- 5 hours ago
Malaysia’s healthcare system is facing a pivotal test.
The Ministry of Health’s RM46.5 billion allocation could face a 10% reduction, equivalent to RM4.65 billion, even as Malaysia continues to grapple with a shortage of nearly 11,000 medical specialists and an estimated 18% vacancy rate for nurses, rising chronic disease burdens and an ageing population.
What do these pressures mean for healthcare access, workforce sustainability, medical inflation and ultimately, Malaysians wellbeing and economic competitiveness?
Join Tehmina Kaoosji on NIAGA SPOTLIGHT as we examine Malaysia’s healthcare challenges for funding, workforce capacity, medicine access, system efficiency and long-term policy priorities.
Featuring:
* Datuk Dr. Thirunavukarasu Rajoo, President, Malaysian Medical Association (MMA)
* Hon. Prof. Amrahi Buang, President, Malaysian Pharmacists Society (MPS)
* Prof. Dr. Sharifa Ezat Wan Puteh
Dean, Faculty of Liberal Studies UKM;
Public Health Physician (Hospital & Health Management), Universiti Kebangsaan Malaysia (UKM)
#NiagaSpotlightWithTehminaKaoosji
The Ministry of Health’s RM46.5 billion allocation could face a 10% reduction, equivalent to RM4.65 billion, even as Malaysia continues to grapple with a shortage of nearly 11,000 medical specialists and an estimated 18% vacancy rate for nurses, rising chronic disease burdens and an ageing population.
What do these pressures mean for healthcare access, workforce sustainability, medical inflation and ultimately, Malaysians wellbeing and economic competitiveness?
Join Tehmina Kaoosji on NIAGA SPOTLIGHT as we examine Malaysia’s healthcare challenges for funding, workforce capacity, medicine access, system efficiency and long-term policy priorities.
Featuring:
* Datuk Dr. Thirunavukarasu Rajoo, President, Malaysian Medical Association (MMA)
* Hon. Prof. Amrahi Buang, President, Malaysian Pharmacists Society (MPS)
* Prof. Dr. Sharifa Ezat Wan Puteh
Dean, Faculty of Liberal Studies UKM;
Public Health Physician (Hospital & Health Management), Universiti Kebangsaan Malaysia (UKM)
#NiagaSpotlightWithTehminaKaoosji
Category
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NewsTranscript
00:08Hello and welcome to Niagara Spotlight with me Tamina Kaosji.
00:11Niagara Spotlight takes us through the week in economic analysis and future affairs.
00:15Now today on future affairs, our spotlight falls on the cost of healthcare cuts.
00:20Malaysia's healthcare sector is in a pivotal moment.
00:23Earlier this year, Health Minister Datuk Street Dr. Zulkifli Ahmad
00:26revealed that the Ministry of Health could potentially face a 10% reduction
00:31to its 46.5 billion ringgit allocation for the year, equivalent to 4.65 billion ringgit.
00:38Now at the same time, the public healthcare system continues to grapple
00:41with an estimated shortage of nearly 11,000 specialists,
00:45roughly 18% vacancy rate for nurses, rising chronic disease burdens,
00:50medicine access concerns and a rapidly ageing population too.
00:53Now, these healthcare issues are fundamentally also economic challenges
00:58with implications for productivity, labour force participation
01:02and long-term national competitiveness as well.
01:05Joining me live in the studios for today's discussion are
01:08Datuk Dr. Thirinovaka Rasu Raju,
01:11President of the Malaysian Medical Association, the MMA,
01:14together with Prof. Dr. Sharifa Esatwan Putih,
01:17Dean with the Faculty of Liberal Studies UKM
01:19and also a public health physician at University Kabangsaan, Malaysia.
01:24And rounded off by, last but certainly not least,
01:27Honourable Professor Amrahi Buang,
01:29President of the Malaysian Pharmacists Society or the MPS.
01:33A very good morning to all of you.
01:35Thank you for making time.
01:37So at a very critical moment, I mean, Parliament is also in session,
01:40discussions have been ongoing.
01:42Datuk, Dr. Rasu, can I start off by asking on the MMA's perspective,
01:46whereby, of course, for decades, now Malaysia has relied on a healthcare model
01:50that benefited from a relatively young population.
01:53But, of course, challenges have shifted across the decades.
01:57Today, of course, we've got a rapidly ageing population.
02:00Now, with the healthcare challenges that we are seeing now,
02:04has it moved beyond financing healthcare
02:06and where the concern primarily is actually more towards the healthcare workers themselves,
02:14some perspectives from the MMA?
02:16Thanks, Tamina and also AstroNyaga.
02:19Okay.
02:20If you look at it, in the healthcare ecosystem, there are many components in it.
02:25But the most vital component in the healthcare ecosystem is the people behind it.
02:30Absolutely.
02:31That is the healthcare workforce.
02:33The data clearly shows 11,000 shortage of specialists,
02:3718% vacancy for nurses.
02:38And more alarming, recently, out of the 5,000 posts available for the housemen intake,
02:45only 500 plus are supplied.
02:48Right.
