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MALAYSIA: Private Hospital Wings Won't Ease Health Woes - Critics
By Anil Netto
PENANG, Malaysia, May 24, 2004 (IPS) - The Malaysian government's plan to set up
private commercial wings in government-run hospitals to stem the brain
drain of doctors to the private sector has come under fire.
Health Minister Dr Chua Soi Lek said a committee, tasked to look into
the idea, would come up with a working model within two months. Patients
would pay ''reasonable charges'' for better facilities at the private
wings, such as private rooms with attached bathrooms and television.
The reaction to the plan was swift. ''It is clear that our
under-financed government health care will become even less available to
the poor,'' said Dr Chan Chee Khoon, coordinator of the Citizens' Health
Initiative.
He warned that private wings in state hospitals would lead to human and
material resources being reallocated to serve the dictates of the health
care market - including ''health tourism'' - rather than the needs of the poor
At present, a nominal fee is imposed for treatment in crowded open wards
while a higher, though still subsidised, charge is billed for more spacious
rooms in general hospitals. Some 80 to 85 percent of Malaysian in-patients
obtain treatment in general hospitals.
The proposal for private wings in general hospitals first came in 1997
from the Section Concerning House Officers, Medical Officers and
Specialists of the Malaysian Medical Association (SCHOMOS MMA), the body
representing government medical doctors.
The aim was to allow government doctors to do private practice to
supplement their relatively low salaries. The health ministry however
deemed the plan not practical.
The MMA kept the issue alive, believing that limited private practice
would help to retain senior and trained staff in the public sector. It felt
that doctors, the government and patients would all benefit from this scheme.
In 1999, the MMA brought the matter up with then Prime Minister Mahathir
Mohamad and senior health officials were said to be keen on having the
proposal implemented by June 2004.
Chua pointed out that 40 percent of the 1,200 positions for specialists
and 25 percent of the 10,000 medical-specialist posts had not been filled -
a critical shortage. The public-private mix has already been introduced in
a few hospitals such as the University Hospital (UH) and the National Heart
Institute (IJN) to plug the brain drain to the private sector.
''It has been a disaster so far,'' said Dr T Jayabalan, advisor on
health care issues to the Consumers Association of Penang.
Drug, procedure, and laboratory charges at the UH has soared, he said.
What's more, ''the IJN is probably the costliest place for heart surgery'',
he noted. ''The waiting time for heart patients who are unable to afford
surgery could be two years or more.''
Some government doctors who once supported the private wings proposal
are having reservations. ''We know among ourselves that there are guys who
will abuse it,'' said a senior doctor at a government hospital who declined
to be named, citing the fear of repercussions.
He said the proposal appears to be targeted at patients who would
otherwise go to private hospitals. But in practice, he pointed out that the
private wings could end up siphoning patients from the public section of
the general hospitals by baiting them with shorter waiting times and
superior care.
The key issue is underfunding of public health care, a subject rarely
discussed openly in Malaysia.
Expenditure on public health care as a percentage of Gross Domestic
Product has traditionally hovered at around 3 percent - well short of the
five to six percent proposed by the World Health Organisation. Underfunding
is responsible for inadequate facilities, long waiting lists and low salaries.
In the Penang General Hospital, for example, the waiting time for
patients needing a Magnetic Resonance Imaging (MRI) brain scan can be up to
five months.
Underfunding also means that government doctors remain underpaid -
despite their heavy workload. Medical officers routinely see some 150
outpatients a day, when the ideal should be not more than 50.
Such conditions have led to an exodus of staff, prompting the government
to hire expatriate Asian and Middle Eastern doctors - and this in turn
creates resentment among local government physicians.
The declining standard of nursing care also plagues the health system.
''It is quite common to enter a ward and see patients with soiled clothes
and (intravenous) drips running dry,'' said Cecilia, an experienced health
care worker. ''It is also common to see groups of nurses chit-chatting
merrily away while the sick yearn for help.''
At the Penang Hospital for instance, nurses expect visiting family
members to change the soiled clothes of bedridden patients and feed them
during mealtimes. Services like cleaning, facilities maintenance and the
catering of meals for patients have been privatised - leading in some cases
to lack of accountability and conflicting responsibilities.
At mealtimes at the hospital, attendants from the private catering firm
merely leaves the meal trays at patients' bedside. An hour later, they come
around to collect the trays - whether the patient has touched the food or
not.
In one incident, Xavier, an elderly bedridden patient, was unable to sit
up and reach for his tray. When the attendant returned and collected the
untouched food, it was pointed out to him that the patient had not yet eaten.
The worker merely shrugged his shoulders and said: ''It's the nurse's
job to see that he is fed. Mine is just to serve the food and collect the
utensils after mealtimes. I have to account for each and every item of
cutlery - anything missing gets deducted from my wages.''
But one of the more diligent nurses flitting around from patient to
patient is Siti. Asked about the indifferent attitude of some of her
colleagues, she sighed: ''You have to be like a Florence Nightingale. You
have to think about how you would like to be treated if you were in their
(the patients') position.''
Said Siti: ''Many of my colleagues - they are here because they can't
find jobs elsewhere. Their hearts are not in it - it's just a means of
earning a living for them.'' (END)
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