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©The Sun (Used by permission)
by Dr Subramaniam Pillay

Malaya – Malaysia from 1963 – was lucky that under the first three prime ministers, the nation had a government that gave emphasis to providing equitable access to basic healthcare.

Because of the people-oriented policies of the earlier leaders, by 1980, Malaysia’s health indicators like life expectancy and infant mortality rates improved dramatically and were not far from those of developed countries.

However, under Tun Dr Mahathir Mohamad’s government, the promotion of private hospitals and privatisation policies have created a two-tier healthcare system, where those who are better off have access to good healthcare while the poor suffer long queues and cannot be certain that they will get quality healthcare. This is the sad situation 50 years after Merdeka.

In 50 years time, I hope that we will have a healthcare system that provides equitable and affordable access to healthcare for all residents in Malaysia, based on their medical needs rather than their income, and at the same time is efficient and effective in the use of resources. In other words, people’s basic needs have to be placed ahead of profits. To this end, we hope that the three major stakeholders in the healthcare system will play their appropriate roles.

First, the public or the consumers of healthcare have to make genuine efforts in changing their lifestyles to remain healthy by eating right, exercising and avoiding bad habits like smoking. They also have to learn to manage minor illnesses on their own so that they do not overload the system. They must be allowed to access hospitals only for accidents and emergencies or via their family doctor and not abuse the system. For this, we need a population which is well-educated in the true sense of the word.

Second, the providers of healthcare, that is the health professionals and hospitals, must be ethical and professional and not abuse the system. Society must have sanctions in place for those who abuse the system.

Third, the government must play a critical role in the next 50 years to ensure equitable access by strengthening its provision of health services, regulating the private sector effectively and making available adequate resources. It should also continue emphasising preventive health.

Thus, within the next 50 years, we hope to see a single payer integrated healthcare system, in which the staff are trained properly and paid adequately. The core of the health system should be based on well-run primary healthcare such that everyone living in Malaysia has the services of a family physician at an affordable cost.

Finally, well before the next 50 years, we need to develop mechanisms to cope with incessant advances in medical technology, where no country can afford all that is available. Society has to set limits on funding and learn to cope with moral dilemmas.

I believe that such a people-oriented national healthcare system will play a crucial role in bringing about social solidarity, which will cut across ethnic and class lines. I hope that in 50 years time, Malaysia’s claim to be a developed and civilised country will be justified in having a healthcare system in which an ill person is not denied adequate and appropriate care because of lack of means.

Dr Subramaniam Pillay is the chairman of the Coalition Against the Privatisation of Healthcare. He teaches at the business school in the University of Nottingham, Malaysia, and is an executive committee member of Aliran.

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