02:48So these are all red flags in the system.
02:50Huge gap then.
02:50Huge gap.
02:51So obviously, we need to address the issues.
02:53And this issue is not a new issue.
02:55It's a systemic issue.
02:56Way back before COVID, the Auditor General's report,
03:00he stated about underfunded, overworked and understaffed after 10 years.
03:07So if you're not going to get our priorities correct, it's going to be difficult.
03:11But to be fair to the Ministry of Health, we must also understand they operate not independently.
03:19They are dependent on the Ministry of Finance for funding.
03:22They are dependent on JPA in terms of positions and training, Ministry of Higher Education.
03:29So at the end of the day, we must look at it in a holistic way.
03:33So we must also look at our other countries, how are they managing it.
03:36So definitely, we need to prioritize and give importance to our underfunding,
03:44our overworked and understaffed workforce in the healthcare ecosystem,
03:49whereby they are taking care of almost 70% of the population.
03:55The burden is to the public sector.
03:57So definitely now, you have the search of number of patients,
04:00but you have limited number of workforce managing them.
04:04So definitely, this will lead to burnouts.
04:07And then we must also look at the number of hospital beds in the country.
04:10So the public sector is almost like 46,000 beds.
04:14The private hospitals, you're talking about probably around 12,000 beds.
04:18And then you have 1,000 plus clinic kasyatan.
04:21And then you have 10,000 plus GP clinics.
04:24So we have the facilities.
04:27Whether it's a public or private, the facilities are there.
04:30Now the issue is the manpower.
04:32You have enough manpower in the private sector.
04:35So how do we leverage this so that we reduce the burden on our workforce in the public sector
04:41by leveraging whatever the resources is already available in the country?
04:45Public-private partnerships could be a starting point since the system is already so much under pressure.
04:50Thanks so much for that, Datuk.
04:52Now, Prof Amrahi, of course, let's bring in what also helps the entire healthcare infrastructure to run,
04:58which is the medicines themselves, right?
05:00And in your perspective, Prof Amrahi, do you feel that medicines can also, of course,
05:06the investment that we are overlooking when it comes to the economic value that they are able to bring
05:12if it is properly managed from the top down?
05:16Yeah, I think if I actually go through this particular question and you talk about is it a cost
05:23or, for example, we are talking about, I mean, what is actually the economic value of medicine?
05:29So, but I think if you say about cost, after that, you take about cost saving.
05:35But maybe now even people looking about even making profit, you know?
05:38So, this is where we are looking at.
05:41I think Datuk also mentioned about the system, isn't it?
05:45We are talking about, okay, what is going on in the public system?
05:48What is going on in the private system?
05:50And so on and so forth.
05:51In my honest opinion, I think as far as the public system is concerned, it's all there.
05:56It's all structured.
05:57But because of the fact that our healthcare system is dwell,
06:01we have the public and also the private.
06:03So, we have issues because it's still fragmented, it's still not, people are working in silos.
06:10So, the population are facing all this.
06:14And as such, under the current condition, we are all facing all this, all this issue.
06:19But if you look into, when you talk about economics per se,
06:25in fact, pharmacists study pharmacoeconomics.
06:28It's part of our curriculum.
06:30See, as a pharmacist, we are trained in a lot of areas,
06:33especially when we really cover all aspects of medicines.
06:37So, that is the first thing.
06:39So, I didn't see any much problem in the government setting for the fact that it's all structured.
06:45So, if you compare to private, it's really everybody is doing on their own.
06:50We are talking about a free market.
06:51We are talking about, you know, everything can do and there's no control, etc.
06:56Okay, is it the MAH going to control all this or are the ministers going to control all this?
07:02So, all these are something that we need to do.
07:05So, as far as how to cut all this down, of course, under the National Medicine Policy,
07:11we are talking about access to medicine.
07:14Of course, we also support generic prescribing.
07:16The policy is all there, you know.
07:19And we also got to understand that, I mean, we're talking about quality, safety and effectiveness.
07:25All products in Malaysia is registered by MPRA.
07:28So, it's really well controlled, you know, under there.
07:32So, I think in terms of that, it's okay.
07:35The issue is actually accessibility, especially when you talk about out-of-pocket expenditure.
07:41That is an issue, people without insurance and so on, right?
07:44And if you look into the way we are handling insurance now, as mentioned in the parliament yesterday or two
07:51days back,
07:52where, you know, it's aside.
07:54I think the PC has given a lot of information how to move.
07:58I will talk about it later.
08:00But rather than looking this way, why not looking at something of value in terms of investment?
08:08Why do you talk about cost when, in fact, you have to invest?
08:11So, I think from the pharmacist's economic argument,
08:15clinical and community pharmacists advocate that targeted pharmaceutical investment,
08:19such as compliance packaging, medication therapy, adherence clinic,
08:24and the use of cost, effective alternative like biosimilars,
08:29dramatically reduce downstream emergency admission and prolonged hospital stay.
08:35Absolutely.
08:35So, every ringgit you spend is going to prevent multiple ringgit being spent downstream.
08:39And then we also talk about systemic reforms.
