Government hospitals struggle to cope with limited resources

A crammed ward section at the Penang General Hospital in April 2016. Where is the moral outrage over crammed hospitals?

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.

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Eric Kuek
Eric Kuek
3 Dec 2017 1.28pm

Good news for Indian estate community. Raj666 please take note: Najib said the BN is committed to transforming the country’s ethnic Indians from being known as an “estate community” to one that is progressive and modern. “I care about the Indian community because ethnic Indians face several unique challenges, especially within the structure of the Indian community from plantation estates, which are slowly being phased out. “And, the new generation needs specific help so that the transition, in principle, from an estate community to a more modern and progressive community will be a success,” said Najib at the Makkal Sakhti… Read more »

5 Dec 2017 7.19pm
Reply to  Eric Kuek

Keeping Indians down with false promises Dety Peshu? As expected, Indian leaders in BN who are beholden to the prime minister are predicting that the Indian community will support Umno/BN in the coming GE14. Najib Razak, too, praised the Indian community for its contribution to the country. In 2013 the prime minister promised to raise the Indian equity to 3% but it still remains at 1.3%, the same it has been for the past 60 years. Indian employment in government services has reduced drastically over the past 50 years to 4.1%, including the employment of Tamil school teachers. The… Read more »

Glorious Dan
Glorious Dan
9 Dec 2017 4.44pm
Reply to  Eric Kuek

Sadly Indian voters will enable BN to win in marginal seats, all because of accepting empty promises and probably a bag of rice with MO1 portrait printed on the wrapper.

1 Dec 2017 11.40pm

Stop shrieking & live longer!
Whatever toxic spewed out will come back like a boomerang.
Stop shrieking & live longer!

P Bhaskaran
P Bhaskaran
2 Dec 2017 12.38pm
Reply to  tunglang

Yes, learn to appreciate the present moment, unlike those Gerakan days!

1 Dec 2017 2.35pm

Good article. Options available:
– Resist marketing on (a) fake, poisoned or over-processed food (b) “modern medicine”.
– Protect health – your greatest asset; it depends on food, activity, rest and thoughts.
– Consider alternative medicine.
– Educate yourself on health, illnesses and “modern” treatments.
– Beware the scams of (a) health insurance (b) loans; live within your means and save for emergencies.

1 Dec 2017 3.19pm
Reply to  glissaantia

At one time, WHO asked Sri Lanka to emulate our medical system. At present WHO says France has the most effective system, but I think Cuba may be better.

30 Nov 2017 7.56pm

Bung Mokhtar wants Robert Kuok to finance more for Malaysia.

P Bhaskaran
P Bhaskaran
2 Dec 2017 12.39pm
Reply to  Heng

Bung should ask Syed Mokhtar instead.

Eric Kuek
Eric Kuek
30 Nov 2017 3.39pm

Better stay safe and healthy (opt for kurang manis diet, watch your BMI) to avoid any visit to government hospital. The Q for medicine is very long, and quantity dispensed is very limited nowadays.