MALAYSIA has one of the highest doctor-to-patient ratios in the world, said surgeon-turned-lawmaker Dr Ko Chung Sen, yet the ratio of hospital bed to population is low.

This mismatch between healthcare infrastructure and the personnel needed to utilise them is the result of years of mismanagement and underinvestment of public health facilities by the former Barisan Nasional administration, said Ko, a former Kampar MP.

The glut in medical graduates, who have to wait months for a houseman post, is one symptom of the former government’s skewed priorities, said the heart surgeon, is who is now Kepayang assemblyman in Perak.

“The former government didn’t blink an eye to spend billions on the East Coast Railway project that the country doesn’t need. But it would not give a fraction of that money to build new hospitals,” Ko, who was MP from 2013 to 2018, told The Malaysian Insight.

“The problem with a glut of medical graduates was something I expected a few years ago. You cannot blame the new government for not being to take them all in because there are only about 3,400 vacancies a year for housemen.

“But there is an average of 5,000 graduates produced every year both by local and foreign institutions. So, to get rid of the glut, you have to cut the number of medical students by 20% in public and private universities,” he said.

The current government is limited by how many houseman slots it can provide because of its financial position, said Ko.

This is because a houseman has to be trained by senior, practising doctors and placed in hospitals with proper training facilities, he said. But many of the government’s training facilities also lack senior doctors.

“So even if the present government had the money, they can’t just take in these housemen as there are no places for them to train and no senior doctors for them to train with.”

Underfunding healthcare

The Malaysian Insight recently ran a story on medical graduates having to wait several months for a houseman posting because there are not enough vacancies in government hospitals.

During his time as a parliamentarian, Ko regularly spoke up on healthcare issues and warned three years ago about the shortage of hospital beds versus the glut of doctors.

In a June 2015 statement, he said there was a sudden jump in the number of doctors from 32,980 in 2010 to 51,835 in 2014. This put the ratio of doctors per 1,000 people at one to 581, above the World Health Organisation’s recommendation of 1 to 600.

“An increase of 57% or 18,855 doctors in five years. Unfortunately, the number of hospital beds has only increased by 3,350, a measly 6%. So, the rate of increase in the number of doctors is 9.5 times that of hospital beds. There will be more doctors than hospital beds soon,” he said in 2015.

In terms of world standards, Malaysia has 1.8 beds per 1,000 people. This is behind Vietnam at 2.7 per 1,000 people and Thailand at 2.2 beds per 1,000.

Malaysia also spends 4.2% of its gross domestic product on healthcare but WHO recommends 7%, said Ko.

The increase in doctors, Ko said was contributed by private universities with medical programmes.

“Twenty years ago, when I was just starting out, there were three medical schools, all of them public schools. Now each state has a private medical school. Medical programmes are popular for private schools as they are very profitable. Some schools do dual intakes a year.”

The increase in hospital beds in Malaysia is also in private centres, he said.

Between 1990 and 2012, beds in private hospitals went up 202% from 4,675 to 14,127. Whereas public hospital beds increased by a mere 28.9%, from 33,124 to 42,707.

“The previous government did not spend enough on healthcare. We spent 2% of GDP (gross domestic product) on healthcare but we needed to spend more.”

As an example, if the country wanted to increase the country’s ratio to 2.3 beds per 1,000 people by 2030, it needed to build 13,562 hospital beds either in new facilities or to upgrade old ones.

Using the Health Ministry’s base cost of RM1.5 million for each hospital bed, Ko estimated that the government needed to earmark RM1.35 billion a year to reach the 2.3 ratio by 2030.

But in Budget 2017, the Najib Razak administration allocated only RM177 million for new hospitals, he said.

“The budget shows just how underfunded our healthcare infrastructure is.” – January 3, 2019.