Malaysia’s Health Agenda: Complex But Crucial – Nadiah Wan

As we await another changing of the guard in our line of policymakers, I want to share some of my thoughts on some important conversations that you shouldn’t miss as you speak about our nation’s vision for health and a healthy population.

Development of a holistic health policy

Health is not just the domain of the Department of Health (MOH) per se. There are various sectors and issues that affect healthcare system performance and population health outcomes.

For example, social determinants of health (SDH)—that is, nonmedical factors such as income, housing, food security, early childhood development, and others—have a tremendous impact on health outcomes.

According to the World Health Organization (WHO), SDH factors can account for between 30 and 55 percent of health outcomes. More importantly, social, behavioral and environmental factors alone account for 70 percent of the determinants of health.

By not introducing health-related policies as part of other departmental plans, and by creating interdepartmental platforms to address these issues, we are effectively ignoring much of what leads to good health outcomes. Additionally, private companies can and should do more to assess and address these issues as part of their overall environmental, social and governance (ESG) commitments.

A coherent human capital development strategy and policy

Training health professionals is long and arduous, not least because it often relies not only on classroom learning but also on hands-on training with real-life patients.

University hospitals and postgraduate programs fall under the purview of the Department of Higher Education, while MOH also offers parallel pathways to specialization and training programs for nurses and allied health professionals.

Training offered or sponsored by the private sector also often relies on MOH hospitals as the clinical basis for training. The Covid pandemic has disrupted many of these training programs, putting the future talent pipeline at risk.

Meanwhile, Malaysian trained nurses, doctors and allied health workers continue to travel to other countries due to the devaluation of our ringgit, rising inflation and increased demand for health workers in other countries.

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While I support changes to the Employment Act that include better regulation of working hours and longer maternity leave, the truth is that for a sector that suffers from chronic labor shortages and predominantly employs women of childbearing age, these measures are likely to result in more labor crunch .

Countries like Singapore and even Indonesia, which have had very inflexible policies in the past, have moved to liberalize their healthcare labor markets to address these issues, admit foreign workers to healthcare, and revise healthcare workforce quotas and employment regulations.

Unless global and structural trends reverse, Malaysia needs to start planning for similar liberalization while ensuring the quality and security of supply is maintained.

Public-private partnership for resilience

The Covid pandemic has made it clear to all of us that a parallel public and private system with very few intersections is not resilient. It took a global pandemic to snap us out of our inertia, and in two years we’ve managed to achieve things that many had talked about but never secretly believed would happen — things like outsourcing healthcare services to the public sector, or almost a national immunization campaign being carried out entirely by private healthcare providers and other services.

It is to the MOH’s credit that in times of crisis it brought together all the actors from the private sector and civil society.

However, the danger usually exists when the crisis is over. In the absence of an immediate need, these initiatives were held back.

Significantly, the 2023 Budget announced earlier this month made no mention of strengthening outsourcing initiatives to the private sector.

The mechanisms by which these public-private partnership (PPP) initiatives have been implemented must be maintained, even if they have not been implemented to the required extent during the Covid pandemic.

By continuing these initiatives, improvements can be made to policies, processes, and communication channels, allowing all parties to respond immediately when needed.

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Ongoing PPP initiatives can also serve as a catalyst to explore other areas of potential collaboration, especially in a highly volatile world where major risks can materialize quickly, whether it be floods due to climate change or supply chain disruptions from wars.

Reform of health financing takes all hands

Politicians often look for the perfect solution to the holy trinity of cost, quality and access.

As with other economic policies, the debate often boils down to a philosophical debate – should the Rakyat be responsible for some of the cost of their healthcare, as the cost depends in no small measure on their own way of life.

Driven by changing demographics, greater economic forces, evolving regulations, technology and innovation, and other factors, our healthcare inflation rates have consistently outperformed national inflation.

The government, stuck between the proverbial rock and the hard place, needs to get serious about health-finance reform to find a viable way forward.

Social and private health insurance schemes need serious consideration, along with a review of how healthcare costs are accounted for and budgeted for in both the private and public sectors.

Areas of urgent need include mental health, aging and geriatrics, and preventive healthcare, which are traditionally excluded from most private health plans and are seeing increasing co-payments.

It will take collective leadership from both the public and private sectors to enact the scale of reforms we need within the tight fiscal space we have as a country.

health as an economic sector

The 12th Malaysia Plan had identified medical tourism as an economic sector to be developed. Covid has massively disrupted this market and the recovery has been slower than expected.

During the lockdowns in Asia, countries in Eastern Europe seized the opportunity to develop further in this area, with Turkey, Croatia and others benefiting from increasing inflows of medical tourists from Europe and the Middle East.

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While it is understandable that the focus of the MOH was on ensuring the health of our own people, it would be foolish to ignore the economic potential of our investments in the healthcare system.

The development of the medical tourism sector and the healthcare economy sector goes beyond the Malaysia Healthcare Travel Council as an intermediary.

There needs to be thoughtful industry policy and planning, as well as a more robust framework that encompasses not only healthcare providers, but also payers, suppliers and others within the healthcare ecosystem.

Eventually, a thriving private healthcare sector and foreign inflows from medical tourism will allow us to develop and fund further investment in the healthcare system that also serves the Malaysians.

Finally

Health means many things to many people. It’s not just about actual delivery and access to care; It is also about job creation and talent development, funding and investment, and building and maintaining resilience.

No complex problem has a simple answer, but I hope that public and private sector leaders are ready to come together to focus on a comprehensive agenda with clear outcomes in terms of building a larger health ecosystem, developing human capital and define strategies to revitalize and sustain health care as a public good and economic sector.

In fact, the private healthcare sector takes these issues seriously as they affect the long-term sustainability of the industry as a whole.

The Rakyat too must have a responsibility to educate themselves on these issues to understand the implications of their decisions and to contribute constructively to deciding what health means for all Malaysians.

Nadiah Wan is CEO of Thomson Hospital Kota Damansara and Group CEO of TMC Life Sciences Berhad. The views expressed are her own and do not represent those of any organization with which the author is affiliated.

  • This is the personal opinion of the author or publication and does not necessarily represent the views of code blue.

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