08:42Okay.
08:44We have to shift from cost to value.
08:47Okay.
08:47So, if we have that paradigm shift of moving from cost to value,
08:51then, as mentioned in the health white paper,
08:55outline a systematic restructuring.
08:57We need to restructure.
08:58Exactly.
08:59So, Prof. Amdami, in conclusion, basically,
09:01the challenge is often that our health budgets,
09:03they will be looking at it for an annual cycle.
09:05They're not actually looking at lifetime savings.
09:08Thanks for the insights.
09:09Prof. Sharifa, moving quickly into and picking up a thread,
09:12of course, that mentioned with Datuk earlier.
09:15Now, looking at the current realities of Malaysia,
09:19whereby, of course, our demographics have shifted,
09:21and we've got the ageing population burdens,
09:24but also the system is still structured for a younger population.
09:29So, coming back to the RM4.65 billion potential reduction
09:33in the overall budget,
09:35what changes in financing and planning does it demand,
09:40given that we are now living in a new reality?
09:43Yeah.
09:43Thank you very much, Demina,
09:44and also for the invite from Niagara Spotlight.
09:48We do understand that the RM4.6 billion that so-called has been cut
09:52is said to be the budget that has been used in leakages in a way.
09:58But on the perspective of the population,
10:01and us, especially from the doctor's side,
10:03we're looking at public health aspect,
10:05this is a big amount, you know.
10:07So, and the demographic of the population has changed.
10:11You've correctly mentioned that we are going into an ageing society.
10:14By 2040, we are an ageing society already.
10:17It's about 14.6%, you know.
10:20So, we are there, almost there.
10:22So, there's a lot of things which are not in place yet.
10:24We are looking forward to the Senior Citizens Bill.
10:27We have to conclude with an ageing society and so on.
10:30But we need to transition more into preventive.
10:33But also, we need to be reactive to the demand of the ageing population,
10:37which some of these are not in place yet.
10:39I know this is not the burden of the Ministry of Health per se.
10:42There's a lot of other ministries that needs to be involved.
10:45We cannot, you know, just point out to the Ministry of Health.
10:49There's a lot of other ministries that's been involved.
10:51Example, on the ergonomics, on the housings,
10:54people are moving into multi-generational families.
10:56So, sometimes they have to, you know, change their house,
11:00do a bit of renovation and things like that,
11:01which will not be concordance with the, you know, PBT and so on.
11:05So, these are changes that have to be in place.
11:07So, we need more of primary care because they can be also adult,
11:12you know, patients that can come in as daycare for the patients who are elderly.
11:18So, these are respite care that is needed.
11:21So, these are transitions that need to be in place.
11:23And, of course, assistive technologies.
11:25So, example, you know, some patients may be,
11:28or some elderly may have been dementia, frailty, Alzheimer's.
11:33How do we keep track of them, especially if they are left at home and so on?
11:36Of course, if we have the money, we can actually put them in the nursing home
11:40or a good respite care and things like that.
11:42That's fine in a way.
11:43Of course, they may still be prone to loneliness.
11:46But what happens if they are at home and things like that?
11:49So, these technologies will be something that is usable.
11:51And we need to drive this technology on assistive technologies for the elderly.
11:55This is not yet in place.
11:57I think we need to have more innovations to take care of this.
12:01But we need to change the perspective of just treating them in the clinics.
12:05So, things like social care, because they are prone to loneliness.
12:08And this is one of the main reasons that people actually succumb to illness and also death.
12:12So, we have to curtail the issues of loneliness in the elderly.
12:16I mean, a lot of us, including us, some of us are going into a pension area
12:20and we're going into that age already.
12:22So, how do we do?
12:23We know we need to...
12:24In place care as well.
12:25Correct.
12:25I think it helps families across the board and across different economy.
12:29How do we pay?
12:29Most of these are not paid, you know.
12:30So, this is something that we need to think about.
12:32Absolutely.
12:32Thanks for highlighting that.
12:33We'll go a little bit deeper into what appropriate budgets should be.
12:37But before that, Dr. Arasu, Datuk, now, MMA also recently clarified that workforce shortages
12:43was actually what is causing the current experiences with really long wait times, etc.,
12:49that Malaysians are facing in hospitals.
12:52And that was a really welcome clarification too.
12:56But since that is the case, do you feel that we are measuring healthcare system performance
13:00using erroneous indicators?
13:03And what should our policy makers actually be paying more attention to since who is feeling
13:09it at the bottom line is always the average Malaysian, the right yet?
13:13Of course, these are indicators set by the experts, right?
13:17But it's always easy to count debates, but it's not easy to count the number of people.
13:21The workforce is needed to make sure that particular patient is safe.
13:25That's very important.
13:27Let me give a classy example.
13:28Recently, when one of the politicians announced that they're going to...
13:33They needed a 500-bedded hospital in Pataling Jaya.
13:37Right.
13:38Okay.
13:38So...
13:39A brand new hospital.
13:40A brand new hospital, right?
13:41So we know very well, easily you can build a hospital in five years, provided no leakages.
13:47Everything is very smooth and transparent.
