Malaysia’s health agenda: complex but crucial – Nadiah Wan

As we await another changing of the guard in our roster of decision makers, I’d like to share some of my thoughts on some important conversations to watch when discussing our nation’s vision for health and a healthy population. .

Development of a holistic health policy

Health is not just the domain of the Ministry of Health (MOH) per se. There are various sectors and issues that influence the performance of the health care delivery system and the health outcomes of the population.

For example, the social determinants of health (SDH) – that is, non-medical factors like income, housing, food security, early childhood development and others – have a huge impact on health outcomes.

According to the World Health Organization (WHO), SDH factors can account for between 30-55% of health outcomes. More importantly, social, behavioral and environmental factors alone account for 70% of the determinants of health.

By not establishing health-related policies within other departmental plans and by creating cross-departmental platforms to address these issues, we are effectively ignoring much of what drives good health outcomes. Further, private companies can and should do more to assess and address these issues as part of their environmental, social and governance (ESG) commitments.

A coherent human capital development strategy and policy

Training healthcare professionals is long and arduous, not least because it often relies not only on classroom learning, but also hands-on training involving real patients.

Teaching hospitals and postgraduate programs fall under the Ministry of Higher Education, while the Ministry of Health also offers parallel pathways to specialization and training programs for nurses and allied health professionals.

Often, training offered or sponsored by the private sector also relies on MOH hospitals as a clinical base for training. The Covid pandemic has disrupted many of these training programs, putting the future talent pool at stake.

Meanwhile, trained Malaysian nurses, doctors and medical professionals continue to leave for other countries due to the depreciation of our ringgit, rising inflation and increased demand for healthcare professionals. health in other countries.

While I support changes to the Employment Act which will allow for better regulation of working hours and longer maternity leave, the truth is that for a sector which is chronically understaffed and heavily employs women of to procreate, these policies will likely introduce a new crunching workforce.

Countries like Singapore and even Indonesia, which historically had very rigid policies, decided to liberalize their health labor markets to solve these problems, allowing foreign labor in the health and revising health workforce ratios and employment regulations.

Unless global and structural trends are reversed, Malaysia must begin planning for similar liberalization, while ensuring that the quality and safety of care is maintained.

Public-private partnership for resilience

The Covid pandemic has made us all realize that a parallel public and private system with very few intersections is not resilient. It took a global pandemic to shake us out of inertia and in two years we managed to achieve things that many had talked about but secretly never thought would happen – things like outsourcing health services to the public sector or carrying out a national immunization campaign almost entirely through private health care providers and other achievements.

It is to the credit of the MOH to have, in times of crisis, gathered around the table all the actors of the private sector and civil society.

However, the danger is usually when the crisis has passed. In the absence of an immediate need, these initiatives remained on the back burner.

Tellingly, the 2023 budget that was announced earlier this month made no mention of boosting outsourcing initiatives to the private sector.

The mechanisms through which these public-private partnership (PPP) initiatives have been implemented must be maintained, even if not at the scale required during the Covid pandemic.

By pursuing these initiatives, improvements can be made to policies, processes and communication channels so that all parties can respond immediately when needed.

Ongoing PPP initiatives can also serve as a catalyst to explore other areas of potential collaboration, especially in a highly volatile world where large-scale risks can quickly emerge, whether flooding due to climate change or supply chain disruptions due to wars.

Health financing reform takes everything in hand

Policy makers are often looking for the perfect solution to the holy trinity of cost, quality and access.

As with other economic policies, the discussion often boils down to a question of philosophy – should rakyat be responsible for part of the cost of their health care, given that the cost is largely a matter of their own choices of lifestyle.

Driven by changing demographics, larger economic forces, changing regulations, technology and innovation, among other factors, our health care inflation rates have consistently exceeded national inflation.

Caught between the proverbial rock and a hard place, the government will have to look seriously at the reform of health financing to find a viable solution.

Social and private health insurance schemes need to be seriously considered, alongside a review of how health care costs are accounted for and budgeted in the private and public sectors.

Areas of urgent need are mental health, aging and geriatrics, and preventative health, which have traditionally been policy exclusions for most private health insurance plans and are seeing rising out-of-pocket spending.

It will take collective leadership from the public and private sectors to undertake the scale of reform we need in the tight fiscal space we have as a country.

Health as an economic sector

The 12th Plan Malaysia had identified medical tourism as an economic sector to be developed. Covid has introduced massive disruption to this market and the recovery has been slower than expected.

During lockdowns in Asia, Eastern European countries seized the opportunity to further develop in this area, with Turkey, Croatia and others capitalizing on the growing influx of medical tourists from Europe and the Middle East.

While it is understandable that the Department of Health has focused primarily on the health of our own people, it would be foolish to ignore the economic potential of our investments in the health system.

The development of the medical tourism sector and the health economic sector goes beyond the fact that the Malaysia Healthcare Travel Council is a facilitator.

There is a need for thoughtful industry policy and planning alongside a stronger framework encompassing not only healthcare providers, but also payers, suppliers and other players in the healthcare ecosystem.

Ultimately, having a thriving private healthcare sector and foreign flows from medical tourism will enable us to develop and fund new investments in the healthcare system that also serves Malaysians.

At the end

Health means many things to many people. It is not just about the effective provision and access to care; it is also about creating jobs and developing talent, financing and investment, as well as building and sustaining resilience.

No complex problem has an easy answer, but I hope public and private sector leaders are willing to come together to commit to a substantial agenda with clear results in terms of building a healthier ecosystem. broad, human capital development and strategies. revive and maintain health care as a public good and an economic sector.

In fact, the private health care sector takes these issues seriously as they affect the overall long-term viability of the industry.

The rakyat must also be responsible for learning about these issues to understand the impact of its decisions and contribute constructively to deciding what health means for all Malaysians.

Nadiah Wan is CEO of Thomson Hospital Kota Damansara and CEO of TMC Life Sciences Berhad Group. The views expressed are his own and do not represent those of any organization with which the author is associated.

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