1. A Discourse on Politics and Current Issues in Healthcare System in Malaysia. Hariz Iskandar Hassan

2. Chapter 1: Politics in Medicine

3. The Constitution Every medical practitioner in Malaysia must be fully registered with Malaysian Medical Council (MMC). Every medical practitioner in Malaysia must be fully registered with Malaysian Medical Council (MMC). Medical Act 1971 Medical Act 1971 Ministry of Health - led by the Minister of Health Ministry of Health - led by the Minister of Health Minister of Health appointed by the Prime Minister after General Election (held every 5 years) – appointment of officers at all levels. Minister of Health appointed by the Prime Minister after General Election (held every 5 years) – appointment of officers at all levels.

4. Extent of Power Administration Administration Development of new healthcare services e.g hospitals, clinics, vaccination, etc. Development of new healthcare services e.g hospitals, clinics, vaccination, etc. Appointment – Dismissal Appointment – Dismissal Budget Budget Etc… Etc…

5. Politicians vs. Physicians Very few politicians are medically oriented. Very few politicians are medically oriented. Implementation of new system. Implementation of new system. Small number of medical representatives in the parliament. Small number of medical representatives in the parliament. Politicians have a greater power. Politicians have a greater power. They have no experience or direct contact. They have no experience or direct contact. Personal agenda. Personal agenda. Not all physicians are united – societies/associations registered but not active. Not all physicians are united – societies/associations registered but not active.

6. When Do Problems Arise? Politicians and physicians do not agree on the new system (either proposed or have been implemented). Politicians and physicians do not agree on the new system (either proposed or have been implemented). Current example: Alternative Medicine. Current example: Alternative Medicine. Money wasted. Money wasted. Rigid regulations Rigid regulations Unnecessary examinations for physicians e.g endless tests on patriotism, patriotic camps for every promotion etc. Unnecessary examinations for physicians e.g endless tests on patriotism, patriotic camps for every promotion etc. Corruption at all levels/ Institutional corruption. Corruption at all levels/ Institutional corruption.

7. Worldwide Corruption Perceptions published by Transparency International The higher the index – more transparent, less corrupt. The higher the index – more transparent, less corrupt. In 2007: In 2007: Malaysia – 43 rd, 5.1% Malaysia – 43 rd, 5.1% Czech Republic – 41 st, 5.2% Czech Republic – 41 st, 5.2% The most transparent country is Denmark. The most transparent country is Denmark. The least transparent country is Somalia. The least transparent country is Somalia.

8. Consequences The public who suffer. The public who suffer. Prolong development of healthcare system. Prolong development of healthcare system. Physicians are not able to work efficiently. Physicians are not able to work efficiently. Research programs are not fully funded. Research programs are not fully funded. Lack of understanding and cooperation. Lack of understanding and cooperation.

9. Proposed Solutions A separate body which is independent of any political party or political agenda must be formed in regulating any health issues that matter. A separate body which is independent of any political party or political agenda must be formed in regulating any health issues that matter. Minimize corruption – new laws and regulations. Minimize corruption – new laws and regulations. Leave the medical practice to those who are qualified – only get involved when it is needed. Leave the medical practice to those who are qualified – only get involved when it is needed. Unnecessary implementation of new system must be reviewed by those who are qualified. Unnecessary implementation of new system must be reviewed by those who are qualified.

10. Chapter 2: Public Service vs. Private Service

11. Healthcare Services The percentage of GDP spent by Malaysia on healthcare services is below 5%. The percentage of GDP spent by Malaysia on healthcare services is below 5%. In 2003 - total expenditure 3.8% of GDP In 2003 - total expenditure 3.8% of GDP 2.2% - Public Sector 2.2% - Public Sector 1.6% - Private Sector 1.6% - Private Sector (In the US, >14% of GDP spent on healthcare services) (In the US, >14% of GDP spent on healthcare services) Human Development Report in 2006 by UNDP Human Development Report in 2006 by UNDP

13. Healthcare Services 2004 – Private sector in Malaysia only accounted for 20% of the country’s hospital beds. 2004 – Private sector in Malaysia only accounted for 20% of the country’s hospital beds. It employed almost 54% of the doctors in Malaysia. It employed almost 54% of the doctors in Malaysia. 1990-2004  70 Physicians for 100000 patients. 1990-2004  70 Physicians for 100000 patients. 70% of specialists are in private sector. 70% of specialists are in private sector.

14. Problems Imparity between public service and private service. Imparity between public service and private service. Lack of quality in public service: Lack of quality in public service: –Understaffed –physicians working long hours –quality of treatment –long waiting list The use of advanced treatment in private service. The use of advanced treatment in private service.

15. Problems Private sector appeals more to the physicians due to higher salaries and better working environment – stiff competition. Private sector appeals more to the physicians due to higher salaries and better working environment – stiff competition. Current implementations of healthcare service like medical hub in SEA, alternative medicine, health tourism are not effective! Current implementations of healthcare service like medical hub in SEA, alternative medicine, health tourism are not effective!