13:49But then to train a specialist, it takes 10 to 15 years.
13:53That's number one.
13:54Number two, in Pataling District itself, when I look at the Ministry of Health data, they
13:59have 12 hospitals, cumulatively... 12 private hospitals with cumulatively 1,400-bed.
14:07And they've got 400-plus GP clinics around that area.
14:10So you need 500-beds.
14:12So I'm very sure you can talk to the private sector.
14:14They might be having a 30% non-occupancy.
14:17That you're talking about 400-plus-beds, right?
14:19Yes.
14:19Rather than building, spending billions to build that, why don't you just outsource?
14:24You solve the patient's problem.
14:26You reduce the waiting time.
14:29You speed up the treatment time.
14:32So you can solve problem.
14:33So I think what is important is that indicators are indicators.
14:37But what is more importantly, we can see the waiting time has increased.
14:41I wouldn't say just because I'm President of Malaysian Medical Association, I'm not defending
14:47the doctors alone.
14:48But we must say the reality is that this is a systemic underfunded for decades.
14:55And today, we are seeing the issue coming up because after COVID, it has just become worsened.
15:01So I think what is important is that everyone, healthcare is not a Ministry of Health issue.
15:08Healthcare is the whole of society, whole of nation.
15:11Again, I'm repeating, Ministry of Finance has an important role to play on these indicators.
15:17JPA has an important role to ensure that enough staffing.
15:21And recently, about the specialty, subspecialty, you know, there's a big, you know, many of
15:27them were denied transparency.
15:29And that caused a huge crunch as well in our future numbers, right?
15:33So these are all very important to make sure that, for me, for us, that these are more
15:37important indicators while, of course, occupancy rate and the length of stay and many other
15:42indicators are there.
15:43But the manpower rate is the most important thing, I would say.
15:47Absolutely.
15:47And, of course, when you are able to actually articulate it, the KKM now public digital tracker
15:54has actually been showing that in 2026, the average wait time for an emergency department
16:00bed in the public healthcare sector sits at around 144.4 minutes.
16:05And definitely, when you have the capacity is not able to address who is coming in through
16:13the doors, that is really the core issue.
16:15Thank you for that.
16:16Prof. Amrahi, now digging a little deeper and going into the fact that Malaysia's healthcare
16:22model was previously designed, Rajji, around treating illnesses per se.
16:26But, of course, our biggest healthcare costs, and you touched on that a little earlier,
16:30let's dig deeper, the NCD burden and managing chronic diseases over the decades, right?
16:35So does our budgeting process, is it still looking at treatment volume rather than long-term
16:41disease prevention and also medication adherence?
16:45Okay.
16:46Okay.
16:46What you give is what you get.
16:48Okay.
16:48Okay.
16:49Meaning that, for example, if your policy into sick care, then you put your education,
16:56that's what we are getting now.
16:57They're thinking about what the problem with NCDs, et cetera, et cetera.
17:01So I think this is something that we have to be clear, especially for NCDs.
17:06When you talk about, by right, you should have a long-term disease prevention.
17:11Meaning, I mean, normally, we want to be healthy from womb to tomb, right?
17:17Okay.
17:17When we are healthy, we are productive and we're happy.
17:20But we are not seeing it now.
17:22No, no, the statistics are very clear.
17:24We've added around 16, 17 years to our national age, but are they healthy years?
17:30I think the Honorable Health Minister also mentioned, okay, let's move from sick care
17:33to health care.
17:34Okay.
17:35That's very good.
17:37But of course, when you talk about all this, of course, when you talk about the spending
17:41of the budget, you mentioned $46.5 billion, and then have a cut of 10%.
17:47So it's really worrying, isn't it?
17:50Really worrying.
17:52And we have to do this.
17:54But how much investment do we have to put into prevention?
17:59Hardly.
18:006.6 only versus 10% to 15% recommended by WHO.
18:07So it's like that at the moment.
18:09But I mean, the Auditor General report way back in, what, 2013 when report, you know,
18:17the whole ministry is underfunding, even lack of manpower, blah, blah, blah.
18:21So I feel that, you know, these are the things that actually is right in front of our eyes
18:26at the moment.
18:27So I think as far as from our point, I think let's move.
18:32I think the shift from sick care to health care is a positive one.
18:37It's also mentioned in parliament.
18:39And I think we should support.
18:41And I think there's one thing regarding your question when you talk about medication adherence.
18:46I mean, to be honest, who's going to do this?
18:48Who's going to oversee?
18:49If not the pharmacy.
18:51We're talking about chronic diseases here.
18:53We're not talking about just giving medicine.
18:55We are talking about managing medicine.
18:57So who's doing it now?
18:58In the government sector, we have M-TAC.
19:02But how about outside?
19:04So these are real challenges and it's affecting the rakyat.
19:08So I think this is something that we have to focus.
19:11And we hope that, you know, with this change of mind, we hope people have to think.
19:18Because a lot of money is being spent on curative care, rehabilitative care, predictive care.
19:25And the end product, everyone knows, right?
19:28Because lack of funding in promotive care and preventive care.
