These clinics don’t make sense
THE 1Malaysia Clinics scheme was started by the previous government with the primary aim of bringing basic health services to the urban poor close to their homes. They were staffed by medical assistants and nurses who provided basic health services, such as blood pressure checks, simple wound dressing, cough and cold medications, etc.
The first 1Malaysia Clinic was launched in Lembah Pantai, Kuala Lumpur, on Jan 7, 2010, right in the heart of the Klang Valley where the highest density of clinics is found in the nation.
Many questioned their effectiveness, as all their services were already available at existing government health clinics. Besides, it is not much of a clinic without doctors, as many medicines can only be prescribed by doctors and most cases, other than simple colds, flu, etc, would need a doctor to review and manage.
Private doctors had appealed that it would be better to use the many existing private clinics that are found in every densely populated area as collaborators in delivering these services or to offer locum positions to private doctors in 1Malaysia Clinics.
Eight years on, it has clearly been shown that 1Malaysia Clinics in their original form served little purpose, and many have been utilised as cheap “pharmacies” for simple remedies – a service that can be easily obtained from the many existing private clinics or pharmacies at similar costs or even lower on certain occasions.
Recent revelations by Deputy Health Minister Dr Lee Boon Chye proves the point: “The cost of operations for all these clinics was RM119mil for the period, or an average of RM18 per patient. ... This is the cost for medicines, reagents and consumables, and does not include operation costs for the manpower and rentals of premises.” (Online at tinyurl.com/star-clinics.)
Realising that clinics without doctors serve little purpose, the current government has now rebranded 1Malaysia Clinics as community clinics and is planning to station medical officers and pharmacists in stages, thus upgrading the services available.
Out of the 347 clinics, 34 will be closed, 20 upgraded to government health clinics, and 293 rebranded as community clinics.
This is a step in the right direction. But concern remains about the heavy financial burden of maintaining the 293 community clinics that duplicate the services of private clinics as well as existing government health clinics.
Private sector data revealed that, on average, the fixed costs of running a clinic ranges from RM20,000 to RM30,000 a month for a clinic operating nine to 10 hours a day, depending on locality. Fixed costs include staff salaries, rental of premises, utilities, stationery, licensing, and associated charges – but do NOT include doctors’ salaries.
For 293 community clinics, it would cost the government an estimated RM70mil to RM105mil annually in addition to the RM119mil of consumable costs.
The cost efficiency of this huge annual allocation can be significantly improved if we take advantage of the economies of scale and share common resources. This would mean we close all 1Malaysia Clinics and consolidate them into regional health clinics, or Klinik Kesihatan. By doing so, we cut costs with shared facilities and staff rather than maintaining so many small clinics duplicating services everywhere, with each clinic needing to have its own set of staff, utilities, etc.
Again, it would not be a popular political move to close all 1Malaysia Clinics, especially when they are meant to serve the B40 (low income earners), a large and under-served group. However, in reality, this group would be better served economically by bigger, more cost-efficient consolidated facilities.
When we stop playing politics with healthcare, the people’s health improves and the nation will be in a better position to progress.
I hope one day, politicians and government will take that position and say no to politics in healthcare.
DR JOHN TEO Kota Kinabalu