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

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

• Hariz Iskandar Hassan

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Chapter 1 Politics in Medicine
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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.

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Extent of Power

• Administration
• Development of new healthcare services e.g
  hospitals, clinics, vaccination, etc.
• Appointment Dismissal
• Budget
• Etc

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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.

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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.

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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.

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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.

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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.

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Chapter 2 Public Service vs. Private Service
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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, gt14 of GDP spent on healthcare
  services)
• Human Development Report in 2006 by UNDP

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Healthcare Services

• 2004 Private sector in Malaysia only accounted
  for 20 of the countrys 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.

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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.

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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!

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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.

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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 -gt the ministers should
  take note.

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

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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.

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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).

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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.

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Solutions

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

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References

• http//www.pmo.gov.my/WebNotesApp/PastPM.nsf/a3105
  90c7cafaaae48256db4001773ea/e59bbd5eccda3c3b482567
  4a002235e5?OpenDocument 
• http//msia-indians.blogspot.com/2007/02/overview-
  of-malaysias-healthcare-system_17.html 
• http//www.annals.edu.sg/pdf/35VolNo1200601/V35N1p
  60.pdf 
• http//www.mma.org.my
• http//www.hospitals-malaysia.org
• http//www.mmc.gov.my