The spike in Covid-19 infections reached 23,564 on 2oth August 2021. With a sharp increase in average daily cases in the past week, it became evident that the nation’s healthcare system was on the brink of collapse. Across the Klang Valley, 85% of the hospital beds were occupied. Hospitals were struggling to make more beds available for both Covid and non-Covid patients. In a bid to tackle the shortage of beds, HTAR even converted its orthopaedic, surgical, and medical wards into Covid wards, based on individual account. This poses the question: Does Malaysia have sufficient capacity to handle a medical emergency?
Health Status in Malaysia
Malaysia has made tremendous gains in terms of improving life expectancy for its people: an increase between 2014 to 2020 for women from 77 to 77.6 years and men from 72.4 to 72.6. For comparison, the world average in 2019 based on 190 countries is 72.86 years. This shows that Malaysia’s current life expectancy is above that of the upper-middle countries but below those with high income. When it comes to life expectancy at birth for female babies, the three states with the highest figures are Kuala Lumpur (79.4 years), Penang (78.9 years), and Sarawak (78.4 years). While for male babies, the three states with the highest life expectancy at birth are Sarawak (74.6 years), Kuala Lumpur (74.5 years), and Selangor (including Putrajaya) at 73.8 years.
Medical Trends in Malaysia
Medical Facilities and Healthcare Workers in Malaysia
In 2019, there were around 154 government hospitals and 250 private hospitals in Malaysia. As of 2018, Malaysia has a ratio of hospital beds to the total population (BPR) of 1.98 beds per 1,000 residents. This ratio covers all hospitals nationwide, including public and private hospitals. Compared with the other countries, we notice that Malaysia lags behind the average target for developed nations, which is 2.5 beds per 1,000, due to specific budget issues. Currently, the BPR is increasing within 0.1 beds per 1,000 residents for every five years under the 11th Malaysia Plan.
Malaysia has enough healthcare workers with a ratio of 1 set of medical staff (consisting of doctors and nurses) to 186 people. This is better than the World Health Organization’s (WHO) 1:225 goal. Malaysia has 71,041 medical doctors in both public and private sectors; this is equivalent to 1 doctor for every 454 people, better than the 1:500 ratio. Out of these, 73%, or 51,912 doctors, are working in the Ministry of Health (MOH). As of 30th June 2020, there are 11,059 dentists in the public and private sectors, equivalent to 1 dentist per 2,963 of Malaysia’s population. Around 59%, or 6,530 dentists, are employed by the government under the MOH. On the other hand, 19,341 pharmacists work in both sectors in Malaysia; this is equivalent to 1 pharmacist for every 1,694 people. The majority of pharmacists, at 60%, or 11,616 pharmacists, are serving in the public sector under the MOH (Ministry of Health).
Budgets on MOH & Healthcare Expenses in Malaysia
The sources of funding for healthcare services and products are from a few public and private sector agencies. The public sector sources of funding are mainly from the federal government, state government, local authorities, and social security funds. While for the private sector, the sources of funding mainly come from private insurance enterprises, managed care organisations (MCO), private household out-of-pocket (OOP), non-profit institutions, and private corporations.
Based on the figure above, we can see that the Total Expenditure on Health (TEH) expressed in % of GDP fluctuates around 3 to 4%, indicates that there is not any huge difference in change. The forecasted healthcare spending will only be possible provided that the forecasted GDP can be achieved. This will subject to how fast Malaysia is able to stabilise and recover from the Covid-19 pandemic.
In 2021, RM31.9 billion was allocated for the healthcare sector due to the pandemic compared with RM30.6 billion (USD7.68 billion) in 2020. Its purpose was to improve the conditions of the industry and front lines. Of the total amount allocated, RM4. Billion, or 6.8%, was set aside for use as development expenditure, while the balance (RM27.2 billion) was used to cover the operating costs. Lesser proportion is spent in Malaysia’s medical sector than other countries such as Singapore and Thailand, with an annual expenditure on the health sector of USD16.3 billion and USD25.3 billion, respectively.
Since the pandemic is expected to persist for several years, an additional RM1 billion has been allocated to stem the ongoing third wave of infections going into 2021, including RM475 million to purchase reagents, tests kits and consumables for the Health Ministry. Another RM24 million was allocated to address mental health issues, given the severity and mounting cases of emotional stress, anxiety, and depression in the community.
Medical Talent Supply in Malaysia
Medical education in Malaysia has a long history dating back to the establishment of the Faculty of Medicine at the University of Malaya in 1963. Between the 1960s and the 1980s, there were only three public universities in Malaysia, namely the University of Malaya (UM), Universiti Kebangsaan Malaysia (UKM), and the University of Science (USM). The number of universities had then shot up to 6 public universities and four private universities from 1995 to 2000. And currently, there are 32 medical schools in the country, such that 11 are public and 21 are private universities.
Approximately 3,500 to 5,000 medical graduates are churned out in Malaysia annually, and another estimated 15,000 Malaysian students are studying medicine abroad. This implies that around 30,000 doctors will be joining Malaysian’s healthcare system within the next five years, and the number is very likely to double. The country’s public hospitals could not offer all new graduates houseman training for 1 to 1.5 years.
More housemen either waited longer for placement in government hospitals, needed extension of training, or both. Besides, more extended stays as house officers, from 22.8 months in 2009 to 27.8 months in 2006, is observed. Around 50 to 60% of the housemen dropped out from training or failed to complete registration as medical officers from 2010 to 2016 who graduated from foreign institutions.
Furthermore, the optimum ratio of trainer to mentee was 1:5, which would require 423 houseman trainers per core discipline. However, the number of specialists could not make it to meet 400 specialists. You would expect to see housemen in a large group. This will eventually dilute the quality of the houseman training. Hence, it is evident that the medical facilities and human resources are not sufficient to cope with the spike in the number of medical graduates and housemen.
To overcome these challenges, local private and overseas medical education institutions should be more tightly regulated. The local private hospitals can also take part in the housemen training program. On the other hand, to achieve a bed rate of 2.5 per 1,000 residents (average for developed countries), it requires high commitment from the government to provide more significant funding for the construction of new hospitals or for upgrading existing hospitals. The MOH can also retain more specialists to ensure quality training for medical graduates and establish an independent tribunal or ombudsman to address grievances by housemen who claimed to overwork or mistreated. However, the rate of increase in the BPR also depends on the economic situation of the country, which may influence the hospital development plans of the private sector in general.
Conclusion
In conclusion, Malaysia has achieved impressive health gains for its population with a low-cost health care system funded through general revenue that provides universal and comprehensive services. Like many other countries in the region, Malaysia has struggled to produce an adequate supply of health professionals and integrate and regulate its rapidly growing private health sector. Public services have not kept pace with population growth in urban areas, and those with higher purchasing power use private rather than public doctors and hospitals, which leaves the public sector with poorer and sicker patients.
