Prof Dr Awang Bulgiba Awang Mahmud.
KUALA LUMPUR: Doctors should be rewarded for promoting good health and keeping people out of hospital, in addition to treating those who are already sick.
A public health expert said any new healthcare model should consider this as preventive care is more cost effective than curative care.
Universiti Malaya deputy vice-chancellor (Research and Innovation) Prof Dr Awang Bulgiba Awang Mahmud noted that under Britain’s National Health Service, general practitioners are rewarded for keeping patients out of hospital.
“I hope a Malaysian model will be less likely to reward the use of (health services) but more likely to reward doctors for keeping their patients healthy and out of hospitals.”
In Britain, GPs are paid cash incentives to improve healthcare. The “pay-for-performance” scheme is designed to pay work by doctors that previously wasn’t funded, such as managing conditions like hypertension as well as monitoring smokers and obese patients.
Prof Awang Bulgiba said there were three grand challenges facing the healthcare system – the rise in lifestyle diseases, an ageing population and rapidly spreading infectious diseases. He said any new healthcare model must address these factors.
“The rise in lifestyle diseases such as cardiovascular conditions, cancer and diabetes is due to our sedentary lifestyles and environmental changes.
“The cost of statins and lipid lowering drugs is getting higher. Healthcare is getting more expensive because more people are affected by these non-communicable diseases,” said Prof Awang Bulgiba, adding that the private sector must play a role in preventive care, which until now has almost exclusively been the preserve of the Government.
He noted that the top cause of deaths in government hospitals was heart disease. The increase in the rate of diabetes prevalence is worrying too. In the National Health and Morbidity Surveys, it increased from 8% in 1996 to more than 14% in 2006. In the fourth survey in 2011, the rate of diabetes was an alarming 20.8%.
Other than the rise in lifestyle diseases, Prof Awang Bulgiba also noted Malaysia’s ageing population would put stress on the country’s healthcare.
“By 2035, more than 7% of Malaysia’s population will be 60 years or older. Healthcare must recognise this fact and take steps to prepare for it,” said Prof Awang Bulgiba, who was the first Malaysian doctor to gain a PhD in Medical Informatics.
He said that with cheap air travel, infectious diseases like SARS and H5N1 can spread faster than ever before.
“What used to take months, now takes days to spread,” he said, noting that Chikungunya, a viral disease from Africa, has been detected in Malaysia.
Prof Awang Bulgiba also highlighted the disparity in the allocation of resources between the public and private healthcare sectors.
In 2011, public healthcare providers had 41,616 beds compared to 13,568 in private facilities.
“Although government institutions provide 75% of beds, only 40% of doctors work in the public sector with the majority in private practice,” he noted.
Prof Awang Bulgiba said there was also an imbalance of resources in healthcare. For example, there are far too many MRIs (magnetic resonance imaging machines) in the Klang Valley, “probably more than in the whole of Australia.”
He was speaking at a lecture on The Evolution of Public Healthcare in Malaysia held at UM recently after his election as a fellow of the Academy of Sciences Malaysia (ASM).
Prof Awang Bulgiba also talked about the rapid growth of private healthcare in Malaysia.
There has been a proliferation of private healthcare facilities, from 174 in 1992 to 660 in 2011. In 1980, there were only 50 private hospitals but in 2011, the number had grown to 220.
The share of private healthcare expenditure has been rising and is almost on par with government spending, from 5.8% in 1981 to 45.4% in 2009.
Looking at the bigger picture, Malaysia’s total expenditure on health was RM33.7bil or 4.96% of Gross Domestic Product. This is below the World Health Organisation’s recommended level of not less than 5% of a country’s GDP.
“As a comparison, the United States spends 15% of its GDP on healthcare,” said Prof Awang Bulgiba.
He noted that although Malaysia has made great strides in healthcare, there is concern on whether the current model is sustainable.
Rising costs would eventually force the government to evaluate how a national healthcare financing scheme can be implemented. Previous attempts, including the 1Care for 1Malaysia plan, have failed to get off the ground following opposition from stakeholders.
“I hope the new model will integrate the public and private healthcare facilities to promote equitable access,” said Prof Awang Bulgiba.