04/03/2025

TUESDAY | MAR 4, 2025

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COMMENT by Dr Shahrul Azman Abd Razak

M ALAYSIA’S healthcare system, once a source of national pride for its relatively affordable care and widespread accessibility, is now facing a convergence of crises that are threatening its foundation. While past achievements in public health are undeniable, a series of deeply concerning “red flags” – a burgeoning non-communicable disease (NCD) epidemic, a rapidly ageing population, chronic underfunding, misallocation of resources, a demoralised workforce and lagging digital infrastructure – demand immediate and systemic reform, not piecemeal adjustments. The current trajectory is unsustainable, placing the health and well-being of millions of Malaysians at risk. The sheer scale of the NCD crisis in Malaysia is staggering. The National Health and Morbidity Survey 2023 revealed that 17.5% of adults battle diabetes, 29.3% grapple with hypertension and a shocking 54.4% are classified as overweight or obese. These statistics are not mere numbers; they represent a profound human cost such as lives cut short, families burdened by chronic illnesses and a workforce diminished by disability. The economic toll is equally alarming, with the direct healthcare costs of NCDs estimated to be at least RM100.79 billion (5.81% of Malaysia’s 2023 gross domestic product), a figure that fails to fully capture the devastating impact on productivity and long-term economic growth. Malaysia is rapidly ageing. Projections indicate that by 2044, over 14% of the population will be 65 years or older, a dramatic increase from 7.4% in 2023. This demographic shift presents an unprecedented challenge to a healthcare system already stretched to its limits. Older individuals require more frequent and complex medical care, often for multiple chronic conditions. Yet, Malaysia is demonstrably unprepared for this demographic reality. A critical shortage of geriatric specialists, woefully inadequate long-term care facilities and a lack of integrated care pathways for the elderly threaten to create a two-tiered healthcare system, where access to quality care becomes increasingly determined by financial status, not need. The financial foundation of Malaysia’s public healthcare system is crumbling. While providing essential services, the system’s reliance on government funding, currently at 4.93% of GDP (RM90,760.20 million in 2023), falls significantly short of international recommendations and the escalating demands of a growing and ageing population. This chronic underfunding has created a cascade of negative consequences such as overcrowded public hospitals, unacceptable waiting times for specialist consultations and

Malaysia’s healthcare system a ticking bomb

working career progression pathways are essential to attract and retain skilled doctors, nurses and allied health professionals. This investment in human capital must be coupled with a rapid acceleration of digital transformation. Implementing a nationwide, integrated EHR system is no longer a luxury; it is a necessity for efficient data management, improved care coordination and informed decision-making. The government must prioritise digital literacy training for healthcare workers and incentivise the adoption of digital health technologies. Finally, fostering a more collaborative and transparent healthcare ecosystem is essential. This involves strengthening public-private partnerships (PPP) but with stringent regulations and oversight to prevent exploitation and ensure equitable access to quality care for all Malaysians. Clear guidelines, transparent tendering processes and robust performance-monitoring are crucial for successful PPP. Furthermore, a culture of transparency and accountability must be instilled throughout the entire healthcare system. This includes publicly accessible data on healthcare spending, performance metrics for hospitals and clinics, and mechanisms for patients to provide feedback and lodge complaints. Ultimately, a reformed healthcare system must be accountable to the people it serves. Malaysia’s healthcare system is at a crossroads. The “red flags” are undeniable and the consequences of inaction are severe. Continuing with the current trajectory will lead to a system that is increasingly unaffordable, inaccessible and unable to meet the evolving health needs of the population. A bold and comprehensive reform agenda, guided by the principles of equity, sustainability and quality, is urgently needed. This requires political will, stakeholder collaboration and a commitment to long-term investment in the health and well-being of the Malaysian people. The health of the nation depends on it. Dr Shahrul Azman Abd Razak is a researcher and Islamic Finance consultant. Comments: letters@thesundaily.com conditions and clear

procedures, and persistent shortages of essential medicines and equipment. Compounding this is a fundamental misallocation of resources. The system prioritises expensive curative care in hospitals while neglecting the crucial areas of primary care and preventative health initiatives, the very

significant strategic disadvantage. Several critical policy disputes further exacerbate the systemic challenges. The ongoing debate over mandatory medicine price displays, while intended to improve transparency, highlights the tension between patient affordability and the financial viability of private providers. The unresolved issue of co

