce.
10:01Refresh my memory.
10:02So the dashboard would be how...
10:04How many doctors are at which region?
10:07Which place?
10:08Okay.
10:09Which hospital?
10:09In terms of specialty, medical officers, nurses, the MAs...
10:14All these things must be mapped out.
10:15So that it is more...
10:16And today with the digital era, technology...
10:19You have all the data, right?
10:20Right.
10:21And our decision must be data driven.
10:22Right.
10:23You have all the data, right?
10:24And our decision must be data driven.
10:25Yeah.
10:26Okay.
10:27It is not purely the Ministry of Health.
10:30We must also make sure the government, the Prime Minister...
10:32This is in two important portfolios are directly under him ok.
10:36So, definitely the...
10:37The Honorable Prime Minister has to take this issue very seriously.
10:41Right.
10:42But that...
10:42There's been a lot of discussion about the reset agenda, right?
10:47Yes.
10:48In the healthcare sector.
10:49Recently, the Ministry of Health...
10:52Bank Negara, to be quite precise, Bank Negara released a white paper...
10:57Proposing a base medical, health and insurance...
11:00Yes.
11:01...takaful...
11:02So, allowing for the people who are not covered by insurance...
11:05...or cannot afford the premium...
11:07...to have an option of a cheaper premium or insurance.
11:12So, that's being positioned as one of the reforms in the healthcare sector.
11:17I'm curious to know what you think of it.
11:18There's been a lot of conversation about whether this is...
11:22...well designed or not going to be enough to...
11:27...address the real issue of medical inflation.
11:30Okay.
11:31I think one thing...
11:32...we need to understand...
11:34...behind the MHIT.
11:35Okay.
11:36Number one...
11:37Of course, the issue one was that the rising in the premium...
11:40...and the medical inflation in...
11:42...and the private healthcare.
11:43Okay.
11:44So, that is how, to be fair, the first time Bank Negara...
11:47...together, the Ministry of Health, the Ministry of Finance...
11:49...and also other stakeholders.
11:50MMA is also part of the...
11:52...Jawatan Kuasa.
11:53...Jawatan Kuasa.
11:54...Jawatan Kuasa.
11:55...Jawatan Kuasa bersama.
11:56So, definitely the idea...
11:57...was that to address the particular issue of those...
11:59...who have already taken the insurance...
12:00...because many of those have dropped out.
12:02...because they cannot continue their premium...
12:04...and also those who want to take it up.
12:06So, it is totally...
12:07...to resolve certain issue that was raised.
12:10Okay.
12:11Okay.
12:12So...
12:12Obviously, it is a good move.
12:14It is a good move to address that particular issue...
12:17...of course, with the support of Bank Negara...
12:19...of course, when the regulator comes in...
12:21...and then we...
12:22...we can see how serious they are to look at that.
12:24I mean, to be fair to the government...
12:25...at least on that part, I think...
12:27...they are doing the right thing.
12:28That is only for the private insurers.
12:30Okay.
12:31Okay.
12:32It is not for the...
12:32...the National Health, yeah?
12:33I understand.
12:34So, this is an option for private insurers to offer this...
12:37...based plan.
12:38Yes.
12:39So, allowing people who...
12:40...as you said, have...
12:41...you know...
12:42...lapsed or dropped out from their insurance coverage...
12:46...because of the rising premiums.
12:48in any way about this that it might not achieve its objective.
12:53So my question is, what needs to happen to make sure that this great idea...
12:58...is executed and achieves what it hopes to achieve?
13:03What is important is that, of course, the intention is very good to be fair to them, but also we have...
13:08...concerned those who are above 60 years old and of course, the fine print when the policies...
13:13...out. But the good part is that at the moment, the government is looking into getting more feedbacks.
13:17Okay.
13:18They are still going to get feedback and there is going to be a POC as announced by the Minister.
13:23The POC towards the end of this year and also it will be only launched next year.
13:28So that...
13:28Definitely there is a lot of room for improvement because the government is getting feedbacks...
13:32...and this is the first time they are doing it.
