WEBSITE REPORT
In February last year, a website that promotes places for people to live after retirement reported that Malaysia was among the top three countries with the best healthcare in the world. The site stated that our medical expertise is equal, if not better, than most Western countries.
Quite a number of people shared this story on their Facebook pages. Some of them applauded the so called achievement. However, most of them questioned the credibility of the report. How can a website that promotes living overseas make a reliable and unbiased “study”, judging healthcare services worldwide? To be honest, even though I am proud of my country, I was sceptical of the survey.
To take a more critical view of the issue, let us compare the scope of the website’s study with the World Health Organisation’s (WHO) standard for healthcare services.
Besides cost and insurance coverage for healthcare services, the commercial website also included the number of patients to a doctor as its study criteria. I don’t think cost can be a good indicator for healthcare service measurement. The value of our ringgit compared with other currencies might give a different definition of how affordable a treatment is.
For instance, to an American, US$10 (RM37) for a doctor’s consultation fee might be very cheap but, for a Malaysian, RM37 is a bit too much. My argument on this issue might be flawed as I am no economist. But it baffles me how general practitioners living in Malaysia claim that they would not survive with even half of that kind of consultation fee. WHO stated that the standard doctor-to-population ratio should be 1:400.
As of 2013, it was reported that the ratio of doctor-to-population here is 1:791. It was, therefore, quite surprising for a country that could achieve only half of the required ratio to be considered one of the best in the world. The website might use other factors to influence the result, but the statistic is indicative enough for the report to be taken with a pinch of salt. For the sake of argument, let us consider the website evaluation to be valid.
We should then go deeper to dissect the healthcare situation in Malaysia. In 2012, Malaysia had more than 36,000 doctors. Only 10,000 of them practised in the private sector, while the majority practised in the public sector.
The country’s population is around 29 million, excluding foreigners, with an annual expansion rate of 1.3 per cent. The number of patients warded in public hospitals was 2.9 million, while only one million patients were warded in private hospitals. For outpatient treatment, it was reported that more than 30 million patients had received treatment in public hospitals and clinics, while only three million patients received treatment in private healthcare facilities. This data provides an insight into our healthcare services.
There is a clear imbalance between patients receiving treatment in public and private health institutions. The majority of patients opted to go to public hospitals.
This might be due to several reasons, including trust, cost and feasibility. It is alarming that medical expenses in private facilities took up more than 55.6 per cent of medical expenses in 2007.
This shows that the cost for having medical treatment in private clinics and hospitals was very high, since the industry that catered to only 10 per cent of the population outspent public medical expenses by more than 50 per cent.
With that in mind, how can practitioners in the private health sector claim that their healthcare system is among the best in the world? We have heard over and over again statements from private medical doctors and groups claiming that we should maintain our healthcare system by rejecting the proposal of separating the professional roles of doctors and pharmacists, since we have been recognised as one of the best in the world. If the survey is valid, the major recognition should go to the public healthcare system since it provides the best care to the majority of the population. It is a fact that public medical institutions in Malaysia practise dispensing separation.
Doctors will diagnose and write out the prescription while pharmacists will screen, dispense and counsel the patient. This has been practised for years. Pharmacists’ involvement has been shown to reduce medication errors, improve compliance and achieve better patient outcome worldwide. It irks me that a certain group of healthcare service providers, serving only a minor portion of our community, claim that their system was the one that was recognised as the third best in the world. If those people want to use the website findings as their argument, they should read and comprehend the outcomes of the survey.
The website said: “The majority of dentists are US- or UK-trained, and the staffs are friendly and professional. The facilities are modern and similar to what you are used to in the US. Prescriptions cost a fraction of the cost in the US, and the pharmacists are well-trained and informed.”
It is intriguing that everybody that cited the website findings failed to mention the above statement. Did they selectively deny the influence of the pharmacists on the outcome of the survey to reject a notion that directly involves the professional roles of pharmacists? It cannot be denied that the proposal for dispensing separation needs to be discussed critically, and studied.
However, those who are for and against it should base their arguments on critical and valid scientific studies and data, instead of plucking whatever available statement that can easily influence and manipulate the public. Being professional is the only way to improve our healthcare services. I think that we have a long way to go to improve our healthcare services, and that dispensing separation is a step forward. However, it must come with mechanisms and enforcement. Let us work together to ensure the improvement of the safety of patients.
F.S.H.,
Shah Alam, Selangor