A Discourse on Politics and Current Issues in Healthcare System in Malaysia.

1. A Discourse on Politics and Current Issues in Healthcare System in Malaysia. Hariz Iskandar Hassan

2. Chapter 1: Politics in Medicine

3. The Constitution • Every medical practitioner in Malaysia must be fully registered with Malaysian Medical Council (MMC). • Medical Act 1971 • Ministry of Health - led by the Minister of Health • Minister of Health appointed by the Prime Minister after General Election (held every 5 years) – appointment of officers at all levels.

4. Extent of Power • Administration • Development of new healthcare services e.g hospitals, clinics, vaccination, etc. • Appointment – Dismissal • Budget • Etc…

5. Politicians vs. Physicians • Very few politicians are medically oriented. • Implementation of new system. • Small number of medical representatives in the parliament. • Politicians have a greater power. • They have no experience or direct contact. • Personal agenda. • Not all physicians are united – societies/associations registered but not active.

6. When Do Problems Arise? • Politicians and physicians do not agree on the new system (either proposed or have been implemented). • Current example: Alternative Medicine. • Money wasted. • Rigid regulations • Unnecessary examinations for physicians e.g endless tests on patriotism, patriotic camps for every promotion etc. • Corruption at all levels/ Institutional corruption.

7. Worldwide Corruption Perceptions published by Transparency International • The higher the index – more transparent, less corrupt. • In 2007: • Malaysia – 43rd, 5.1% • Czech Republic – 41st, 5.2% • The most transparent country is Denmark. • The least transparent country is Somalia.

8. Consequences • The public who suffer. • Prolong development of healthcare system. • Physicians are not able to work efficiently. • Research programs are not fully funded. • Lack of understanding and cooperation.

9. Proposed Solutions • A separate body which is independent of any political party or political agenda must be formed in regulating any health issues that matter. • Minimize corruption – new laws and regulations. • Leave the medical practice to those who are qualified – only get involved when it is needed. • Unnecessary implementation of new system must be reviewed by those who are qualified.

10. Chapter 2: Public Service vs. Private Service

11. Healthcare Services • The percentage of GDP spent by Malaysia on healthcare services is below 5%. • In 2003 - total expenditure 3.8% of GDP • 2.2% - Public Sector • 1.6% - Private Sector • (In the US, >14% of GDP spent on healthcare services) • Human Development Report in 2006 by UNDP

13. Healthcare Services • 2004 – Private sector in Malaysia only accounted for 20% of the country’s hospital beds. • It employed almost 54% of the doctors in Malaysia. • 1990-2004  70 Physicians for 100000 patients. • 70% of specialists are in private sector.

14. Problems • Imparity between public service and private service. • Lack of quality in public service: • Understaffed • physicians working long hours • quality of treatment • long waiting list • The use of advanced treatment in private service.

15. Problems • Private sector appeals more to the physicians due to higher salaries and better working environment – stiff competition. • Current implementations of healthcare service like medical hub in SEA, alternative medicine, health tourism are not effective!

17. Consequences to the Public • Not everyone can afford private service. • People in Malaysia are not exposed to the importance of health insurance – very few are covered. • Danger in treating patients as there is a lack of medical practitioners including nurses.

18. Proposed Solutions • A better scheme should be introduced to attract more physicians to stay in the government service e.g higher salary, opportunity of research and further training. • Money should be spent wisely – improve the service for the public -> the ministers should take note.

19. Chapter 3: The Influence of Religious and Cultural Belief in Medical Practice.

20. Problems • Extreme religious group of physicians exist in Malaysia (especially when they come back from overseas). • Narrow minded thinking. • Against a few ideas in medicine e.g direct contact between men and women. • Superstitious ideas of treatment and cure. • Alternative medicine which has not been proven by scientific research.

21. Alternative Medicine • Not all alternative medicines have been proven effective – no cross reactions tests and chemical analysis. • 1997 - Americans spent USD 3.24 billion on herbal products and herbal medication whereas Malaysians spent USD 2 billion. • Each American spent about RM45 on herbals, each Malaysian spent RM91, which is twice as much, taking into account populations of 273 million and 22 million respectively.

22. Alternative Medicine • Alternative medical practice is based on the influence of culture and religion. • It is also a ‘promising’ business with high profits. • Some doctors are against it but some have been supportive especially in Malaysia. • Prime Minister announced in Oct 2007 – Malaysia will invest more than RM200mil (~USD90mil).

23. Prejudice • HIV/AIDS patients have to pay twice the service fee in some hospitals in Malaysia e.g HUKM. • Sexual Transmitted Diseases and Sexual Education are considered taboo. • But sex before marriage is high regardless of religions and races – people are in denial. • Homosexuality – discrimination due to misunderstanding and lack of knowledge.

24. Solutions • Education • Physicians must be open minded – no discrimination. • Every delicate issue must be handled professionally. • Not just medically oriented but all rounded.

25. References • http://www.pmo.gov.my/WebNotesApp/PastPM.nsf/a310590c7cafaaae48256db4001773ea/e59bbd5eccda3c3b4825674a002235e5?OpenDocument • http://msia-indians.blogspot.com/2007/02/overview-of-malaysias-healthcare-system_17.html • http://www.annals.edu.sg/pdf/35VolNo1200601/V35N1p60.pdf • http://www.mma.org.my • http://www.hospitals-malaysia.org • http://www.mmc.gov.my