13:33So, we are doing that to be fair to them.
13:34So, definitely we have also raised some of our concern especially those who are about
13:3860 years old...
13:38...and then what about the exclusion lease and also they must be very clear in terms...
13:43...there should not be any hidden exclusions, you know.
13:47Right.
13:48So, we want it to be very transparent and also the coverage coverage in terms of the...
13:53diseases.
13:54It must be very clear and then they should not be...
13:56...they should not be very clear about the premium or...
13:58...also the next couple of years.
13:59We should not be in the same situation in another 5 years until the premium goes up.
14:03So, there should not be another policy to coming out.
14:05Okay.
14:06So, this was very important for them to ensure...
14:08...that these things are also addressed.
14:10Okay.
14:11So, really it is in clarifying the details...
14:13..making sure that the details are right but also in tweaking it.
14:17Tweaking...
14:18Yeah.
14:20what it hopefully is intended to achieve.
14:23We've been talking a lot about reform.
14:25I think a lot of the focus has been on treating illnesses.
14:30Unless I'm preventing illnesses, early interventions.
14:34I want to talk to you.
14:35Because you yourself are a practising GP.
14:39So I am curious.
14:40I want to know about how we can reorient our healthcare.
14:45Towards primary care.
14:48Preventative and primary care.
14:50I think the most important thing, Melissa, if the government...
14:55really is looking into the long-term solution for medical inflation.
15:00Number one is to strengthen the primary care.
15:03This world was strengthening primary care.
15:05The primary care has been spoken about many, many years.
15:08And it started in 2015.
15:10For enhancing primary care, after the government engaged Howard Group to do...
15:15some studies, right?
15:16You know our country is very good at engaging.
15:18Excellent consultant.
15:19Do a lot of studies.
15:19Studies after studies, right?
15:20Like what you rightly said is execution.
15:23And then we had this health white paper.
15:25That was passed in the parliament by both political sides.
15:30So the four pillars has already been clearly defined.
15:32And one of it also is to strengthen the primary care.
15:34In the what?
15:35White?
15:35Yes.
15:35So now looking into that, so we see our...
15:40So, we have close to 10,000 plus GPK links in the country.
15:45Oh, wow.
15:46And then you have another 2,000 close to 2,000 clinical setan and also clinic days.
15:50So, from here we know we have 10,000...
15:55So, we have 10,000 plus GPK links well distributed throughout the country based on the population...
16:00So, how do we leverage this particular resource that we already have?
16:04The government...
16:05The government underspends in the public sector, right?
16:08So, only the private sector have the...
16:10It has the infra and they also have the manpower.
16:12So, it is the time that if the government...
16:15What they should do is that...
16:16They should start looking into outsourcing certain things to the private sector.
16:20So, that the clinical setan, they can focus into more...
16:25Complex cases.
16:26So, that the resources are not overstretched.
16:28Like for example...
16:29National...
16:30National Immunization Programme.
16:31The GPS has been involved in immunization since independence, right?
16:34Yes.
16:35And then during the COVID-19, we did a fantastic job.
16:38Okay?
16:39We did a fantastic job.
16:40So, these are the areas where they can outsource to the government...
16:43Outsource to the private sector.
16:44Yeah.
16:45And then...
16:45Also based on the Coleco PC study done in 2015 as well.
16:48And they clearly mentioned that...
16:50The public sector focusing more complex cases and more wide services whereas...
16:55GPs, they are focusing on acute illness and also...
16:58But they are able to give personalised care because of...
17:00The family doctor concept.
17:01Right?
17:02Talk to me about that.
17:03The family doctor concept.
17:04So, before I cover...
17:05Our interview, I spoke to...
17:07Did a kind of an anecdotal survey about...
17:10How many people still practice having a family doctor?
17:14And...
17:15Not a lot, I have to say.
17:16Is it so...
17:17Achievable?
17:18Not a lot, I have to say.
17:19Is it so...
17:20Achievable?
17:20Sustainable?
17:21Or even...
17:22Desirable?
17:23In this day and age to have a family...
17:25The doctor system.
17:26Okay.
