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We Have a Long Way to Go in Healthcare

Published in the New Straits Time, 1st April 2015

In February last year, a website that promotes places for people to live after retirement reported that Malaysia is among the top three country with the best health care in the world. The site stated that the medical expertise that we have in this country is equal if not better than most western countries.

When the posting get published, quite a number of people shared it in their facebook pages. Some of them applauds the so called achievement. However most of them questions the credibility of the report. How can a website that promotes living overseas made a reliable and unbias ‘study’ judging health care services worldwide? To be honest, even though I am proud, I was also a little bit skeptical with the said survey.

To have a more critical view on the issue, let us compare the scope of the website’s study with World Health Organisation’s (WHO) standard for health care services. Beside costs and insurance coverage for health care services, the website also included the number of patient to the doctor as its study criteria. Personally, I don’t think cost can be a good indicator for health care service measurement. 

The value of our Ringgit compared to other currencies might give different definition of how affordable a treatment is. To a United State of America citizen, USD 10 for a doctor’s consultation fee might be very cheap but for Malaysian, RM 38 is quite much. My argument on this issue might be flawed as I am no economist. But it still baffled my mind how can general practitioners living in Malaysia claim that they would not survive with even half of that kind of consultation fee alone.

WHO stated that the standard doctor to population ratio should be 1:400. As of 2013, it was reported that the ratio of doctor to population here is only 1:791. It was quite suprising for a country that could only achieve almost half of the required ratio to be considered one of the best in the world. The website might use other factors to influence the result but the statistic is indicative enough for the report to be taken with a pinch of salt.

For the sake of the arguments (and because being considered as 3rd best is quite amazing), let us consider the website evaluation to be valid. We should then go deeper to dissect the current health care situation in Malaysia.

In 2012, Malaysia have more than 36,000 doctors. Only 10,000 of them practice in private sector while the majority practice in public sector.

The total number of population in Malaysia is around 29 million (excluding foreigner), with expansion rate of 1.3% per year. The number of patients warded in public hospitals were 2.9 million while only 1 million patients were warded in private hospitals. For outpatient treatment, it was reported that more than 30 millions patients had received treatment in public hospitals and clinics while only 3 million patients received treatment in private health facilities.

This data provide an insight towards our health care services. There is a clear imbalance between patients receiving treatment in public and private institutions. Majority of the patients opted to go to public hospitals. This might be due to several reasons including the trusts of patients, perception, cost and feasibility.

It was an alarming issue when the medical expenses in private was more than 55.6% compared to medical expenses in 2007. This shows that the cost for having medical treatment in private clinics and hospitals was very high since an industry that cater only 10% of the population could outspend the public medical expenses by more than 50%.

With that in mind, how can practitioners in private sector claim that their health care system is among the best in the world? We have heard over and over again statements from private medical doctors and groups claiming that we should maintain our health care system by rejecting the proposal of separating professional roles of doctors and pharmacists since we had been recognized as one of the best in the world.

If the website survey is valid, the major recognition should go to the public health care system. They are the one who provide the best care to majority of the population in Malaysia.

It is a known fact that public medical institution in Malaysia practices dispensing separation. Doctors would diagnose and write out the prescription, pharmacists would screen, dispense and counsel the patient. It was practiced for years and pharmacists involvement had been shown to reduce medication errors, improve compliance and achieve better patient outcome worldwide. It just irked me for the groups of minority health care service providers claiming as of their system is the one that was recognised as the third best in the world.

If those people wanted to use the website findings as their argument, they should really read and comprehend the outcomes of the survey. The website stated that;

“The majority of dentists are U.S. or UK trained and the staff are friendly and professional. The facilities are modern and similar to what you are used to in the U.S. Prescriptions cost a fraction of the cost in the U.S. and the pharmacists are well-trained and informed.”

It was intriguing that everybody that cited the website findings failed to mention the above statement. Did they selectively deny the influence of the pharmacists on the outcome of the survey in order to reject a notion that directly involve the professional roles of pharmacists?

It is not denied that the proposal for dispensing separation need to be discussed critically and studied. However those who are for and against it should base their arguments with critical and valid scientific studies and data instead of plucking whatever available statement that could easily influence and manipulative to the public. Using fake facebook pages, petty youtube videos and insulting comments and statements should be avoided as being professional is the only way to go forward in order to improve our health care services.

I think that we have lots of ways to improve our health care services. And I believe, dispensing separation is a step forward. However it must come with proper mechanisme and enforcement. Let us work together in order to ensure the improvement of the safety of the patient.

*This is the personal opinion of the writer and does not in any way represent any ministry and government policy.

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