Malaysia Public Health Care

Health care is an expensive welfare that every country facing funding problem. (Including Japan/Taiwan/China/US). Currently Malaysia government subsidies 90% cost of the health care system. Government hospital charge RM1 for every patient who visit Accident and Emergency (A&E) or government clinic (Klinik Kesihatan) and Klinik Pakar for RM5-15/visit including dr's consultation/investigation/treatment. For those who admitted hospital charge RM 10/day including 4 meals(breakfast/lunch/tea time/dinner), nursing care, dr's consultation, investigation and treatment. Medical equipment and treatment is expensive, for eg MRI cost RM600-1000/scan, ordinary blood investigation (full blood count/renal or liver profile) cost RM50-150, drug for lowering blood pressure/cholesterol/sugar cost RM0.50-5.0/tablet (1-3 tablets/day). The cost may be terribly high if public need to pay in full amount. That's the reason why people always shocked with the bill when they seek treatment at private hospital.

It's important to create a SAFETY NET for the poor as everybody has the right accessing Basic Health Care Service. However, under current condition, as government reluctant to increase the funding(due to financial/political reason), the Imbalance of Supply/Demand causing a lot of problem which MOST OF THE TIME is the FRONTLINE HEALTH WORKERS taking the BLAME.

As government providing low cost service, the amount of patient load is terrifying. Everybody (including poor/middle class/rich) seeking treatment from gov hosp but the resources are limited(reasons as above). Supply/Demand is imbalance. Government refuse to raise funding and unable to raise charge (the VOTE is important), health workers welfare is sacrificed (UNDERPAY, not enough man power, struggling with limited resource) hence patients best interest also affected.

REAL SCENARIO:
Anyone can visit any government hospital medical ward (Seremban/KL/Penang/Klang/Kajang) which is patient overload, filled with extension beds until no space for people to walk/stand.
3-5 nurses/shift looking after 30-50 patients per ward with quite a number of them need closed monitoring. 1-2 specialist (only main hosp), 2-4Medical officer, 1-3 House officer (only main hosp)per ward. Imagine if u were the medical staff nurse, how can u look after so many ill patients at the same time? eg 4 nurses looking after 40 patients at H. Seremban?Come on, if our government got the money to send astronaut to aerospace for "Space travelling", why don't u spend the money like hiring more nurses? Thus, shortfall will present no matter what with limited man power.


I strongly believe that,
ONE mistake is personal fault
2 errors are incidental
3 errors are occasional
REGULAR errors is SYSTEM FAILURE!

How can our PUBLIC/POLITICIAN blaming individual medical staff for SYSTEM FAILURE?
In every field there will be 'Rat Shit spoiling the porridge", I don't protect those medical staff who is not performing (as i observe there are ALOTS especially those HIGHER POST SENIOR STAFF using MOUTH only not moving their ass to work), I'm depressed as medical doctor serving public in government hospital struggling with various limitation, the PUBLIC nowadays only pointing finger and not appreciating our good job/effort.

Waiting hours too long at government clinic/A&E?
-My colleague come review patient at 7am daily till 10-11am then go medical clinic see patient with number of patient 100/clinic and only 2-4 dr working(which the OFFICIAL CLINIC HOURS IS 9AM-1PM), and being complained by patient for coming late. REMINDER: NO extra doctor sitting in clinic only. U need to running around within hospital as clinic/ward always looking for doctors, eg patient collapse in ward, patients complaining/yelling at clinic for long waiting time. Do our new MOH Dato Liaw know this (never serve as a DOCTOR in Gov Hosp) who is so ambitiously want to cut down the waiting time? Provide ADEAQUATE DOCTOR please! Before start talking Hoo-Haa, study the real problem and work it out. If keep on saying" the doctor without loving kindness please leave gov hosp bla bla bla", i'm sure more doctors are leaving soon and HE who is not even a doctor should be sitting in hospital seeing patient himself in the near future.

My dear minister and our Public, do u think that 3-5 doctors seeing 100 patient in 2-3 hours is reasonable? This is SPECIALIST CLINIC eg. Medicine, Rheumatology, Nephrology. These patients need adequate examination and review (unlike the common cold or cough) which need 20-40 minutes/patient. Should we compromise these patients best interest in order to "SEE but not REVIEW" these patient at clinic? If that's the case, why don't we send them back to Klinik Kesihatan? What's the difference between Specialist Clinic and ordinary gov clinic?

Offering gov doctor with Salary of RM3-4k but working like a Cow does not make any sense. Our country is wasting money for those gigantic "White Elephant" project but not able to raise the health worker paycheck to a REASONABLE rate. Doctor's on call for 24 hours got RM170=RM7/hours, Foot Massage cost us RM60 for 60 minutes, don't u think that the on call rate is humiliating this profession as if the knowledge/professional skill can't even compare with a foot therapist? Money is not the MOST IMPORTANT factor, but be fair and reasonable. U can't keep on subsidy those BIG GLC like MAS/Proton but continue sacrificing those people who did their hard work to serve the country and people.