17:27That's a very good question.
17:28Because if you look at today's era, right...
17:30Especially in an urban, fast moving area, right...
17:33We can see a person...
17:35They will have...
17:36What do you call it?
17:37A doctor at the...
17:40Place where they stay.
17:41And they will have a doctor at the place...
17:43Where they send for babysitter.
17:44And...
17:45And then they will have a doctor at the place where they work.
17:47Okay.
17:48And then they will have a friend who is a doctor.
17:49And then you have...
17:50Online doctors...
17:51Or anything you Google and check, right...
17:53So this...
17:54This is the reality...
17:55And we need to...
17:55To accept the fact that...
17:56This is how...
17:57The current generation is going to behave.
18:00Okay.
18:01But having said that...
18:02What we have noticed in our...
18:04In most clinics...
18:05Even study done by MMA in 2018, right...
18:08So we have seen 60 percent...
18:10Of the patients...
18:11Visiting...
18:12The clinics...
18:13A family unit...
18:14Even they come as a family...
18:15And then...
18:16And most clinics...
18:17This is a small study we have done...
18:18Okay.
18:19In a private...
18:20In a private group...
18:21Almost 70 percent patients are repeat patients.
18:23So there is...
18:24There is a demand...
18:25For doctor...
18:26Patients who are looking for...
18:27The same doctor.
18:28Right.
18:29Because why they want to...
18:30They do not want to repeat the same thing...
18:31Correct.
18:32To somebody else, right?
18:33So definitely...
18:34The concept is there.
18:35But now the question...
18:35Is that...
18:36Most patients are coming because of...
18:37Acute illness...
18:38But if...
18:39We...
18:40revert it more towards enhance the private GPS to manage long term cases like for example
18:45NCDs so definitely they will come to us.
18:50The policy also must be very clear so the policy must be clear the system must be clear so
18:55that the.
18:55The government can actually leverage and optimize the GPS in the country.
18:58Can you talk to me more about that?
19:00What kind of health services could be outsourced to.
19:05GPs beyond immunization what are you hoping how are you hoping.
19:10To empower that the government empower GPs to help strengthen.
19:15Preventive and primary care.
19:17Okay number one the GPs role is one is.
19:20Preventive and Promotive.
19:21Preventive and Promotive.
19:22Okay.
19:23Preventive and Promotive.
19:24That is where you.
19:25You should invest because the earlier you catch something you are able to address it right.
19:30Yeah.
19:31So under the preventive we can do screening.
19:34We screen.
19:35So when we scale for example Pekka B40.
19:37It is a good initiative by the government.
19:39Then you have so.
19:40So.
19:40Screening right.
19:41You screen.
19:42So what is next.
19:43So.
19:44Is.
19:45It is important to have continuity of care right.
19:46So now what is next is that.
19:48If this patient is under the B40.
19:50Group.
19:51Or can't afford.
19:52We just refer them to clinical syatan.
19:53So what the government can do is that.
19:55They should allow the GPs to manage the NCD cases.
20:00They only refer to them.
20:01Okay.
20:02When it is necessary based on the clinical guidelines.
20:05So what does that entail manage NCD cases.
20:07Okay sorry.
20:08Managing diabetes.
20:09Okay.
20:10Hypertensis.
20:10Intention.
20:11Cholesterol.
20:12Even obesity.
20:13So this can be managed at the GP clinic.
20:14Okay.
20:15So the government should sit down together.
20:17And see how they can outsource to the GPs.
20:20Is it not currently managed.
20:21No.
20:22We are only doing.
20:23No.
20:24Basically those.
20:25Managing.
20:25It is either out of pocket patients.
20:26That means they pay on their own.
20:27I understand.
20:28Or it is a corporate client.
20:29So what we are telling.
20:30That means that.
20:31We see a big pool going to the hospital.
20:32Clinical syatan.
20:33Right.
20:34So the government can actually look at them.
20:35The numbers.
20:36And look at the mathematics.
20:37And then they can say.
20:38Why don't we do outsource.
20:39And this has been.
20:40Spoken about for more than 20-30 years.