19:32So good.
19:33I acknowledge that the government have done that.
19:35And keep up, we need to do that and let's move.
19:39Exactly.
19:40And also there have been other efforts as well, such as prioritizing local generic medication production that saved almost around
19:48a billion ringgit as of this year.
19:50So lots of positive things happening, but perhaps more of a focus on what exactly that you said, overseeing medication
19:57intake,
19:58particularly as we see more and more of the aging population not only living alone, but perhaps not having the
20:05in-house assisted care, because that, of course, costs money as well.
20:09All right.
20:09Well, moving on from there, Prof Sharifa, now coming into the GDP question, and let's focus on this.
20:17We spend roughly anywhere between 4% to 5%, still single-digit budgetary numbers for our health, which is much
20:25lower than many other OECD countries.
20:28So the debate is often focusing on how much more should be spent, etc.
20:32But in your perspective, is Malaysia truly facing a healthcare funding problem or an efficiency-related issue?
20:40Yeah, you're right.
20:42We spend a dismal amount of our GDP devoted to health.
20:48However, if we compare this with other sectors, a ministerial in the government, we are one of the highest proportion
20:57that obtain money from the government.
20:59Healthcare, meaning that healthcare and education is one of top two devoted by the government, budget spent on that, but
21:07it's still not enough.
21:08If you look at, of course, OECD, as you correctly mentioned, it's almost 11%, 10% to 12%.
21:14But if you look at the OECDs, but sort of the lower categories of lower OECDs, they also spent about
21:216% to 7% of their GDP.
21:22And this is among the, you know, UMIC or LMIC countries.
21:27They still spent about 6% to 7%, which is about 2% more than us.
21:31So that means we are chronically underfunded.
21:34We have to agree with that.
21:36We do understand the government is trying their best.
21:39The Ministry of Health, in specific, has obtained an increment in most of the years.
21:45Not talking about this cut, but most of the years we have an increment.
21:48Year on year, yes.
21:49Yes, but it's still not enough.
21:51And we keep building hospitals.
21:53It's not to say this is bad.
21:55It's good.
21:56But for me and my personal opinion, this should be devoted into the prevention.
22:01And also promotive and also proactive care, meaning that we should also look at how to prevent patients or population
22:09from getting the disease in the first place.
22:12And this is where the primary care, which can be by the public, but also by the private and the
22:17GPs.
22:18We have thousands of clinics and they are waiting for patients, but we have to work together.
22:23The model actually presented by the previous Peker B40.
22:27We are still having that, not the previous, we are still having it.
22:29The Peker B40 example, where the patients can actually, of course, these are not all patients.
22:34These are patients which are, you know, in a way tech, they have the, you know, capability to actually go
22:39to either public or private.
22:41If they go to the private, they are seen in a way free or semi-free, you know.
22:46So the cost that they need to pay is basically subsidized by some entity.
22:51At the moment, it's by the government.
22:53But of course, in future, if we have this PPP, you know, private partnership, we have a more social responsibility
23:00coming in from the industries and all.
23:02They are able to pay for the population.
23:04That will be good.
23:05Then the patient can actually go to the private GPs and seek care from them without having the financial burden.
23:12So this is something what universal health coverage is all about.
23:15And this is where Malaysia is, you know, we have a good, so-called good universal health coverage.
23:20Our index of UHC is quite high and we want to keep that.
23:24So this is where I think the government should, you know, move towards not only budget for the hospitals where
23:29the patient is already, you know, having complication or severity level which is already high.
23:33We should have more devotion on preventive care to prevent the patients or the population from getting sick.
23:41So this is very important because we talked about aging just now.
23:44We want aged population which are healthy, which are able to contribute.
23:48Of course, we need to rescale and we need to retrain them on certain scales and so forth, but they
23:53are able to contribute to the population.
23:55So these are something which I think the government should move towards.
23:59And I think we should follow other countries which are doing that.
24:03Devotion on private sector only is not so good in the long run.
24:08We do know that some private, you know, entities like private insurance, which are good for especially for the, you
24:15know, upper income level population.
24:17These are good. There's no issue with that.
24:19They can pay whatever they want.
24:21They can pay the premium.
24:22They are able to afford it.
24:23But we're talking about the middle income and also lower income, especially post-COVID.
24:27You can actually see that a lot of the middle income population actually transition into lower income.
24:31They lost their job.
24:33They don't have the savings.
24:34The saving has finished and so forth.
24:36So we need to curtail for them.
24:38Figuring, of course, the allocation of resource management.
24:41Correct.
24:42So the resource management is to be, you know, probably changed a bit.
24:45We already have the white paper, which is like three years ago.
24:48And I think we should move towards that, where the coverage of the population, some sort of insurance through, it
24:54can be tax funded as well, you know, where the patient can actually go either public or private.
24:59But they are covered, so they don't have to be financially burdened on that.
25:02Not only about higher GDP allocations, but of course, the value you get from what you have.
25:07Exactly, because the highest GDP is actually US.
25:09It's about 18% of their GDP.
25:11It does not translate into a better outcome.
