THE Malaysian Medical Association (MMA) urges the government to adopt an “all of healthcare” approach rather than an “all of government healthcare” approach in the fight against Covid-19.
Our government healthcare facilities should not be taking on this battle all on its own. Private healthcare, an important component in our country’s overall healthcare system, can be an added strength in managing Covid-19 but is still underutilised.
It is time we ease the strain on our public healthcare and look into the combined strength of public-private partnerships in healthcare to enhance efforts in the country’s management of Covid-19, as well as other healthcare needs.
MMA believes ultimately, it is the rakyat that will benefit from such collaborations. Patients will also be better served when both sectors maximise its healthcare services rather than working in isolation.
There are over 7,000 Health Ministry-trained GPs and around 3,000 plus private specialists serving in more than 200 private hospitals nationwide. 2018 figures showed the private sector were served by 14,649 doctors, 5,174 pharmacists and 34,874 nurses.
Private healthcare spending is around 50% of the total national healthcare expenditure with millions of Malaysians and non-Malaysians attending private facilities daily. The private healthcare sector also contributes to millions of jobs nationwide and forms an integral part of the Malaysian economy.
Since the MCO in March this year, the Malaysian Healthcare response had been largely led by the government healthcare facilities. There were peak pandemic times when government facilities were stretched to the maximum in certain hospitals or areas and assistance or donations were extended by public, NGOs and concerned citizens.
The private healthcare sector since March has been on a downward trend, generally, with patient numbers contracting significantly.
Among the various reasons were the lockdown rules that forced patients to delay their health checkups while others were trying to avoid attending clinics or hospitals out of fear of contracting Covid-19. Affordability among many patients had also decreased significantly due to the economic impact of the pandemic.
Many clinics and hospitals nationwide were reporting reduced patient attendance, some by as much as 70% to 80% with significant income reduction, severely threatening the sustainability of their practice.
Many senior doctors with their wealth of experience are also contemplating closing or retirement. It is estimated that around 200 clinics nationwide will close by year end.
Our Sabah branch had recently conducted a survey on private sector healthcare in the worst affected state by the pandemic, thus far. Out of 209 private doctors who participated in the survey, 68 per cent were GPs and 32% specialists. 79% of the doctors surveyed were practicing in urban areas.
According to the survey, since the Covid-19 lockdown in March and now the 3rd Wave with CMCO implemented in October, 70% of private GPs and specialists have a reduced patient load of over 50% or more. 32% reported the need to close clinics temporarily for various reasons, with one of the main reasons being the need to quarantine due to Covid-19 exposure. Other reasons include doctors themselves being in the high risk group and the need to stop services at the height of the pandemic.
If the current situation continues in Sabah, 17% of practices estimate they will not be sustainable in the next 3 months, with another 33% saying they may not last beyond the next 6 months. Only 25% in the survey estimated they can be sustainable for up to 12 months or more. In the survey, a mere 14% of doctors surveyed reported that they are providing Covid-19 testing.
Overall, the contraction and loss of private sector doctors and clinics in the country will inevitably lead to more congestion at government facilities, further straining government funding and finances, not to mention its facilities and human resources.
The proposed 2021 Government healthcare budget of RM31.9 Billion is a mere 4.3% rise compared to the 2020 allocation, and may hardly be adequate if the private healthcare sector is to contract significantly resulting in more shuttling of patients to governmental facilities. Consequently, patient care and medical access may be compromised if overcrowding of public facilities increases.
Moving forward, MMA proposes the following:
1) Private-public collaboration and that healthcare is strengthened in both sectors simultaneously catering to the spectrum of health needs and affordability.
2) Government to support the private healthcare sector in the recovery phase of the Covid-19 pandemic through tax exemptions and grants to the sector targeted at sustaining and strengthening primary care in particular.
3) Decongestion of public hospital and clinic patients to the private sector through outsourcing of services such as, follow up of patients with non-communicable diseases or antenatal care by general practitioners or elective operations by private specialists at an agreed sustainable rate.
MMA believes the cost effectiveness of outsourcing services and stimulus investments into private healthcare will yield many benefits in expanding healthcare access for all. The public and private healthcare sectors need to be in a symbiotic relationship if the nation is to have the most effective healthcare system to contain the pandemic and beyond. – The Vibes, November 20, 2020
Prof Datuk Dr Subramaniam Muniandy is president of MMA
