What’s ahead for healthcare?

HEALTH Minister Dr Dzulkefly Ahmad, among other measures, has promised to reduce the waiting time at public hospitals. This is a good first move. It shows responsiveness to the needs of the people.

There is a lot more that has to be done given the huge neglect that healthcare has faced in the last several decades.

First, healthcare has to be approached holistically. Healthcare (and its lack) occurs within the context of society, ie cultural values, income inequality, economic opportunities and public awareness, not to mention other factors.

Some of these factors can be addressed by the Ministry of Health (MoH) while others cannot.

Two issues that fall within the ambit of MoH are primary healthcare and public awareness. Primary healthcare is the service provided by general practitioners, community pharmacists, opticians and dentists. It includes the diagnosis and treatment provided by these practitioners, health education, disease prevention and screening.

Public awareness is important because it addresses "lifestyle" diseases such as diabetes and cardiac disorders. There is some evidence that cancer can, in some instances, be lifestyle related, too.

These diseases are on the rise and impose a heavy cost on the public health system. They will be a greater source of expenditure on the public system as Malaysia's population ages.

Creating more awareness about the causes of diseases and their preventability will help reduce their incidence.

Communicable diseases (eg TB) can also be prevented or reduced. Diseases such as dengue can be prevented through proper vector control.

If people take better care of themselves and their environments, they will not be adding to the long queues at the public hospitals. That is why due consideration must be paid to primary healthcare.

Second, a comprehensive health financing scheme is overdue. This has been postponed for far too long, with numerous studies having been conducted and no action taken.

Health financing cannot be ignored as a larger proportion of Malaysia's population grows older. It is estimated that by 2030, about 14% of the population would be aged 60% and above.

What that means is that by 2030, there will be more senior citizens, more people with health problems, longer queues at public hospitals, and the government having to bear higher medical costs.

Third, the government will have to review forthcoming trade agreements so as to avoid any agreement that will increase the cost of healthcare. There may not have been adequate discussion on these issues for previous free trade agreements.

Fourth, firm action must be taken against pharmaceutical companies that engage in anti-competitive practices. A thorough study must be conducted to determine if there is presumption of companies exercising monopoly power and unfairly raising the prices of drugs.

Fifth, MoH must visit the question of separating the functions of medical doctors from pharmacists. A study must be conducted to understand the feasibility and efficiency of such a separation of duties.

Appropriate policies should be introduced if the separation of functions is found to be beneficial, and, helpful, in reducing the cost of healthcare.

Sixth, an adequate response is necessary to the increasing supply of medical graduates. MoH should find ways of absorbing these graduates because they improve the population's access to doctors.

A favourable ratio of doctors to the national population is a positive attribute.

Not only should this ratio be satisfactory for the nation as a whole, it should also apply to rural areas.

Seventh, new models of hospitals should be explored. It would be fruitful to consider if new models of pricing by public hospitals can be applied.

Budget airlines have made travelling affordable. The concept of budget hospitals and alternate forms of price discrimination can be studied.

Public hospitals can cater to senior citizens and the bottom 30 while private hospitals are doing a good job of attending to the top 20. Alternative models are necessary for the middle 50.

Finally, the government should play an active role in making healthcare accessible and affordable. True, Malaysia has a good model; but that does not mean that it cannot improve existing facilities.

The American system of access to health- care on the basis of payment is a flawed one.

Malaysia's currently troubled fiscal condition may not allow a transition to a state-run healthcare system as practised by Canada, Australia and the UK. A middle path is necessary.

If countries like Taiwan can effectively intervene in the healthcare market, why not Malaysia?

Dr Shankaran Nambiar is a senior research fellow at the Malaysian Institute of Economic Research. He is author of The Malaysian Economy: Rethinking Policies and Purposes and Malaysia in Troubled Times. Comments: letters@thesundaily.com