25:13There you go.
25:14Well, thank you very much for the very interesting discussion so far.
25:17We take a quick break.
25:18Don't go anywhere.
25:18We'll be back with the rest of the conversation right here on Niaga Spotlight.
25:41Welcome back to Niaga Spotlight.
25:42Still with me, Tamina Kausjee.
25:43And today, the topic of discussion is the cost of health care cuts with our panel live in the studios.
25:48So, Dato, moving back into the conversation and focusing again on, of course, labor shortages.
25:56Now, a lot has been said, of course, about automation, AI, et cetera, medical advancements.
26:01That is certainly also something which the medical industry is fast catching up on.
26:06But, of course, it does not quite solve the issue when it comes to specialists in particular.
26:11So, tell us more about Malaysia's public health care system and what way in which we are looking at doctors
26:19and specialists.
26:20And it's not just about recurring costs, right, but about really building that infrastructure so that the workforce, the human
26:29labor force for them is actually, they're becoming more and more scarce.
26:33And this is also happening at a time of automation.
26:36So, where is the avenue of opportunity?
26:40Yeah, I think one thing we have to recognize that talent migration is a global issue that has been happening
26:46way back in 1990s.
26:47It's nothing new.
26:48I think what is important is that for us to understand healthcare workforce is an investment.
26:54It's not a line item in the budget.
26:56It takes 15 years to train a specialist.
26:59So, what else can we invest and how much can we invest to make sure they're here?
27:04Because most of them, when they leave, whether the nurses or the doctors, specialists, most of the time, it's always
27:10a push factor.
27:11So, what are the push factors?
27:12For example, the work-life balance.
27:15You cannot be asking them to work for 60 hours and 70 hours.
27:18Because if you look at the private sector, the labor access, even though it's below 5,000, but then you
27:24cannot ask somebody to work more than 45 hours.
27:27So, now the question is that why…
27:28That cap is amazing, right?
27:30In the private sector, why is it not being applied to the public sector?
27:33So, can we perceive that the public sector, our colleagues in the public sector are treated differently?
27:40Differently, that's one thing.
27:41And the other one is the promotion.
27:43There are great tasks for the specialists.
27:46If you have done a speciality, if you're a full specialist, you don't have to wait for 14 years and
27:5015 years waiting for your promotion.
27:52These are all the simple, simple things that can be done.
27:54And the other thing is, of course, it's good to know that the government is going to abolish the contract
27:58system.
27:58One of the major failure on the healthcare policy that has pushed away the young doctors in the country.
28:03It's good to know that the minister has announced they're going to abolish.
28:06The Secretary General has announced, MOH has announced that this is already a work in progress.
28:10So, these are the areas that actually we have to make sure that how we can keep them in.
28:13And the other one is allowance.
28:15We understand the tight fiscal budget the government is facing.
28:18We understand that.
28:19Okay.
28:20But importantly, you must also allocate funding.
28:23Funding in terms of, what do you call it, to train the specialists and also the allowance.
28:28And recently, the government is talking about saving money.
28:30And I think there was a report recently came out that there were 50-hour trips overseas by various ministers
28:35and also various top officials that are counting so much of money.
28:39So, sometimes, the leadership is by example.
28:42You cannot talk something and expect the healthcare who are facing on a daily basis feeling demotivated and whereas these
28:50kind of things are happening.
28:51So, I think we need to recognize, we know the problem.
28:53But more importantly is that the execution.
28:57That is what we are lacking.
28:59Exactly.
29:00And I think it's also of note, in particular, that from around 1,046 specialists and around 5,000 medical
29:07officers who overall cumulatively left our public healthcare system over the past five years or so, about 54, 55%
29:14of them just transitioned to the Malaysian private healthcare sector.
29:18They did not necessarily migrate.
29:20Malaysians do want to stay in Malaysia, even professional qualified Malaysians, right?
29:24It's all about just giving them their due to ensure that they're able to work and perform and also have
29:31the economic stability to be able to do that all together.
29:35Thank you for that.
29:36Prof. Amrahi.
29:36Now, of course, we had touched a little bit on the fact that pharmacists are increasingly also becoming the most
29:43accessible healthcare professionals within communities.
29:46And would you have any ideas about how this can practically be flowed out rather than having to leave it
29:54to, let's just say, individual pharmacists and what they are seeing from the customers who walk in day in and
30:00day out?
30:01What kind of a, perhaps, policy could we have to encourage, actually, pharmacists to be viewed less as just medicine
30:08dispensers, but they are actually more of an untapped primary care resource?
30:12Maybe, maybe, I have to sort of look into, actually, we talk about the profession per se.
30:20Definitely, the word retail pharmacy doesn't exist anymore in terms of practice.
30:25We have actually converted into community pharmacy because, as you rightly mentioned, the pharmacist is actually the most accessible healthcare
30:33professional.
30:34So, it's very clear.
30:35In fact, if you go around, you must know the difference between a community pharmacy or a pharmacy than just
30:43a drug outlet or a drug seller.
30:45So, pharmacists are not drug sellers.
30:47Okay, we are actually a professional.