17. Consequences to the Public Not everyone can afford private service. Not everyone can afford private service. People in Malaysia are not exposed to the importance of health insurance – very few are covered. People in Malaysia are not exposed to the importance of health insurance – very few are covered. Danger in treating patients as there is a lack of medical practitioners including nurses. Danger in treating patients as there is a lack of medical practitioners including nurses.

18. Proposed Solutions A better scheme should be introduced to attract more physicians to stay in the government service e.g higher salary, opportunity of research and further training. A better scheme should be introduced to attract more physicians to stay in the government service e.g higher salary, opportunity of research and further training. Money should be spent wisely – improve the service for the public -> the ministers should take note. Money should be spent wisely – improve the service for the public -> the ministers should take note.

19. Chapter 3: The Influence of Religious and Cultural Belief in Medical Practice.

20. Problems Extreme religious group of physicians exist in Malaysia (especially when they come back from overseas). Extreme religious group of physicians exist in Malaysia (especially when they come back from overseas). Narrow minded thinking. Narrow minded thinking. Against a few ideas in medicine e.g direct contact between men and women. Against a few ideas in medicine e.g direct contact between men and women. Superstitious ideas of treatment and cure. Superstitious ideas of treatment and cure. Alternative medicine which has not been proven by scientific research. Alternative medicine which has not been proven by scientific research.

21. Alternative Medicine Not all alternative medicines have been proven effective – no cross reactions tests and chemical analysis. Not all alternative medicines have been proven effective – no cross reactions tests and chemical analysis. 1997 - Americans spent USD 3.24 billion on herbal products and herbal medication whereas Malaysians spent USD 2 billion. 1997 - Americans spent USD 3.24 billion on herbal products and herbal medication whereas Malaysians spent USD 2 billion. Each American spent about RM45 on herbals, each Malaysian spent RM91, which is twice as much, taking into account populations of 273 million and 22 million respectively. Each American spent about RM45 on herbals, each Malaysian spent RM91, which is twice as much, taking into account populations of 273 million and 22 million respectively.

22. Alternative Medicine Alternative medical practice is based on the influence of culture and religion. Alternative medical practice is based on the influence of culture and religion. It is also a ‘promising’ business with high profits. It is also a ‘promising’ business with high profits. Some doctors are against it but some have been supportive especially in Malaysia. Some doctors are against it but some have been supportive especially in Malaysia. Prime Minister announced in Oct 2007 – Malaysia will invest more than RM200mil (~USD90mil). Prime Minister announced in Oct 2007 – Malaysia will invest more than RM200mil (~USD90mil).

23. Prejudice HIV/AIDS patients have to pay twice the service fee in some hospitals in Malaysia e.g HUKM. HIV/AIDS patients have to pay twice the service fee in some hospitals in Malaysia e.g HUKM. Sexual Transmitted Diseases and Sexual Education are considered taboo. Sexual Transmitted Diseases and Sexual Education are considered taboo. But sex before marriage is high regardless of religions and races – people are in denial. But sex before marriage is high regardless of religions and races – people are in denial. Homosexuality – discrimination due to misunderstanding and lack of knowledge. Homosexuality – discrimination due to misunderstanding and lack of knowledge.

24. Solutions Education Education Physicians must be open minded – no discrimination. Physicians must be open minded – no discrimination. Every delicate issue must be handled professionally. Every delicate issue must be handled professionally. Not just medically oriented but all rounded. Not just medically oriented but all rounded.

25. References http://www.pmo.gov.my/WebNotesApp/PastPM.nsf/a310 590c7cafaaae48256db4001773ea/e59bbd5eccda3c3b482 5674a002235e5?OpenDocument http://www.pmo.gov.my/WebNotesApp/PastPM.nsf/a310 590c7cafaaae48256db4001773ea/e59bbd5eccda3c3b482 5674a002235e5?OpenDocument http://www.pmo.gov.my/WebNotesApp/PastPM.nsf/a310 590c7cafaaae48256db4001773ea/e59bbd5eccda3c3b482 5674a002235e5?OpenDocument http://www.pmo.gov.my/WebNotesApp/PastPM.nsf/a310 590c7cafaaae48256db4001773ea/e59bbd5eccda3c3b482 5674a002235e5?OpenDocument http://msia-indians.blogspot.com/2007/02/overview-of- malaysias-healthcare-system_17.html http://msia-indians.blogspot.com/2007/02/overview-of- malaysias-healthcare-system_17.html http://msia-indians.blogspot.com/2007/02/overview-of- malaysias-healthcare-system_17.html http://msia-indians.blogspot.com/2007/02/overview-of- malaysias-healthcare-system_17.html http://www.annals.edu.sg/pdf/35VolNo1200601/V35N1p 60.pdf http://www.annals.edu.sg/pdf/35VolNo1200601/V35N1p 60.pdf http://www.annals.edu.sg/pdf/35VolNo1200601/V35N1p 60.pdf http://www.annals.edu.sg/pdf/35VolNo1200601/V35N1p 60.pdf http://www.mma.org.my http://www.mma.org.my http://www.mma.org.my http://www.hospitals-malaysia.org http://www.hospitals-malaysia.orgwww.hospitals-malaysia.org http://www.mmc.gov.my http://www.mmc.gov.my http://www.mmc.gov.my