OUR public health system is perhaps the most underrated public institution in Malaysia. The reality is that not only does it ensure healthcare costs are some of the most affordable in the region, its services are not discriminatory and unconditional. So, why are we letting such a noble national treasure decline from the state it once was?

Malaysia’s public health system was inspired by the Britain’s National Health Service (NHS). The core principles binding the NHS are that health services must be comprehensive, universal and free at the point of delivery. It also stipulated that patients should be treated based on his/her clinical needs, and not the ability to pay. The NHS is so popular and sacrosanct among Britons that one survey in 2013 suggests that it is more valued than the monarchy and army. Seventy-two per cent of Britons were adamant that NHS is “a symbol of what is great about Britain”.

At first glance, there is a lot to be admired about our public health system. Similar to the NHS, our public health system offers comprehensive, universal health services at a miniscule cost to the patient.

Our public health system is wholly government-led and financed mostly by tax revenue. It is able to provide health services to more patients due to its larger capacity, and has consistently provided more inpatient and outpatient care as compared to the private sector. A survey conducted by the Health Ministry also shows that around three-quarters of respondents prefer government health facilities when seeking treatment for major health problems.

Our public health system usually has its strongest presence in semi-urban/rural areas. A total 86.2% of households live within 5km of the nearest public health centre according to Household Income and Basic Amenities Survey 2016. The government was instrumental in constructing rural clinics and district hospitals, and employing doctors, nurses, pharmacists and related healthcare workers. It is to the government’s credit that the principle of delivering comprehensive and universal healthcare was faithfully adhered to, and Malaysians, regardless of income level and locality, are offered an equal opportunity to enjoy these services.

However, due to rising demand and population boom, Malaysia’s public healthcare has been heavily strained. Public hospitals have been beset by long waiting times and a lack of beds. The delivery of quality healthcare from public hospitals has also been affected by capable doctors and specialist going to private practice.

Escalating cost and the failure to contain costs at private hospitals also increase the dependency on public hospitals. This also exposes the fact that privatised healthcare will not lead to cheaper treatment. It is undeniable that our public health system has been challenged by the realities of the 21^st century, and it is at risk of failing to live up to the noble intentions that underlie its founding.  

Regrettably, the state of our declining public health services is because of the wrong – or lack of – policies. These policies include the government underfunding its health services, untrammelled expansion of private hospitals, privatisation of health services, long shifts of trainee doctors and the lack of capable specialists in public hospitals. Health policies such as these would continue to squeeze our public health system and reduce the quality of care and services being offered.

The underfunding of the Health Ministry is the most telling of policy errors. It is unfortunate that Pakatan Harapan has not increased its healthcare spending to 4% of gross domestic product, as it has promised in its manifesto.

Moreover, the recent announcement of MySalam B40 National Protection Scheme also does not bode well for the future of the public health system. Firstly, offering a one-off contribution of RM8,000 when the public healthcare is practically free seems contradictory and puzzling at best.

More significantly, the implementation of the scheme does not address the fundamental problem of an underfunded public health system and will not improve it.

At the time of its establishment in 1948, the architect of NHS, Aneurin Bevan heralded the NHS as the “the most civilised achievement of a modern government”. This is because, in Bevan’s view, a civilised and advanced government would ensure there is affordable and easily accessible healthcare to its citizens.

We, in Malaysia, have a public health system that was designed to achieve that purpose. As Malaysia strives to become a developed nation, our new government must bear in mind that the gem of our public healthcare system is worth sustaining to uphold the principle of universal healthcare. – January 31, 2019.

* Kenneth Cheng has always been interested in the interplay between human rights and government but more importantly he is a father of two cats, Tangyuan and Toufu. When he is not attending to his feline matters, he is most likely reading books about politics and human rights or playing video games. He is a firm believer in the dictum “power concedes nothing without a demand. It never did and it never will”.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.