30:49So, I think, and you can, if you look into the ratio per se, I think a lot have been
30:54told about the ratio.
30:55So, maybe I can share about, do we have enough pharmacists to do all this, right?
31:00We're a little under the quota, right?
31:02At the moment, we talk about the ratio of pharmacists to population is about 1 to 1.6, roughly, in
31:10Malaysia.
31:10But from WHO, it should be about 1 to 1,000.
31:14So, but we're still building because we have, what, 22 pharmacy schools in the country.
31:19So, I think it's good.
31:21But I think the most important thing is that let's face the current situation, all right?
31:26I did mention about medication, we did mention about medication adherence.
31:30So, I think, for me, I think we want to offer our services.
31:36We are trained to do all this, especially when you talk about medication adherence.
31:40It is a big issue because it's not like dishing, just give the medicine and so on.
31:46Really, you need to monitor the dose, et cetera, et cetera.
31:49So, all these are being trained.
31:51So, with that, we hope that, you know, with what is currently happening, all right?
31:56I mean, even during COVID, we came and actually do what we feel that we can do.
32:02So, we don't have problem at that time because we respond to the crisis.
32:06So, under these circumstances of underfunding, we will come out and face this together, yeah?
32:12So, I think, well, we can decongest the clinics in that sense.
32:18And also, we have to be involved in chronic disease management.
32:22And this is also very important.
32:24So, of course, it's not rocket science, you know?
32:27We can do screening and so on, which will help, you know?
32:30So, we hope that it is very important that let's go to this paradigm of enhanced preventive care
32:39because we are in MPS, okay, we are actually talking about this already,
32:44you know, talking about, you know, a preventive care framework, you know?
32:49So, we are actually putting all this.
32:51So, I think as far as this is concerned, it's very important that we do it.
32:57So, I would suggest, you know, under the current condition,
33:02I would love to see the interprofessional collaboration between the general practitioner
33:08and the community pharmacist, real collaboration to help the patient.
33:14What would that look like?
33:15Yes, because of the fact that we understand how they practice, you know?
33:19But we also know that, you know, what we can do for the patient.
33:23So, I would actually appeal, you know, to doctor, to GP, let's work together.
33:28We can see, because this is actually a thing that we can do
33:32and I think we have to have this interprofessional collaboration
33:36and I think this collaborative approach will solve all the things
33:41in terms of, at the end of the day, is patient outcome.
33:44So, expanding healthcare, of course, capacity, this could be the fastest possible way
33:49while we are also in the wings for training enough specialists and et cetera.
33:54Prof Sharifa, now, of course, many of the costs which are associated with poor health,
33:59lower productivity, workplace absenteeism, early retirement, et cetera.
34:05So, all of that, it does not appear in healthcare budgets at all.
34:09Now, do you feel that we're underestimating the overall economic impact
34:13of underinvesting in health overall because we just don't calculate it in official budgets?
34:20Yeah, that's true.
34:22The direct medical costs, like I mentioned before, we have already have underfunded already.
34:29The greatest, I think, important way to look at it,
34:33the output would be looking at the GDP spent on healthcare.
34:37Yeah, and when you talk about, you know, some of the uncalculated, you know,
34:42costs or outcomes of underinvestment, which is bigger, right?
34:47You talk about absenteeism, you know, early death, and also having longer complications.
34:53When you have longer complications because of, let's say, NCDs and so forth,
34:57not only the cost of treating, example, at the moment,
35:00there's one report that mentions about 10 billion per annum,
35:04but one of the other outcomes is that you have an early death.
35:07So you have, you're supposed to live, let's say, 80 years old or 75 for men
35:13and we have slightly longer for females, but you have an early death of 10 to 15 years
35:17because of this, you know, NCDs or certain diseases, cancer,
35:22and you have lower quality of life because you might have suffered from, you know,
35:26mental health issues and so forth.
35:28So when we calculate for costs, we don't really look at it in general.
35:33We look at the direct costs.
35:35By direct costs as well, this is already underfunded.
35:38This is where the GDP played a role.
35:40Now, if you calculate all this, you know, unintended or, you know,
35:43slightly unaccounted medical costs like absenteeism, mental health issues,
35:48number of NCs and so on, this is going to be greater.
35:51And I would expect that will contribute another 40% to 50% of the actual costs
35:55if you calculate that already.
35:57So that's going to be huge.
35:59So in reality, we have mentioned this repeatedly, all of us.
36:04It is a chronic underinvestment, even at the direct medical costs.
36:08And when I say direct medical costs, this will look at, you know,
36:12treatment costs by the doctors, by the pharmacies,
36:15the cost of drugs that we give, most of the time free.
36:18If you're talking about public health care, most of the drugs are free.
36:22Of course, you need to pay a small amount and things like that,
36:25but most of the drugs are free.
36:27So these are direct medical costs.
36:29But other costs that are involved, including the patient's costs,
36:32when they have to travel, buy their own food, buy their own meal,
36:36and some of them have to pay for lodging, example, for cancer care,
36:39they have to go for daily treatment and so forth.