Comparing the charges and the service/treatment offered by gov hosp, i think it's good enough even u comparing it to other country. Remember, U Get What U Pay. If the service is so good (air condition ward, plenty of nurses/doctors, most advance technology/treatment) and the cost u need to pay is merely RM1, what will happen? Everybody will rush to gov hosp and end up flooding the whole country gov hosp with patients.At the end, it'll back to the same situation with Supply/Demand Imbalance.

Nothing is free, other than BASIC HEALTH CARE SERVICE, we should take care of our own body. Will u blame others if u not taking good care of your car and finally the engine just break down? Same line of thinking, how can public blaming others/doctors/government if u are over-eating, overweight, smoking non-stop, drink alcohol like water, drunk and drive, taking Ecstacy, careless driving, sleep late wake up late, never exercise? U should responsible for your OWN BODY/OWN GOOD HEALTH. I never sympathy for those who drunk then accident as they DESERVE it.

We can't neglect the poor by privatising WHOLE HEALTH CARE SERVICE. It's a nightmare and inhuman for the poor. We need to provide SAFETY NET for the poor with BASIC HEALTH SERVICE. If u are badly injured in an accident which need emergency operation, GOV should provide this with minimum charge. If u are unlucky and was diagnosed having Cancer, GOV should provide treatment with minimum charge. If u are pregnant and going to deliver, GOV should provide mid-wife/doctor's aid with minimum charge.

If a country/society doesn't provide Basic Health Service to the poor, it's not only inhuman but it'll cause society instability. The poor losing hope/faith in gov will create chaos/riot and eventually everybody will be in big trouble. (Can't we imagine similar condition Myanmar/Africa?)

However, Basic Health Care has its limitation. For example, we don't provide the latest therapy but the most cost efficient therapy. Quantity supervene quality. Like ordinary chemotherapy for cancer may cost RM1000-3000/ cycle of treatment, compare with the latest chemotherapy with less side effect (Nausea/Vomit/Hair drop) and more efficient (may or may not prolong patients life for 6 months-1 year compare to ordinary chemotherapy) which cost RM10,000-30,000/cycle, ordinary regime is the choice. Another example, we know that Impotence (Man unable to erect) is a Disease, but should we include Viagra (around RM50/tablet) in Basic Health Service?


Sadly, I think Life Isn't Equal, Not Even Same PRICE (Though we always claim that life is PRICELESS). U Get What U Pay, that's the principle. Europe country providing marvelous welfare is based on the expense of High Tax Rate (around 40-50% for income tax, compare with M'sia, no tax for those earning less than RM25,000 annually and Max is around 24%). However, they also facing problem with rising cost of health care and running out of budget. (No country should spend all their budget in Health Service alone Right?)

For those who can afford the medical expenses, u should consider private service as Basic Health Care should never full fill everybody demand, eg. air-condition ward, plenty of dr/nurse who attending your every single complaint (non-urgent), immediate response for non-urgent call, complete/routine but may not truly indicated test like X-ray/Scan/blood test any or every time u visit dr. And for the rich one, why should u fighting with the poor for our limited Health Resources?

That's why i STRONGLY AGAINST providing 1ST CLASS in Gov Hosp. Patients who admitted to 1st class pay the full room fee only (around RM200-350/day) but still enjoying the subsidy treatment/investigation. For those who want and can afford 1st class, u should go to private hospital. And OUR GOV/ Minister should revise the policy, make those who admitted to 1st class in Gov Hosp pay in full amount for the treatment/investigation/doctors and nurses service as they can afford to pay more. By serving these 1st class patients now (Usually POLITICIAN/SUPER VIP/and some middle class, eg our Ex-PM Dr.M, some Big Businessman) who can afford the full cost of health care, it's unfair to the poor as OUR GOV ALLOW THE RICH "SHARING"(sometimes it's ROBBING the poor, eg Dr M can have immediate heart operation at Institut Jantung Negara when he need while the rest of the public, or the poor, need to wait for 6-12 months for their slot of operation) THE LIMITED RESOURSES WITH THE POOR.

I'm sure we can do better to improve our Health Service. But our public, please don't abuse our limited resources by visiting A&E for non-emergency condition, asking for unnecessary investigation. And please don't blaming/complaining the front line health worker for not serving u up to your heart content. WE(front line health worker) serve and sacrifice because of good faith, not because WE OWE U, or We Should Serve U Like Master and Slave. Be grateful and respect. If not, more people will leave government health care service and it's not the POLITICIAN/VIP/RICH will suffer, it's THE POOR AND THE PUBLIC.

I'm looking forward for that time of change to come.