Providing patients quality service

Saturday March 14, 2009
Providing patients quality service


MALAYSIA’S healthcare problems are two-fold. While the poor are forced to contend with the difficulties and inefficiencies of the public sector, many of those who prefer to go to private clinics and hospitals are struggling to pay for the medical services.

This suggests that people go to government doctors only because they have to. Does that reflect the quality of the services in the public healthcare system?

Gleneagles Penang consultant general surgeon Dr Vimal K. Vasudeavan says he enjoyed his 16 years of service at the Taiping General Hospital, providing care to patients, especially those with nowhere else to go.

“People do not realise the workload of public sector doctors is very heavy. Doctors don’t get the credit they deserve. The procedures we do in the public sector are very high-end. The drugs and equipment used are of the latest technologies,” he says.

In fact, because treatment is more expensive in the private sector, sometimes the doctors don’t use the most advanced equipment because they would otherwise have to charge more.

In this respect, Vimal says, patients in the public sector sometimes benefit more.

He feels that doctors in the public sector are unfairly criticised. “You get the good and the bad, whether in the public or private sector. Not all private sector doctors are brilliant.

“Eventually, public sector doctors go to the private sector because the money is better. If the doctor has worked longer in the public hospital, he would have seen a great number of patients. Hence, he is better,” he argues.

Dr Kong Chee Kwan, a medical officer with Universiti Malaya Medical Centre’s surgical department, says surgeries for hernia, knee or hip replacement, and removal of gall bladder stones can have a waiting list of two to three months, and sometimes longer.

“Such cases aren’t considered life-threatening, although there can sometimes cause pain and discomfort. Due to the long waiting list, the patient has no choice but to wait,” he adds. However, he feels that in the case of life-threatening conditions, public hospitals are generally efficient.

Vimal would like to see the public sector doctors being rewarded on merit. He says these doctors ought to be appreciated by the patients and their relatives, and by the Health Ministry.

“Many doctors, especially those who have reached their 40s, will think of leaving when the monetary factor becomes more important. When the senior doctors leave, there is not only a brain drain, but the juniors are unable to learn from the experience and expertise of the seniors. That training opportunity is gone,” he says.

Kong says when doctors are on call, they are entitled to an allowance of RM150 per day, which works out to RM6.25 per hour.

“The workload is heavy and because we are always being rotated, we don’t have a personal relationship with patients as the doctors in the private sector do,” he says. Not surprisingly, he plans to move to the private sector once he obtains his surgical specialisation qualifications.

There is little doubt that government doctors are overworked, and it will get worse as the economy slows down, forcing more people to rely on the public healthcare system.

The Government handles 75% of Malaysia’s healthcare needs. The Health Ministry provides virtually free services to civil servants, pensioners, their dependents and the poor.

Of the 22,500 medical practitioners in 2007, 13,500 were in the public sector and the rest in the private sector.

While statistics are not publicly available, studies have shown that the public sector treats three and a half times as many inpatients compared to the private sector, and public beds constitute more than three quarters of all hospital beds.

Public facilities also treat six to seven times as many outpatients as private hospitals.

With the public healthcare sector being so heavily subsidised, the Government recovers only 3% of its annual operating budget.

The Health Ministry’s operating expenditure has increased from almost RM3bil in 1996 to close to RM12bil in 2008. However, Malaysia’s healthcare spending (approximately 2% of GDP) is considered modest when compared with that of Singapore (3.7%) and Thailand (3% to 3.5%).

The World Health Organisation says a country should budget a minimum of 5% of its GDP for healthcare services.

Dr Chan Chee Khoon, professor and convenor for health and social policy research cluster at Universiti Sains Malaysia, says the Malaysian public sector healthcare is underfunded.

“Widely accessible, well-funded, adequately staffed, competent healthcare provided by the public sector can be a fallback option that can serve as a price bulwark and hence restrain price increases in the private sector,” he says.

“In Singapore, for instance, the government’s strategically located and well-equipped polyclinics account for only 20% of primary healthcare on the island, but their subsidised outpatient services provide sufficient price competition to help restrain fee increases of the private clinics. In Hong Kong, well-remunerated and adequately-staffed public sector healthcare achieves a similar effect.”