Last week, our PM revealed the 11th Malaysia Plan (RMK 11). As usual, a lot of sugar-coating and wonderful plans were mentioned. With the current reputation that our PM is enjoying, it has to be taken with a pinch of salt. The market did not respond well this time around. On Monday, our Bursa crashed. That simply shows that no one believed what was mentioned in RMK 11.
I will not talk about the entire plan as many of it are repetitive issues. I will concentrate on the medical field as attached below. Let’s look at the 1: 400 ratio. This is nothing new. Right from the beginning, the government’s intention is to achieve the ratio by 2020. That’s the reason why numerous medical schools were given license to start. As usual, our government is only interested in quantity rather than quality. We want to achieve everything on paper but in reality, half of it ” tak boleh pakai !!”. First they said that it is WHO recommended ratio, but last year, WHO has made it very clear that they never came up with such a ratio. Interestingly, just last month, MOH said that we are short of post and there are too many graduates coming into the market, but suddenly everything changes. I believe our PM do not know what he is talking about, as usual. Secondly, with the number of graduates being produced now, we will achieve the ratio 1: 400 by 2017. Don’t need to wait till 2020. All our 36 medical schools will be producing graduates by 2017. We have already reached a ratio of 1: 600 in 2013. The statistics for 2014 is yet to be announced.
Whatever said, these ratio does not mean anything as it includes both government and private doctors as well as doctors in administrative jobs. No matter how many beds that you have in the government sector, it will always be overcrowded as 80% of patients are dependent on government hospitals. This brings me to another question of bed ratio; 2.3: 1000 patients that was mentioned in RMK11. This ratio includes both private and government, but only 20% of patients will use the private sector. Unless the government comes up with a National Health Financing Scheme (which was not mentioned in RMK 11), the bed ratio do not mean anything. Everything will look glorified on paper but meaningless in reality.
Now, let’s look at the “so-called” new hospitals that are going to be built. Are they really new hospitals?
1) Hospital Bentong : There is already a 152 bedded hospital in Bentong. So, is this new hospital replacing the existent one?
2) Hospital Baling : Again, a 160 bedded hospital is available in Baling. So, nothing new either.
3) Hospital Kamaman: A 116 bedded hospital is available
4) Hospital Maran : A 60 bedded Hospital Jengka is in Maran, about 40km from Maran town. A 500 bedded Hospital Temerloh is also about 40km. I am not sure where exactly these new hospital is going to be but likely it will be quite nearby to the existing hospitals.
5) Hospital Pendang :This will be a new hospital
6) Hospital Pasir Gudang : Hospital Sultan Ismail, a 500 bedded hospital is just 15km from Pasir Gudang. There are also 3 private hospitals in Pasir Gudang District: KPJ Pasir Gudang, Regency Specialist Hospital and Penawar Hospital. So, do we really need another hospital there? Will it ever materialise. It is an industrial area where most workers are foreigners.
Building an upgraded hospital is good. However, looking at our track record, likely these hospitals will never see the light of the day. Remember, Hospital Shah Alam is yet to complete since RMK 9. Remember, Hospital Sultan Ismail was delayed for almost 3 years? Furthermore, most of these hospitals are only going to replace the existing hospitals with better facilities. It is not going to increase the number of new post very much. There will still be too few of a new posts for increasing number of new graduates.
What about cluster hospitals ? In early 1990s, a concept known as Nucleus Hospital (under RMK6) was introduced. Hospital Manjung, Hospital Sg Siput, Hospital Kulai, Hospital Segamat, Hospital Batu Pahat etc are few of the hospitals that are Nucleus hospitals. A total of 12 was introduced based on a system in Britain. It suppose to be community based hospital which acts as a nucleus for further expansion and upgrading. Unfortunately, many remained as district hospitals with some basic speciality. I got no idea what this cluster hospital is all about. I presume it is sharing of manpower and facilities among hospitals within a district/area. If that is the case, specialist may be running between few hospitals. I remember our Health Minister did mention about this few months ago. It may end up chasing away more specialist from the government sector.
Upgrading of health clinics is a necessity. Unfortunately, many of the current clinics are already facing shortage of funds and expired equipments. I hope the current ones could be upgraded first before selecting a “few” for upgrading work.