interventions that could stem the tide of NCDs and reduce long-term healthcare costs. The backbone of any healthcare system is its workforce, and Malaysia’s public healthcare professionals are facing a crisis of morale and retention. Low salaries, excessive workloads and limited opportunities for professional development have created a deeply demoralising environment. This has fuelled a significant brain drain, with skilled doctors, nurses and allied health professionals seeking better prospects in the private sector or overseas. The resulting staff shortages in public hospitals directly impact the quality of care, leading to longer wait times, increased pressure on remaining staff and a heightened risk of medical errors. In an era defined by technological advancements, Malaysia’s healthcare system lags dangerously behind in digitalisation. The lack of a comprehensive, integrated electronic health record (EHR) system is a major impediment to efficient and effective care. This absence of seamless information sharing between healthcare providers leads to fragmented care, unnecessary duplication of tests and an increased risk of preventable medical errors.

“A fundamental overhaul of healthcare financing is paramount. Malaysia must sustainable model that moves beyond the current heavy reliance on general taxation. transition towards a more

payments between insurers and policyholders creates uncertainty and financial hardship for patients. This policy paralysis sends a clear message in which the urgent needs of the healthcare system are being sacrificed to political expediency and vested interests. Strategies to improve A fundamental overhaul of healthcare financing is paramount. Malaysia must transition towards a more sustainable model that moves beyond the current heavy reliance on general taxation. This requires exploring alternative financing mechanisms, including a national health insurance scheme, potentially with mandatory contributions from employers and employees, alongside a robustly regulated private insurance sector.

Crucially, this financial reform must be accompanied by a strategic reallocation of resources. A significant shift in emphasis and funding from expensive curative care towards preventative measures is needed. This includes substantial investment in public health campaigns promoting healthy lifestyles, expanded access to early screening programmes for NCDs and strengthening primary care services to act as the first line of defence, reducing the burden on hospitals. Addressing the human resource crisis within the public healthcare sector is equally critical. Competitive remuneration packages, improved

The vast potential of digital health technologies to improve patient care, streamline administrative processes and generate crucial data for public health planning remains largely untapped, representing a

LETTERS letters@thesundaily.com

Not all managers can turn the tide MANAGERS are an integral part of any football club, orchestrating the team’s strategy and taking responsibility for every decision made. However, the debate over what defines a truly high-calibre manager remains open.

Naturally, these managers were favoured to succeed, given the depth of quality in their squads. However, when these managers take charge of clubs without the financial resources to meet their demands, they have struggled. Not all players at their disposal are up to the required standard, and that ultimately impacts the team. Mourinho and Conte failed at Tottenham Hotspur. If they are truly serial winners with proven track records, this is where they should have demonstrated their managerial prowess. The true hallmark of a great manager lies in taking charge of an average team and guiding them to glory. One of the first names that comes to mind is Brian Clough. He achieved remarkable success with Derby County, leading them from the second division to become champions of England within just three years in the 1970s. Clough went on to achieve even greater glory with Nottingham Forest, guiding them from the second division in 1977 to winning the first

Antonio Conte, Jose Mourinho and Pep Guardiola are acclaimed as great coaches. Hailed for their remarkable achievements, they are known as serial winners who consistently help fill the trophy cabinets of the clubs they serve. Conte was successful at Juventus, Chelsea and Inter Milan. Mourinho was magnificent at Porto, Chelsea and Inter Milan. Guardiola needs no introduction, having had a chequered tenure at Barcelona, Bayern Munich and Manchester City. However, it is important to note that the clubs they have managed were backed by wealthy owners, with cash readily available. The owners were able to meet their demands and players they requested were acquired without much hesitation.

Conte

Mourinho

Guardiola

division title the following season. Similarly, Claudio Ranieri’s achievement as manager of Leicester City during the 2015/16 season is nothing short of remarkable. Having narrowly survived relegation the previous season, Leicester City defied all odds by winning the Premier League. Mauricio Pochettino’s achievement with Tottenham Hotspur also deserves mention. Managing a cash-strapped team and unable to bolster the squad with new signings, Pochettino worked wonders by guiding Spurs to the

Champions League final in 2019. The situation at Tottenham Hotspur, much like our Malaysian national football team, highlights a key lesson: constantly changing managers without achieving success reveals that great managers cannot always turn around average teams. The true recipe for success lies in team chemistry – deeper understanding of teamwork, team management and a positive atmosphere. Thiagarajan Mathiaparanam Klang