It’s up to you and me

The ‘best’ healthcare system is one that involves us in managing our own health.

A RECENT article in a foreign magazine named Malaysia as one of four countries having “the best healthcare” in the world.

The story, which also said we had some of the region’s “best-trained doctors”, was highlighted by the health minister, who naturally welcomed the recognition.

I know of others, though, journalists included, who were rather incredulous. “Best” is certainly contentious, especially from the view of waiting lines in unglamorous public hospitals. But then, the article was written from the angle of medical tourism (and based on the affordability of medical procedures).

I wade warily into these waters because the subject of healthcare can be bewilderingly complex and politically explosive. But we need to set the record straight. Malaysia does have a darned good healthcare system. For those who think otherwise, go spend some time in other middle-income countries. It’s all relative, of course, so don’t compare us with a rich nation.

The numbers, though, don’t lie. Our health indicators – which provide benchmarks on health system performance – are pretty good, some even on par with developed nations. Our maternal and child mortality rates are so impressive that Malaysia is considered a model for other developing countries. The chance of a woman dying from childbirth has drastically dropped since Independence, from more than 500 deaths per 100,000 live births compared with less than 30 today (which ranks us pretty close to the United States).

In terms of the health system itself, we also do well, going by indicators set by the World Health Organisation (WHO). People usually can get care, and decent care, at an affordable rate. The poor usually don’t go broke paying for treatment. And we roughly spend the recommended proportion (though perhaps a little on the low side) of our GDP on healthcare.

In a 2013 report on universal health coverage, the international poverty reduction organisation Oxfam cites Malaysia as a success story. The health systems of Malaysia and Sri Lanka “provide citizens with some of the highest levels of financial risk protection in Asia”, it says. Now this is Oxfam, mind you, a leading global charity, not some expat magazine.

An awful lot of people in this world fall into poverty paying for healthcare. According to Oxfam, some 100 million – or three people every second – become poor this way. This doesn’t just happen in India or China but even in the United States. This is why providing affordable healthcare is important to end poverty. Of course, our healthcare system is far from flawless. There’s plenty of room for improvement – in, for example, waiting times, quality of services, and infection control. The system is overloaded, and a growing private sector has emerged. Which means we’re heading into a divided system, where the rich get private care and the poor get public care. Also, specialists are leaving the public sector for the private sector. And many people paying for private care directly from their own funds. These “out-of-pocket” costs are worrying, because that’s what pushes people into debt and poverty.

In the long-term, as the population ages and lifestyle diseases increase, our current system looks rather fragile. The Government is actually already weighing future options and studying healthcare systems in other countries. It’s a huge task.

Perhaps, though, we need to also turn the whole system on its head. Rather than focus at the top end of care in hospitals, we should look at how to prevent not treat disease.

“We have done well in structure and systems”, but we need to shift to preventive care where “way of life is key”, says former Universiti Sains Malaysia vice-chancellor Prof Tan Sri Dzulkifli Abdul Razak, who has been an advisor to the WHO on drug policy.

To do this will require empowering people and communities to govern their own health through education, he says. This would apply to lifestyle diseases and drug use, and even dengue, which requires community engagement to prevent it.

That’s right, people, it’s up to us. The “best” healthcare system is one that involves you and me. It hasn’t happened yet. But it will do, it has to, in the future.

Mangai Balasegaram writes mostly on health, but also delves into anything on being human. She has worked with international public health bodies and has a Masters in public health.

In the long-term, as the population ages and lifestyle diseases increase, our current system looks rather fragile.