By CHRISTIE CHUA
The need for a well-established and progressive healthcare industry is now seen as one of the pressing needs in any country.
The well-being of people is seen as a core aspect by many nations around the world and huge investments are sourced to ensure that people are given the best healthcare possible.
Malaysia too has been competing with other countries around the globe to ensure that we are one of the best healthcare service providers.
Though dealing with the growing demand within the nation is seen as a challenge, Malaysia has always been positive in moving forward and meeting the demands of local patients as well as medical tourists from abroad.
There is a growing subsector of the Malaysian healthcare industry known as medical tourism, where tourists visit the country for medical purposes because the quality of treatment that is available to them here, which is comparable to that in their home countries, but at a far more affordable rate.
The recent data from the Malaysia Healthcare Travel Council (MHTC) shows that the number of medical travellers to our country has increased since 2011, reaching an all-time high of 1.05 million travellers last year.
In fact, MHTC bagged the ‘Medical Travel Organization of the Year Award’ at the 2018 Asia Pacific Healthcare and Medical Tourism Awards for the second year in a row – a testament to the standard of care our private hospitals are capable of providing.
The healthcare system in our country is a two-tiered one: a government-led and tax-funded public sector that is available to all citizens at heavily subsidised costs, and a private sector that is fee-for-service, in which patients pay according to the type of healthcare service rendered to them.
Since public healthcare is subsidised, patients – especially those who cannot afford private healthcare – tend to flock to public facilities and hospitals in order to receive the medical care they need.
Tackling the imbalance
One common grouse among Malaysians is definitely our public healthcare system that lacks proper distribution in terms of medical personnel. Appointments with doctors may take many months and treatments or follow-ups can lead to agitating delays.
This is because while approximately 70% of healthcare in the country is delivered by the public sector, it is served by just about 45% of all registered doctors. The private sector, on the other hand, caters to only about 30% of the population, but is made up of around 55% of all registered doctors.
The repercussion is that the public sector is overcrowded, which leads to long waiting times and delays in treatment, while the private sector is underutilised, with most private hospitals having 20% of their beds underutilised most of the time.
The cost of providing private healthcare continues to rise, due to the escalating costs of medical supplies and technology. As a result, more and more people are opting for public healthcare. This further puts much strain on the public sector’s capacity to provide timely medical care.
Datuk Dr Jacob Thomas, the Private Healthcare Productivity Nexus (PHPN) Champion for the Malaysia Productivity Corporation (MPC), says that this imbalance between the public and private healthcare sectors is not productive, as we are not maximising the available resources that we currently have.
He states: “We already have world-class infrastructure in place – even in the public hospitals where we have the latest in equipment, and doctors are highly qualified and experienced. Treatment is also readily accessible compared to many other countries. The issue, however, is that the distribution of these facilities and services is not even.
“On one hand you have the public sector, where the hospitals are stretched to the maximum with overwhelming demand for beds and facilities (like operation theatre time) whilst on the other hand, you have the private sector, with many empty beds and ample operation theatres which are not being fully utilised. This is surely not efficient.”
The challenges faced by both of these sectors are inextricably linked, and Dr Thomas believes that we need to consider a new healthcare model that will allow both sectors to share currently available resources, thus resolving issues with capacity and productivity.
1) Public-private partnerships
According to Dr Thomas, the government and the Ministry of Health (MOH) are currently looking into the idea of a national insurance scheme.
He envisions Malaysians making a monthly contribution to the scheme, and when they are in need of medical attention, they would be able to seek treatment from any hospital, be it public or private. The cost of the treatment would then be reimbursed by the scheme.
One might say that it would then be unfair for those who are actually paying out of their own pockets for treatment at private hospitals, but Dr Thomas cites a model which has been successfully implemented and can benefit everyone involved.
He explains that in Australia, there are large public hospitals managed by the private sector that have a designated wing for patients who are covered by the national insurance scheme, while another wing caters to self-paying patients who can afford to pay more and therefore get better rooms and facilities. However, the medical staff who serve both these wings can be the same individuals.
“The public-private partnership is alive there, and it works very well. So why can’t we introduce something like that here?” asks Dr Thomas.
It is clear that we cannot replicate all the healthcare best practices of other countries in our environment due to differences in medical needs, diseases and even culture. However, we can surely adapt those best practices which meet our needs.
“As it is, the World Health Organization (WHO) thinks that Malaysian healthcare is of a very high standard,” shares Dr Thomas. “So, we don’t want to change what we already do well, but we want to realign and refocus on areas that we can do even better.”
2) Private-private partnerships
The biggest challenge in the private healthcare sector is keeping operating costs low, so that it translates into more affordable medical care for patients.
“If you don’t pay your staff adequately and retain talent, they will leave. If you don’t invest adequately in expensive technology and make it available, patients will go elsewhere. If you don’t buy the medicines with the best effects, the patient outcomes might not be good,” Dr Thomas elaborates. “It boils down to managing these resources and talents efficiently. It comes back to being productive.”
When asked about the investments in facilities, he had this to say: “If you build a new hospital but your operation theatres are empty, that’s a waste. Or, if you buy equipment like an MRI machine but only use it 25% of the time, that’s not being productive, because you’re not maximising a very expensive resource.”
How then, can we encourage productivity in the industry?
Dr Thomas suggests that not every private hospital needs to buy the full range of state-of-the-art medical equipment, which is expensive – they should instead, for a start, make full use of what they already have.
He adds that if two private hospitals are located near each other, he does not see why they both cannot share their expensive equipment.
“You can send some patients over to one hospital for an MRI, and that hospital can send some patients over for a CT scan – it doesn’t make either hospital look less efficient or credible.” This requires a change of mindset in the way we provide services today.
On the brink of change
Dr Thomas says that at the moment, there is still a clear delineation between the public and private sectors, but this is slowly changing as the MOH is becoming more open to deliberate on issues affecting the private sector and how to engage with them as partners.
“I believe it’s going to be a national healthcare productivity agenda in the end – we’ve certainly got all the ingredients,” says Dr Thomas optimistically.
At present, the PHPN is seeking to fully utilise the industry’s current assets and identify new areas that require attention. This includes technology and innovation, the medical workforce and their capabilities, as well as outdated regulations which may be hampering progress.
He is positive about having real change in the near future because of the way the PHPN is structured. PHPN serves as a platform to drive multi-stakeholder initiatives to increase productivity in the Private Healthcare subsector.
The PHPN is tasked to identify immediate as well as long-term initiatives that will empower private healthcare players to augment productivity. Apart from that, the PHPN also facilitates and complements existing and future initiatives which are in line with the MOH’s direction.
“We were told to come up with a wish list,” shares Dr Thomas. “We were told not to think about whether it will work or not. ‘If you encounter hurdles, bring it up to us.’ We’re fortunate that our new health minister is also very keen on the public-private partnership. We know we cannot continue as before, so we need to work together to make this change happen – and we need it to happen soon.”
“In the end, we want our Malaysian healthcare to be accessible for all and of the highest quality. If patients need treatment, they will get the best treatment possible in a timely manner. All these efforts will also help ensure that our patients have good outcomes,” Dr Thomas concludes.