20:41Oh.
20:42So it is not a new idea.
20:43It is nothing new.
20:44It is nothing new.
20:45So what.
20:45What is.
20:46Hindering this.
20:47From maybe.
20:48Moving towards outsourcing it.
20:49I.
20:50I.
20:51I.
20:52I.
20:53I.
20:54I.
20:55I.
20:56I.
20:57I.
20:58I.
20:59I.
21:00I.
21:01I.
21:02I.
21:03I.
21:04I.
21:05I.
21:06I.
21:07I.
21:08I.
21:09I.
21:10I.
21:11Is it something feasible that could be done?
21:12Definitely something feasible compared to the amount of money we are spending.
21:16when they are going into illness and also complication right so we put the most money
21:21in the hospitals when somebody is already into complication but what is the outcome
21:26so why cannot we focus more into the primary care strengthen the primary care
21:31and then today with digitization digitalization you can monitor health
21:36outcomes well you talked about can you use the phrase continuity of care and
21:41is that hindered by the fact that we don't have kind of
21:46digital records that can follow a patient from one
21:51you know one gp to another so there can be continuity of care so of course at the mooc
21:56of course at the moment we all work in silo private sector whether
22:01gp's among the gp's and also gp and hospital we work in silo government clinic
22:18you
22:06clinic asetan within each other and clinic asetan with the hospital also working in silo right
22:11okay so we have a lot of silo then ministry of defense and ministry of higher hospital i mean
22:16like pp ukm so on so forth right so basically
22:21of course so we are aware that the government has done uh they have they have actually
22:26they have digitized many of their clinic asetan to be fair to them yes okay they have done that and
22:30then the the
22:31of course they are currently sharing with the patient through maize jatra which is very commendable
22:35commendable
22:36and also at the reset meet at the the the at the jauhtan kosa last week when the minister announced
22:41that they are also looking into sharing of data of starting from imaging
22:55you
22:46so these are all good ideas to be fair to the ministry of health they are doing that okay we can
22:51see there's a progress a progress from the ministry of health with the limited resources they are doing
22:56all these things okay so definitely certain things we are on the right direction okay but
23:01they must do it fast okay but our concern is that in the last five
23:06five or six years we are worried about it should not be a political cycle
23:11you see healthcare is a marathon there must be continuity
23:25you
23:16you do not want a new political cycle comes in and then a new narrative goes in
23:21okay so it must be very clear so health paper was passed is good the current minister is following some
23:26part of the health paper uh elements or the pillars to do that so it must be a constant effort
23:40you
23:31because for healthcare you must have a clear direction yeah you must plan it next it's a long game
23:43you
23:36next 10 years mid-term short-term mid-term and long-term plan must be clearly planned manpower
23:41your facility mapping all must be done then so that whoever comes
23:55you
23:46whichever government comes in the future they just have to carry forward and healthcare should not be political
23:51law is adequate and technology decides that is very very important that is a real concern isn't it
23:56it, especially if you are concerned that reforms are not
24:01fully implemented, not fully institutionalized yet, that there could be
24:06changes with the political cycle. So something to be definitely...
24:11cognizant of. I'm curious to know, so one of the things that we had...
24:16spoken about with making sure that primary healthcare is...
24:21invested in is given the opportunity to help.
24:26Relieve or alleviate some of the burden that being put on public healthcare.
24:31Is there anything you would like to see in terms of prioritization?
24:36With primary healthcare, particularly with GPs.
24:39There's a lot of conversation around GPs...
24:41fee structure, regulatory caps and all of that. How do you see...
24:46GPs fitting into the national reform?
24:51For healthcare, are they being sidelined or neglected or...?
24:56Forgotten about?
24:57I would say yes, you are correct. I know I am on...
25:01TV. I have to tell that that's what's happening.
25:03Because we have been speaking about this for many, many...
25:06years and some of the... You see, your policy direction must be very clear.
25:10Okay. Even the government...
25:11Government structure...
25:12If you look at the Ministry of Health, the government structure itself, right...
25:15Under the Deputy...
