Healthcare in Private and Public Sector

Surgery in Malaysia (Photo by Phalinn Ooi)

BY SBMEDIX

sbmedex from Canada, a former healthcare worker. He has been living and working in Malaysia (Kebansang Hospital and University of Malaysia)

In South East Asia, Malaysia appears to have one of the best healthcare programs for its citizens. Like most other countries, Malaysia has a dual tiered system of healthcare; one which is led by the government and funded by taxpayers and the booming private sector.

Malaysian citizens can access any public healthcare facility. Of course, they are free to choose the private sector if they can afford it. In general, no Malaysian citizen goes without healthcare.

The majority of older Malaysian healthcare workers have been trained in the UK, New Zealand, or Australia. The newer generation of healthcare workers are home trained. English is widely spoken everywhere and the staff are generally very hospitable.

There are public hospitals in almost every city that cover the majority of basic medical and surgical services. Patients who come to public hospitals only pay a nominal fee for selected procedures. Open heart surgery, for example, is free but the patient may have to pay for the heart valve. In case he is unable to pay, the hospital will involve social services and derive the funds from a charitable organization.

The biggest problem of the public health system in Malaysia is the low salary for healthcare workers. Thus, many doctors and nurses are now moving into private care. This leads to another issue with the public hospitals: while they do cover most basic healthcare services, there is often a serious shortage of specialists since they prefer to work in private clinics. Thus, in Malaysia it is not unusual to see many foreign doctors working in the public hospitals. The one big advantage of working in public healthcare institution is that the shifts are shorter, there are more holidays, and the pensions come with numerous lifelong benefits.

Today, the public health hospitals only account for 45% of the healthcare staff while looking after 70% of the population.

The private sector in Malaysia has been booming for several decades. It offers almost every type of medical and surgical service that can be found in Western countries. One area where the private sector has blossomed is cosmetic and plastic surgery. The desire to look young and beautiful has created a backlog of young and old Malaysians waiting to be cut or prodded with a needle.

Another area where the private sector has expanded significantly is in medical tourism. Many of the private hospitals in Malaysia offer state of the art facilities, and every possible amenity that a patient can want. In Malaysia, the cost is much lower than in South Korea, Hong Kong, or Singapore and thus, patients from India, Sri Lanka, Indonesia, neighboring Singapore, Hong Kong, and even Japan come to Malaysia for their medical treatment. Some of the best surgeons and physicians in Malaysia now work in private care and cater to medical tourists.

While the services and care of patients in private care are excellent, the same cannot be said in regard of the public hospitals. There is a general lack of urgency among healthcare staff to do things while at the same time bureaucracy seems to be causing bottlenecks everywhere. Patients often wait for weeks or months to see a specialist and cancellations in surgery are not uncommon. Beds in public hospitals are often difficult to access because most hospitals are full. There is little accountability of healthcare providers in public hospitals and most of the services are delivered by junior doctors or doctors in training. Patients are often left at the mercy of the healthcare providers and most Malaysians would prefer to get their care in private practice. Unfortunately, it is prohibitively expensive for locals to pay out of the pocket for private healthcare in Malaysia. Since all of private healthcare is for profit, prices of all medical services and surgeries are high. As a result, only the wealthy or people with a private health insurance have access to private healthcare.

For medical tourists, however, the costs are much lower compared with their own country. Plus, Malaysian medical tourism also offers package deals with sightseeing and stay in five-star hotels. According to The Health Ministry, Malaysia welcomed about 850,000 medical tourists in 2015 with revenue amounting to more than RM900mil compared with RM777mil in 2014. Within the past 5 years, the number of medical tourists coming to Malaysia went up by about 100%.

Today, there appears to be no integration between public and private healthcare in Malaysia. And like in most countries the cost of healthcare in Malaysia appears to be skyrocketing while at the same time Government subsidies has been decreasing. It is doubtful if private healthcare will vanish any time soon; more likely there will be better regulation of the public health care and more incentives for healthcare workers to remain with the Government rather than seek greener pastures in private practice.

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