Finally, another 165 “1Malaysia clinics” will be introduced. This is a disaster for GPs. Some of this 1Malaysia clinics in N.Sembilan and Selangor is currently being filled by MOs. While it is a good publicity stunt, it will affect many GP’s income.
While everything looks good on paper, many may not happen. With the current economic situation, where will the government get the money? That is the question many economist are asking. Some of these projects will be shelved as usual, or postponed to 12th Malaysia Plan. Many may fail, as happened again and again, countless number of times……… History repeats itself!
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UTAR have apparently got permission to build a university hospital in Kampar, which would be an upgrade from the current district hospital. Not part of RMK11 obviously. MCA currently busy raising money for it. Whether it will ever see the light of day … who knows?
UTAR is a private university. Thus, the hospital will be a private hospital. Most universities which planned to have their own private hospital postponed their plans, including IMU, UCSI, Monash, MMMC, Perdana etc.
hello doctor ,im a malaysian student and planning to apply for medicine programme in some established university in indonesia ,is it indonesia a good place to study medicine ? Such as universiti padjajaran bandung
It depends on which uni you are talking about. Padjajaran and Gajahmada are OK. I heard Padjajaran has stopped taking Malaysian students since their twinning program with UKM started.
With so many local med schools, why are you thinking of Indonesia?
because i wanna work in indonesia !
Our health system will collapse. It is not sustainable. The salient points are simple:
1.People within the public system are expected to provide care for an unlimited number of people on a limited budget based on a business model (patient-client concept). No business can ever survive like this.
2.Private healthcare is way too expensive and has a huge gap compared to public healthcare. As a result private hospitals are forced to charge exorbitant fees on patients and insurance companies, making fraudulent claims more rampant and crowding public hospitals/clinics even more.
3.Promotion within the system is based on seniority not meritocracy. No matter how little your contributions and achievements are, just as long as you’re there doing time, you’ll get promoted.
4.The Health Ministry keeps giving stuffs away too cheaply and bleeding money.
Don’t worry, be happy. Bolehhands had billions & billions of $ fr fossil fuel & palm oil,our gov will source others if the oil were to dry up one day. we can lease our land & sea, exporting our doctors, dentists, pharmacists…God bless us, with a sahara desert, we’ll run out of sands if we continue to spend without return..
The minister has spoken about tightening the entry requirements to medical schools.i wonder just how long it will take?next year maybe?.sigh………..
he is been talking about it since last year. All talk no action
Due to the increase in housemen in local hospitals, the moratorium on the launch of new medical courses in local universities will be extended beyond April next year to five more years. what is ur opinion on this statement doctor ?
Moratorium does not mean anything. If they allow more medical schools, we must be the stupidest government in the world, if not already!
The existing ones will continue to maximise the students to make profit. IF each of the current 34-36 medical schools recruit 150 students, it will already be more than 5000 graduates every year! More than enough to become jobless.
That is not even including those graduating overseas, who will return. At it’s peak, there were about 1000 graduating each from Russia and Egypt, and non will be staying back to work in Russia and Egypt, unlike the Western Developed Economies.
There is a considerable time lag in doctor training, and a wrong decision will mean 5-10 years of wrong numbers. We are entering that period now.
Dear Sir,
I have been reading all your articles for the last 3 years.
But looks like we (Indians) are just starting to accept the fact.
please read the article in the following website.
http://www.godyears.net/
This is a better strategy actually from the Government.
The previous plan was to integrate public and private services. But this approach is a more pragmatic and practical method. Essentially, strenghtening public services and allowing private services to grow organically based on competition and supply-demand.
This is what we demanded when the idea of 1Care was mooted. So why are we complaining about it now?
Resources are scarce everywhere. Malaysia still has one of the best healthcare services in the world (I know, its shocking for a Malaysian. But you have to think from a health economics perspective. We achieve universal health coverage with an unbelievable low cost compared to the rest of the world based on GDP and GNP)
So what does this mean?
Do what you do best.
