Here lies the paradox: the government spends billions annually on public healthcare, providing quality treatment for the masses, but struggles with overcrowding, long waits, low doctors' salaries, and high turnover of key medical staff. Despite having state-of-the-art equipment and medical expertise, which has led to public hospitals being highly rated even by foreigners, the problem arises when these public facilities become too popular.
Back in 2019, around 77 million people sought treatment at public hospitals, a significant increase from just 17 million in 2008. Five years later, with healthcare being a major concern and private treatment beyond affordability for many, patient numbers have surged even further, exceeding the annual 77 million as public hospitals continue to grapple with capacity issues.
A case in point is the Kulai Health Clinic, which Johor Menteri Besar Datuk Onn Hafiz Ghazi visited during a spot check. He found the clinic struggling with insufficient equipment, worn-out facilities in the waiting lounge, and a lack of X-ray and ultrasound machines, all while treating 1,000 patients daily—clearly beyond its capacity. Onn Hafiz emphasized the need for the Johor government to collaborate with the Health Ministry to extend "excellent healthcare services," a pledge that has been underappreciated.
Public hospitals, which number 146, are often filled with people on tight budgets looking for quality healthcare. Unlike private hospitals, which can be prohibitively expensive unless one has high-premium medical insurance, public hospitals and even semi-private facilities charge nominal or minimal fees. This affordability, coupled with the competence and reliability of public hospitals, makes them a crucial part of the healthcare system. However, the situation is complicated by the fact that government doctors, especially the younger generation, are often underpaid. This issue is exacerbated by cyclical shortages of specialists, nursing staff, and beds, highlighting a generational and economic problem.
Improving salaries, allowances, and benefits for key medical staff could help retain them, but the government faces a challenge. It cannot continuously replace departing staff with new doctors serving their bonds or hire more expensive contractual specialists. This problem is further compounded by the rejection of pleas for higher on-call allowances, as doctors cannot be paid more than other civil servants. As a result, there is a steady attrition of medical staff lured away by the private sector's more attractive compensation packages.
Ironically, while the government is frugal in other areas, it does not hesitate to spend on healthcare maintenance and the construction of new hospitals and clinics. However, it remains unwilling to make exceptions for key medical staff's salaries. With overcrowding and a shortage of beds persisting, further aggravated by an increase in migrant workers, there is an evident need for more and larger facilities, as well as an increase in the number of medical staff.
Despite these challenges, Malaysians continue to trust and rate their healthcare system highly, often more favorably than the more advanced facilities found in the United States and Britain. This sentiment is shared by foreigners; in 2019, Malaysia attracted 1.3 million international healthcare tourists who spent US$380 million on hospital expenses. This indicates a high level of confidence in the country's healthcare system. However, if the fundamental issues related to infrastructure and basic services are not addressed, this confidence could be undermined.