Time to revamp Malaysia’s healthcare system, says ex-DG

Former health director-general Dr Mohd Ismail Merican says there must be political will to make changes. (Facebook pic)

GEORGE TOWN: A former top health official today offered suggestions on how to overhaul the country’s healthcare system and wean it off public funds.

Former health director-general Dr Mohd Ismail Merican said he had three ideas to improve healthcare in the long run. The first was to form an alliance with public and private healthcare sectors, the second was to strengthen primary care (typically outpatient treatment) and third, a new national healthcare financing system.

He said if there was an integration of the private and public sectors, overcrowding would be lessened, resources might be shared and general practitioners would be more eager to open up clinics in rural and underserved areas.

“There has been mismatches in resources and workload between the public and private sectors. The public sector handles 60% of general healthcare while the private sector has a 23% share,” he said.

Ismail proposed a regional healthcare service which might even be self-funded by imposing mandatory premiums on those who could afford and providing free medical care to those who couldn’t.

Ismail said once the reforms of the government healthcare system was completed, the authorities must aim to devolve powers to an area health authority, which might be divided into regions in the country.

He said full autonomy would be given to these new bodies, where they were given a set funding and the authority to devise plans for the areas on their own.

Ismail said these newly-formed bodies would follow guidelines and safeguards by the ministry. He said the area authorities would cut down the need for patients to travel to other state hospitals to seek specialist treatments. This would then ensure a better healthcare delivery to taxpayers.

He gave an example of a heart patient being able to seek treatment at a general hospital instead of going to the National Heart Institute, or IJN, which is the practice now.

“But if they cannot do the procedures at the local hospitals, then patients can be referred to IJN. Patients ideally should be managed at the cardiac centres in the authority’s area itself,” he said.

Ismail said Health Minister Dzulkefly Ahmad and the government must have the political will to make changes for the better. He urged them to take the time to listen to experts before making decisions.

“The days of ‘government knows best’ is over. The people know what they want, and it is pointless making decisions in the boardrooms anymore.

“The KKM (Malay acronym for the health ministry) is often called the Kementerian Kekerapan Mesyuarat (ministry of regular meetings). I know this, we have a habit of having meetings all day long. We should be less punitive and become more customer-friendly.

“Once upon a time, we often heard our healthcare was one of the best in the world. Today, I will say it is a ‘yes’ and ‘no’ at the same time, as there are many areas left to be desired.

“On May 9, we surprised the world, but let’s surprise the world again by having an all-encompassing, affordable and quality healthcare system,” he said at a talk hosted by the Galen Centre for Health and Social Policy in Kuala Lumpur today.

Dr Ismail said at present, the medical service had an air of “despondency”, where workers were working hard to please their bosses rather than patients, through “unnecessary KPIs” created to impress bosses.

He said this had led to a deterioration in handling matters such as dengue and the hand, foot and mouth diseases (HFMD).

“Our tried-and-tested gotong-royong (for dengue) has not been working, even our vector control is not effective. Instead of old measures, we should have strict enforcement and new strategies.

“There are a lot of avoidable errors… but there is an air of despondency with healthcare. The most common response we get is ‘budget has been cut’, ‘nothing we can do’ and ‘biasalah’ (that’s normal),” he said.

Ismail said Malaysia’s healthcare system could only change if the government leaders “dared to make decisions” and had the political will to do so.

“The mindset change depends on the leader, if you have a leader who wants to do the best for the country on healthcare, then he or she must dare to make decisions.

“But if we have someone who wants to be popular, then we have a problem.”