It is not sustainable. As you can see the quality of care is dropping despite the excellent accessibility and affordability of the civil service. Yes, we may have reduced maternal and perinatal mortality but look at the increasing ESRF, complications of diabetes, Heart Disease, deaths from asthma and infections etc. The RMK11 plan also do not address these issues. Building hospitals and KKs do not mean anything when the standard of care is dropping. Maintenance of facilities is another issue all together. Doctor :population ratio is meaningless if the current system continues.
Regarding the problem of oversupply of doctors.
Either way we are screwed.
Either we have a smaller group of well trained doctors but cannot service the nations demand of healthcare which will lead to potential loss of lives OR
A large group of not so well trained doctors who service the nations demands of healthcare with potential loss of lives
Either way, the option of training a large number of high quality, safe doctors was never there. Classic developing country problem. Populational growth was outstripping institutional growth.
Prof Phua Kai Hong, the Public Health guru from Singapore. While Im not one of those fellas who believes we should emulate Singapore in every way possible, their philosophies of implementation are truly well researched and reflects their continuous rejection of Western ideals in achieving Western outcome. In other words, they tailor the solution to the problem better than any other Asian countries.
http://www.thestar.com.my/News/Nation/2015/01/31/Publicprivate-healthcare-the-way-to-go/
Click to access Session%202%20Slides%202%20Phua%20Kai%20Hong.pdf
Private hospitals need to buck up as most of them are catered more for tourism hospitals instead of treating patients. Nice staying amenities are the way to go while overcharging patients most of the time. Most ICU in private hospitals are just an empty shell, with poor nurse to patient ratio, no in-house intensivist or doctors, only primary doctor reviewing once daily in ICU at best on weekdays and none on weekends while charging the consultation fees. Mismanagement and lack of quality runs deep down in the veins of both public and private doctors including specialists.
Recently, my grandmother was admitted to one of the private hospitals in KL at the age of 82 with initial investigations showing acute on chronic renal failure secondary to pneumonia. She had chest pain, but blood ix showed hyperkalemia at 6.5 and anemia (Hb 4). She was attended by the cardiologist. It was told that my grandma had MI and the choice was given for thrombolysis or angiogram. She was then started with oral anticoagulants with PPI cover (IVI esomeprazole) and to transfuse 4 pint packed cells starting in the evening.
The cardiologist must have missed the extremely tall tented T-waves or the blood ix. Nevermind that the patient had nil urine output or the urea 40+ with creat 1000+ with abg with pH of 7.0. At midnight, my grandma developed SOB during the second pint transfusion and was intubated immediately (likely the standard locum ED MO) and was also supported with inotropes IVI dopamine. In view that it was Saturday early morning, my grandma was referred to Nephrologist due to worsening acidosis at 6.9 and potassium 7.8. Of course, she was advised not for dialysis by the nephrologist which I did agreed upon, but there was no further management and to “stabilize” in ICU without any doctor or intensivist, only by nurses. My point is, my grandma had been missed on the early part with mismanagement while the system in private hospital sucks you dry on a dying patient. We were kept in the dark as the doctors were too busy to see us (even busier than government hospital) and the ix was later known after her deceased with the release of blood report.
Being a doctor, I would have known that her condition is of no hope from the start, but keeping the patient and family members in the dark while slapping you with a large bill is unethical.
The cardiologist even lamented that we do not appreciate that he is doing his best. Given that he came with the wrong diagnosis, overloading patient with rapid transfusion and not doing something ffor the hyperkalemia in the first place and still insisted that it was MI even after that, and yet not coming for rounds on the weekends (he could pass over the case) while charging the consultation round fees, it is hardly his best. He must have been too busy managing his property investment firm, or the fact that he is running over 8 hospitals with no attention to his patient but his luxury lifestyle. A sickening attitude even from a “consultant”.
Didn’t I say this long time ago? I had written about problems in private hospitals and issues concerning private doctors almost 3-4 years ago. Only the big private hospitals have proper ICU management. The rest are not really ICUs. The cost is also extremely high for any cash paying patients. That’s why I will always advise patients who need ICU care to transfer to GH. Unethical practise is not unusual in private sector. As for busy consultant, it is indeed a busy life for most private consultants as they do not have any HO or MOs to handle their cases. Thus, they usually will need to prioritise the patients. Saying that, you can’t miss something that obvious!