THE HEALTH | JULY-AUGUST , 2022
| Issue |
Future-proofing public healthcare
There is a need to shift from a curative and treatmentfocused mindset to a focus on wellness and preventative or promotive healthcare
BY KHAIRY JAMALUDDIN
THANK you very much to the NUS Saw Swee Hock School of Public Health for inviting me to speak at this Public Health Thought Leadership Dialogue .
In this regard , before I continue with my lecture , I would like to take this opportunity to pay tribute to the outstanding professional working relationship that has developed between Minister Ong Ye Kung , Singapore ’ s Health Minister and myself . The decision to open our border was not an easy one especially the causeway , which is one of the busiest land crossings in the world .
We knew once we advised our respective Prime Ministers that the time had come to open the land border , we would effectively become one epidemiological area . We had to trust each other ’ s judgement and trust in each other ’ s pandemic response and data .
In the weeks and days leading up to the announcement , Minister Ong and I consulted each other , almost daily , until we were both able to make the crucial judgement call . I learned much from his analyses of the situation and we are now both extremely relieved that the reopening between our countries has been done safely .
Why ‘ future-proofing ’?
The title of my speech today is ‘ Future- Proofing Public Healthcare ’. Now this sounds extremely aspirational , perhaps overly so , and some of you would be right to ask what we mean by ‘ future-proofing ’ when we ’ re already having to address the so-called ‘ problems of tomorrow ’ today .
Future-proofing equitability of access means we must also be efficient in how to achieve our ambitions of coverage and
quality within the ecosystems in which we operate . Malaysia ’ s dual health care system , comprising both public and private health care providers , ensures a reasonable level of physical access for the majority of the population .
Both are important players in Malaysia ’ s health care delivery system . While private providers tend to be in urban areas , the public health care sector is fundamental to Malaysia ’ s health ecosystem with an extensive network of public health and disease surveillance services , clinics and hospitals across the country . Mobile health teams serve in areas where physical facilities are not feasible .
Nevertheless , I must admit , the public and private sectors are not yet well integrated . Malaysia ’ s dual healthcare system is largely dichotomous , with the primarily tax-funded public sector on the one hand , and fee-for-service private sector providers on a parallel track , funded primarily via for-profit private insurance and out-of-pocket payments .
The public sector caters for two-thirds of outpatient and inpatient cases but 75 per cent of specialists in Malaysia are in the private sector . Resources , burden of work and data are not easily shared between the two sectors , leading to delays in diagnosis and treatment , unnecessary repeat investigations and added costs .
During the pandemic , these twain tracks did meet when , under emergency conditions , the government procured services for public vaccination from private GP clinics and sent non-Covid cases , decanted them to private hospitals . We decanted non-Covid patients from public hospitals to private healthcare facilities when we hit surge capacity during peak Delta .
Expanding public-private partnerships
Even today , we have continued this approach to reduce some of the public sector ’ s case backlog . We had something like 50,000 surgical and medical cases which were delayed because of the pandemic and bringing together the public and private sector in massive surgical initiatives , we have been able to lower this to about 30,000 .
We plan to expand such public-private partnerships further so that we can effectively maximise all the existing healthcare capacity in Malaysia , including those from the non-profit sector , in a way that reduces service ‘ dark spots ’ and waiting times , while ensuring that costs are contained and fair .
The close partnership between sectors can also increase treatment options for our lower- and middle-income groups , including oral health services and Traditional and Complementary Medicine services which are mainly driven by the private sector . To ‘ future-proof ’ this for Malaysia however , several structural changes need to happen including : the development of feasible payment models , strengthening strategic purchasing , ensuring good demand mapping as well as putting in place better processes and tools for referrals and consultation ( including shareable electronic medical records ). These are just some of the structural reforms needed to implement greater public-private partnership sustainably and ultimately , deliver better equitability of access in the long-term .
But one note of caution , more publicprivate partnership does not mean that service quality in public facilities remain at current levels . In fact , future-proofing equitability of access requires us to ensure that public sector hospitals and clinics are set on a path of significant and lasting service improvement .
As a first step , one of the key structural reforms that Malaysia is currently studying is to grant greater operational autonomy to our public hospitals , so that these overburdened and constrained flagship institutions are given the room to be more responsive to the changing needs of the population . We intend for this change to also facilitate better integration and publicprivate partnerships .
In the long run , this would allow the Ministry of Health ( MoH ) to focus on policy , regulation , research , public health surveillance and interventions , while devolving service delivery .
Bringing ‘ health ’ back to healthcare
We can ’ t be complete in talking about future-proofing if we do not talk about