25:16Director General, you have three for the Deputy DGs. So, there is one under Purubatan.
25:21It goes under Perkembangan, Amalan and then C-caps. So, the focus more towards...
25:26It's regulating the practice of the GPs. And then you have another Deputy Director General
25:30is under Public Health.
25:31Then under that only comes the Klinik Kesihatan.
25:33So, where do we stand?
25:35Okay.
25:36Because the Ministry of Health is the Ministry for all. Not only for the Public Health.
25:41It's also for the private sector. For the private sector, the policies must be to face...
25:46Facilitators.
25:47Okay.
25:48If let's say we are opening up a clinic. So, the regulatory burden, they must ease the regulatory...
25:51How can they support in terms of developing the practice?
25:56Okay.
25:57We are not asking for money.
25:58Clear policy direction.
25:59How they can assist?
26:00The simple thing, how can...
26:01How can they map GP clinics to the Klinik Kesihatan and also the public hospitals?
26:06Okay.
26:07Because we play a very important role.
26:08Yeah.
26:09There should be some kind of synergy.
26:10We see hundreds of...
26:11thousands a day, the whole country, right?
26:14So, imagine the amount of burden we are taking...
26:16The government clinic with their own funding. Okay.
26:20There is no...
26:21No burden.
26:22Those who are doing very well, they pay taxes as well.
26:24Yeah.
26:25Right.
26:26So, that's why it's very...
26:26Important.
26:27If you look at countries like Australia, Singapore or UK...
26:31They know that it's important to strengthen.
26:33But here, you have resources available.
26:36Including your consultation fees, right?
26:3733 years.
26:38That's right.
26:39It hasn't been changed for 33 years.
26:41The minister has announced that it will be done soon.
26:43Hopefully.
26:44But we know he's working very hard on that.
26:46Now he's on...
26:46Administrative issues should be done.
26:47Dr. Rasul, I've lost track of time and we've got a minute left and I do...
26:51I want to ask you what your priorities will be as MMA president this year.
26:55It's a short tenure.
26:56It's one year, isn't it?
26:57Yes.
26:58Are you hoping that you'll be able to achieve something during 2026?
27:01I'm very confident.
27:02I think what is important is that even though our 28 tenure...
27:06It's one year but this is a continuous struggle that all the...
27:11President has been pushing.
27:12So, we'll push and of course some of the things that we are looking at...
27:16I'm more confident of the GP fees.
27:17Okay, this year.
27:18Hopefully.
27:19Yeah, this year.
27:20I'm hoping this month or next month.
27:21Oh.
27:21Okay.
27:22Then we're also looking into the workforce.
27:24For the government side, we're also looking...
27:26We're looking into the workforce.
27:27For example, we've been pushing for the incentive for those who are travelling...
27:31We're going to Sabhas Rava.
27:32We've been pushing there, right?
27:33So, we have disheartened and and you know...
27:36It's 4.2 million a year, our assumption, compared to the amount of wastages and corruption
27:41that's going...
27:41You know, the country is a small money and is how do you appreciate your workforce?
27:45Okay.
27:46So, I think we want the government to understand that this is something they will continue
27:50to fight for.
27:51Okay.
27:52And then we believe not only the doctors, the entire healthcare workforce, the public...
27:56sector, they deserve this recognition.
27:58And for the private sector, the government should also acknowledge...
28:01Okay.
28:02Acknowledge and make sure that the policies are very clear and also we will...
28:06strongly continue to advocate to the public as well because healthcare...
28:11is a whole of nation and whole of society approach and healthcare is everyone's responsibility...
28:16including you and myself.
28:18Okay.
28:19We cannot just outsource it to the government.
28:20Absolutely.
28:21So, our job is to make sure the government's responsibility to ensure the system is in place.
28:25Dr. Rossi, thank you so much.
28:26for your time.
28:27That's all the time we have for you on this episode of Consider This.
28:29I'm Melissa Idris signing off for evening.
28:31Thank you so much for watching and goodnight.
28:32Thank you so much for watching and goodnight.
28:36Thank you so much.
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