THE HEALTH | JULY-AUGUST , 2022

BY KHAIRY JAMALUDDIN

In this regard , before I continue with my lecture , I would like to take this opportunity to pay tribute to the outstanding professional working relationship that has developed between Minister Ong Ye Kung , Singapore ’ s Health Minister and myself . The decision to open our border was not an easy one especially the causeway , which is one of the busiest land crossings in the world .

We knew once we advised our respective Prime Ministers that the time had come to open the land border , we would effectively become one epidemiological area . We had to trust each other ’ s judgement and trust in each other ’ s pandemic response and data .

In the weeks and days leading up to the announcement , Minister Ong and I consulted each other , almost daily , until we were both able to make the crucial judgement call . I learned much from his analyses of the situation and we are now both extremely relieved that the reopening between our countries has been done safely .

Why ‘ future-proofing ’?

The title of my speech today is ‘ Future- Proofing Public Healthcare ’. Now this sounds extremely aspirational , perhaps overly so , and some of you would be right to ask what we mean by ‘ future-proofing ’ when we ’ re already having to address the so-called ‘ problems of tomorrow ’ today .

Future-proofing equitability of access means we must also be efficient in how to achieve our ambitions of coverage and

quality within the ecosystems in which we operate . Malaysia ’ s dual health care system , comprising both public and private health care providers , ensures a reasonable level of physical access for the majority of the population .

Both are important players in Malaysia ’ s health care delivery system . While private providers tend to be in urban areas , the public health care sector is fundamental to Malaysia ’ s health ecosystem with an extensive network of public health and disease surveillance services , clinics and hospitals across the country . Mobile health teams serve in areas where physical facilities are not feasible .

Nevertheless , I must admit , the public and private sectors are not yet well integrated . Malaysia ’ s dual healthcare system is largely dichotomous , with the primarily tax-funded public sector on the one hand , and fee-for-service private sector providers on a parallel track , funded primarily via for-profit private insurance and out-of-pocket payments .

The public sector caters for two-thirds of outpatient and inpatient cases but 75 per cent of specialists in Malaysia are in the private sector . Resources , burden of work and data are not easily shared between the two sectors , leading to delays in diagnosis and treatment , unnecessary repeat investigations and added costs .

During the pandemic , these twain tracks did meet when , under emergency conditions , the government procured services for public vaccination from private GP clinics and sent non-Covid cases , decanted them to private hospitals . We decanted non-Covid patients from public hospitals to private healthcare facilities when we hit surge capacity during peak Delta .

Expanding public-private partnerships

Even today , we have continued this approach to reduce some of the public sector ’ s case backlog . We had something like 50,000 surgical and medical cases which were delayed because of the pandemic and bringing together the public and private sector in massive surgical initiatives , we have been able to lower this to about 30,000 .

We plan to expand such public-private partnerships further so that we can effectively maximise all the existing healthcare capacity in Malaysia , including those from the non-profit sector , in a way that reduces service ‘ dark spots ’ and waiting times , while ensuring that costs are contained and fair .

The close partnership between sectors can also increase treatment options for our lower- and middle-income groups , including oral health services and Traditional and Complementary Medicine services which are mainly driven by the private sector . To ‘ future-proof ’ this for Malaysia however , several structural changes need to happen including : the development of feasible payment models , strengthening strategic purchasing , ensuring good demand mapping as well as putting in place better processes and tools for referrals and consultation ( including shareable electronic medical records ). These are just some of the structural reforms needed to implement greater public-private partnership sustainably and ultimately , deliver better equitability of access in the long-term .

But one note of caution , more publicprivate partnership does not mean that service quality in public facilities remain at current levels . In fact , future-proofing equitability of access requires us to ensure that public sector hospitals and clinics are set on a path of significant and lasting service improvement .

As a first step , one of the key structural reforms that Malaysia is currently studying is to grant greater operational autonomy to our public hospitals , so that these overburdened and constrained flagship institutions are given the room to be more responsive to the changing needs of the population . We intend for this change to also facilitate better integration and publicprivate partnerships .

In the long run , this would allow the Ministry of Health ( MoH ) to focus on policy , regulation , research , public health surveillance and interventions , while devolving service delivery .

Bringing ‘ health ’ back to healthcare

We can ’ t be complete in talking about future-proofing if we do not talk about