36:42So these are some of the indirect costs which are not really entailed in costs.
36:48So we don't talk about them in our budget because it's basically the population budget.
36:53But if you calculate, it's going to be huge.
36:56This is true.
36:56This is very true, Tamina.
36:58And most of the, if you look at research or certain specific reports
37:02required by certain entities where they want to look at the society's costs,
37:07and this would include the provider's costs,
37:09which are the doctors, hospitals, clinics, and so forth,
37:12but also the patients or the population costs.
37:15Now, if you have one number of patients, let's say, having cancer,
37:18breast cancer, example,
37:19this is a very good example where, you know, our treatment is actually very late.
37:24The patient would be at stage three, four, until they actually get proper treatment.
37:30And it's not to say that Ministry of Health is not doing their job.
37:33They are trying their best.
37:34But the number of doctors, example, oncologists,
37:38the number of doctors who are, you know, catering for children with cancer,
37:42is just not sufficient.
37:43And this relates to the mention by Datuk Arasu.
37:48Some of them have left the country.
37:51Some of them are in Malaysia, but they have gone into the private.
37:54Some have opened their own, you know, practice, and so forth.
37:58So, in a way, we are losing them.
38:00So, we need to have a way to retain them.
38:02And I know that the government have tried.
38:04This includes the Rakan KKM or the, you know, full-paying patients.
38:09Even if they go to the public sector, they still have to pay.
38:11And the private wing in the teaching hospitals.
38:15So, these private wings are ways that we try to retain the public doctors.
38:21There are issues.
38:22I can't, you know, we don't have time to discuss the issues of that.
38:26But these are ways that the government is trying to retain them.
38:30It doesn't work all the time.
38:31So, we need to have a more holistic way.
38:34And if you compare, I think one of the major is,
38:36if you compare the emolument that we pay our doctors,
38:40this is chicken, you know, chicken feet.
38:42If you compare this to regional doctors as well,
38:45of course, if you compare this to OECD countries, it's just unbearable.
38:48But the amount is so low.
38:50And in the end, we need more doctors, which is related to the GPA.
38:54We need more posts for the doctors.
38:57And again, it relates to the budget.
38:59So, it goes back to the museum.
38:59Everything is a cascading impact as well.
39:01And overall, of course, hopefully, the startling numbers of added costs,
39:07which could spiral to even 98.3b, if you're including mental health
39:11and other associated impacts, is what will hopefully persuade
39:15the government of the day to take this rather seriously.
39:19I think to conclude with, perhaps from Datu Arasu,
39:23let's just have a little bit of a perspective about the fact that
39:26Malaysia is, of course, health white paper.
39:28It outlines a 20-year transformation agenda.
39:31But, of course, annual budget decisions are made within much shorter
39:35political as well as the fiscal cycle.
39:37So, how do we address the growing disconnect between that
39:42while ensuring that year on year we are making progress
39:46rather than coming up with even more hurdles?
39:50That's a very good question, Tamina.
39:52Okay, we all know that health white paper is a bipartisan.
39:56That means it's not a political issue.
39:57That's very clear.
39:58Because it's a political issue, and now with how the member
40:02of parliament is right, they'll be fighting for it.
40:04But at least they know this is a non-political agenda.
40:08So, you have 15 years.
40:09You have already clearly put it on papers the first five years,
40:12second five years, and third five years.
40:14But then, having said that, you have a 15 years horizon,
40:18but then your budget is being hijacked in every October.
40:23Because how can you do a 15-year plan when your budget is only annual budget?
40:29So, what is important to be done, you know in 15 years what you're going to do,
40:33calculate how much money is needed to do this in the next 15 years,
40:36then you work backwards.
40:38Then you work backwards.
40:40And for this to happen, you need the political support.
40:43The prime minister himself has to be the main person pushing the reform.
40:47We know the health ministry, they're working on certain part of the pillars already
40:50at the health ministry level.
40:52But for this kind of reform to take place at the national level,
40:56because this affects 36 million of the population.
41:00It will affect all of us.
41:02And today, many of us probably using the private sector,
41:04probably our own insurance, or probably you're under employment health benefit.
41:07And the moment you are out of work, you'll be going back to the public sector.
41:11That's right.
41:12So, similarly, all the members of parliament, I would like to urge them,
41:16now the parliament session is going on, it is a collective decision,
41:20it is a collective responsibility for all the single members of parliament
41:23sitting in the parliament to ensure this national agenda.
41:26And the prime minister must lead and support the Ministry of Health
41:30in the reform process.
41:31Thank you very much for that, Dr Arasu, Prof Amrahmi, as well as Prof Sharifa.
41:37Now, of course, healthcare overall is ultimately an investment in people.
41:41And as Malaysia balances fiscal realities with growing healthcare demands,
41:44the reminder is that sustainable solutions will require not just more spending,
41:49but smarter planning, stronger workforce strategies,
41:52and of course, a long-term commitment to keeping Malaysians healthy,
41:55productive and economically resilient.
41:58That's all we have time for today.
41:59I'm Tamina Khosji signing off for now.
42:01Here's to a productive week ahead.
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