Healthcare Delivery in Malaysia

Yi Xiang Teo, MD

The healthcare system in Malaysia consists of both private and government (public) hospitals. Public hospitals also serve as teaching hospitals where medical graduates complete their two-year housemanships (like sub-internship rotations). These hospitals are heavily subsidized by the government, making cost a significant differentiating factor between the two tiers.

Malaysia provides universal healthcare for all citizens. Instead of providing a public or government health insurance policy, the government heavily subsidizes the cost of treatment through public facilities. For instance, the consultation fee per office visit for a general practitioner in a public hospital is RM1 (approximately $0.20) and RM5 (approximately $1.20) for specialist consultations. In contrast, private healthcare costs range from RM30-RM125 for a general practitioner and RM80-RM235 for a specialist visit. This is demonstrated by Table 1: Examples of healthcare cost comparison between public and private sector[1]. This subsidized practice was established in the 1970s, and it aims to ensure affordable healthcare for all Malaysian citizens. Moreover, there are several health safety nets for low-income citizens.

However, the affordability of public healthcare leads to overcrowded hospitals, which in turn affects the quality of care and results in a lack of individualized attention for patients. This overcrowding is a major drawback, contributing to longer waiting times and reduced patient satisfaction. Many physicians are concerned about the sustainability of this model. Despite heavy subsidies, rising operational costs are straining the public sector, making it difficult to maintain adequate compensation for physicians. This situation has led to physician burnout and challenges in retaining talent within the public sector.

Hence, with their ability to afford out-of-pocket costs, citizens with higher household incomes often opt for private healthcare. This is where private health insurance (PHI), sold under Medical and Health Insurance (MHI) policies, comes into play. These policies, available since the 1970s, can be purchased voluntarily either by individuals or through employer-sponsored health insurance (ESHI) schemes.

Most private health insurance policies in Malaysia primarily cover inpatient treatment. A significant aspect of these policies is that patients are usually required to pay their medical bills upfront and then seek reimbursement from the insurance company. This protocol can deter individuals with lower household incomes from purchasing private health insurance, as the initial medical expenses may be prohibitive, despite eventual reimbursement.

The MHI market in Malaysia saw significant growth in the 1990s following the introduction of personal income tax relief in 1996. This tax relief made private health insurance more financially attractive, leading to a decrease in the uninsured rate from 85% in 2005 to 57% in 2011. The likelihood of being uninsured in Malaysia is strongly linked to factors such as income and education, with higher income and education levels correlating with higher insurance coverage rates [2,3].

General practitioner (GP) clinics are widely accessible and accept walk-in patients and are available in both public and private sectors. In the private sector, specialists accept patients without a GP referral, offering more direct access to specialized care. Conversely, the public sector requires a referral from a GP for specialist consultations. These primary care services include preventive care, treatment for common illnesses, maternal and child health services, immunizations, and health education.

Healthcare disparity remains a challenge in the Malaysian healthcare system. For instance, the LGBTQ community continues to suffer from discrimination and stigmatization both socially and medically. There is a growing recognition of the need for inclusive healthcare services that respect the identities and experiences of LGBTQ individuals. Training healthcare professionals on LGBTQ issues and reducing discriminatory practices are essential steps in this direction, but much remains to be done.

Malaysians have increasingly embraced traditional Chinese medicine (TCM) as part of their healthcare regimen, evident in the proliferation of TCM clinics and practitioners across the nation. These establishments cater not only to the Chinese Malaysian community but also to individuals from diverse ethnic backgrounds seeking alternative or complementary healthcare solutions, including acupuncture and herbal medicine. While TCM offers additional support for conditions like chronic back pain, its growing popularity also raises concerns about potential misinformation and biases that could affect patients' understanding and decisionmaking regarding healthcare, with rural and low socioeconomic status communities being the most vulnerable population for such negative impact.

In conclusion, healthcare accessibility and affordability in Malaysia are commendable. However, sustaining this progress and enhancing care quality requires continuous reforms and targeted initiatives. Addressing existing challenges is key to the success of healthcare in Malaysia such as including the healthcare needs of marginalized communities like the LGBTQ population and enhancing the overall health literacy of the populace.

Table 1: c omparison of medical fees between public and private healthcare systems.

Yi Xiang Teo, MD, born and raised in Malaysia, completed his medical education in Shanghai, China. He is currently a fellow in Pulmonary and Critical Care at UMass Baystate, after having completed his chief residency at St. Vincent Hospital.