KUALA LUMPUR: Malaysia's health system is struggling to meet the current needs of the population, just as other countries globally are facing a similar predicament.
Health Minister Khairy Jamaluddin said the current health systems are arguably stuck in the paradigms of the past and the incremental improvements to old models no longer suffice.
"There are enough indications that our health system is struggling to meet the current health needs of the population, problems faced by many countries around the world.
"The situation naturally worsened during the Covid pandemic when there was a sharp surge in demand for health care that overwhelmed the healthcare system.
"The pandemic has brought many issues into sharper focus, not least issues of sustainability and how prepared we are for the future," he said today.
Khairy said this at the Public Health Thought Leadership Dialogue: "Future-Proofing Public Health Care" held at NUW Saw Swee Hock School of Public Health in Singapore, today.
The Health Minister said future-proofing required the country to make some significant structural changes to the way the healthcare system is organised, financed and governed.
"We need to build back better towards resilience, towards a resilient health system that is capable of absorbing shocks such as public health emergencies, of managing demographic challenges like an ageing population and dealing with the effects of climate change," he said.
He said Malaysia is in the midst of developing a Health White Paper aimed at making the case for structural changes in future-proofing the country's healthcare system.
Khairy adds his Ministry is looking at reform involving four broad areas – equitability of access; sustainable healthcare financing; governance, oversight, and accountability; and bringing 'health' back to healthcare.
He explained that to future-proof equitability of access to Malaysia, there is a need for greater public-private partnership.
"I have to admit, the public and private sectors are not yet well integrated. Malaysia's dual healthcare system is dichotomous, with the primarily tax-funded public sector on one hand, and fee-for-service private sector providers on a parallel track, funded primarily via for-profit private insurance and out-of-pocket payments.
"The public sector caters for two-thirds of outpatient and inpatient cases, but 75 per cent of specialists in Malaysia are in the private sector.
"Resources, burden of work and data are not easily shared between the two sectors, leading to delays in diagnosis and treatment, unnecessary repeat investigations and added costs.
He said the Health Ministry is planning to expand the public-private partnerships to effectively maximise all existing healthcare capacity in the country.
He adds that close partnership between sectors can also increase treatment options for lower- and middle-income groups, including oral health services, traditional and complementary medicine services which are mainly driven by the private sector.
"To 'future-proof' this for Malaysia however, several structural changes need to happen including the development of feasible payment models, strengthening strategic purchasing, ensuring good demand mapping as well as putting in place better processes and tools for referrals and consultation which includes shareable electronic medical records.
"As a first step, one of the key structural reforms that Malaysia is currently studying is to grant greater operational autonomy to our public hospitals, so that these overburdened and constrained flagship institutions are given the room to be more responsive to the changing needs of the population.
"We intend for this change to also facilitate better integration and public-private partnerships."
On sustainable healthcare financing, he said the public healthcare system is chronically under-funded, which results in a plethora of issues.
"From understaffing to badly maintained infrastructure to outdated equipment.
"With limited publicly managed funds, opportunities to integrate the public and private sectors through strategic purchasing are also severely limited. All these issues contribute to high out-of-pocket payments."
He said the government is discussing raising allocations for healthcare spending to solve the issue.
"Malaysia's total healthcare spending to GDP (Gross Domestic Product) ratio, at 4.7 per cent, is far below the middle-income country average of 6.6 per cent.
"If you stripped that and you look at Malaysia's spending on public sector healthcare is at 2.6 per cent of GDP, also below the average of 4 per cent GDP among middle-income countries and below the 5-6 per cent of GDP recommended by the World Health Organisation."
He added Malaysia needs a dedicated healthcare fund that is both tax-funded and that is supported by contributions from the people who can afford it if the country wants a future-proofed Malaysia's healthcare system.
"For equity, contributions into the healthcare fund should be on a sliding scale in line with an individual's income, and be fully subsidised or waived for low-income groups.
"One of the critical missions of the Malaysian Health White Paper is to put forward a statement of intent on how the country's healthcare model can be put on a sustainable footing, at the same time addressing past legitimate concerns on the architecture, phasing, costs and governance of this reform," he said.
On governance, oversight and accountability, he said the ministry would seek bi-partisan support for the proposed reforms contained within the Health White Paper by tabling the White Paper to Parliament.
"To be clear, there will still be many details and plans of action that will need to be worked out in the immediate coming years.
"But by having bi-partisan agreement, a national green light as it were, on the overall principles and direction of structural reforms for Malaysia's healthcare system, is absolutely critical."
Khairy also highlighted the need to shift from a curative and treatment-focused mindset to a focus on wellness and preventative or promotive healthcare.
"In this regard, we have started the 'Agenda Nasional Malaysia Sihat' or the 'Healthy Malaysia National Agenda', which is a cross-stakeholder 'whole of society' platform set up in 2021, involving relevant ministries, private sector organisations and civil society organisations.
"To strengthen the programme and partnerships together with the community by changing the way we live, not just in terms of the healthcare system, but every other determinant that is important to healthcare outcomes."