Government hospitals struggle to cope with limited resources

The other day I accompanied a friend of mine to an eye clinic at a general hospital in the north of the peninsula.

What greeted us was a smallish room in which dozens of people accompanied by family members were crammed. Overworked staff tried their best to manage the crowd, many of them senior citizens. The cramped conditions did not help matters.

I looked around the room of the eye clinic: most of the patients appeared to be from the lower-income group or senior citizens. Where were the foreigners – the migrant workers and the refugees?

Compare that with the mushrooming of private hospitals where prompt treatment is assured in posh hotel-like spacious surroundings.

Many have noted the impact of budget constraints in various forms on government hospitals around the country. Recently a report highlighted the recycling of single-use medical items in government hospitals, sparking another round of controversy.

The privatisation of the general medical store in 1994 resulted in the cost of medicine rising three fold. Since then, other support services were privatised.

Our fine network of government hospitals and clinics have to operate under tight constraints. Malaysia spent just over 2.3% of GDP on public healthcare in 2014, according to World Bank data. In contrast, countries with among the best healthcare systems in the world spent a lot more on public healthcare: Canada spent 7.4%, the UK 7.6%, Australia 6.3%, the Netherlands 9.5%, and Cuba 10.6%. [Private healthcare spending in Malaysia amounted to another 1.9% of GDP in 2014.]

The majority of specialists are now working in private hospitals, where queues are shorter, working conditions better, and specialists’ incomes much higher.

Experienced specialists and physicians are thus enticed to jump ship to the private sector. Those dedicated ones who remain in the government hospitals find themselves with a heavier workload.

This is because, of the total specialists in the country, only a minority work in government hospitals, which in turn have to cope with the majority of outpatients.

To encourage these specialists to remain in government hospitals, some of these hospitals have introduced a new “full-paying patients” scheme. This effectively allows local patients who can afford it to jump the long queues and see specialists of their choice in government hospitals after hours.

While the specialists in government hospitals may thus earn more, the fear is that the regular patients might get neglected as the “full-paying patients” would receive prompt attention.

To complicate matters, some federal government-linked companies or state governments have shares in certain hospitals, thus creating a third a layer of hospitals, in addition to general hospital and private hospitals. Over 40% of hospital beds in Malaysia are controlled by these large GLCs. In addition, some government-owned hospitals are run like private hospitals.

This creates more complication: these GLC-linked hospitals and government-owned corporatised hospitals earn handsome profits, thus putting the government in a conflict of interest position. If the government improves conditions in the regular government hospitals, fewer patients will seek treatment in the corporatised government-owned hospitals and GLC-owned ‘private’ hospitals.

In addition, the government is also encouraging medical tourism ie encouraging foreigners to seek treatment in Malaysian private hospitals. This has the side-effect of enhancing the ability of these private hospitals to lure experienced specialists, doctors and nursing staff from the public sector.

This is happening at a time when the cost of living is rising in Malaysia. The burden on ordinary Malaysians is aggravated by higher household debt, a weak ringgit, and GST.

The effect is that government hospitals, struggling to cope with a limited budget (public healthcare spending of just over 2% of GDP), have to cope with an influx of outpatients who are unable to deal with the higher cost-of-living.

No wonder our government hospitals operate under heavy constraints. Crammed wards, extra charges for surgical components and tight controls on dispensing medicine, which inconvenience senior citizens, are some of the familiar stories we hear.

The sad thing is that if our federal budget had been more prudently managed and corruption and “leakages” and wasteful mega projects minimised, we could have had a world-class public healthcare system.

If only the billions lost had been spent not only on hospitals but a system of preventive healthcare including education on the importance of a healthy diet, exercise and a stronger team of health inspectors to curb the spread of diseases like dengue!

In the meantime, scenes like the crowded waiting room my friend and I witnessed will remain a familiar sight to long-suffering patients who have to silently endure them.

This article first appeared in the Catholic Herald Weekly.