The demand for healthcare is rising and continues unabated, with opportunities for improvement and innovation in diagnoses and treatment. However, economic uncertainties and budgetary constraints continue to put significant financial pressures on the provision of healthcare services.
The net impact of these contradictory pressures is uncertain. What will Malaysian healthcare be like in 2018?
Impact on Patients
The Federal Court reaffirmed in Kok Choong Seng & Sunway Medical Centre v Soo Cheng Lin in 2017 that the legal standard for the provision of information to patients is the Rogers v Whitaker principle, i.e. doctors have a duty of care to disclose material risks.
A risk is material, if “in the circumstances of the particular case, a reasonable person in the patient’s position, if warned of the risk, would be likely to attach significance to it, or if the medical practitioner is, or should reasonably be aware that the particular patient, if warned of the risk, would be likely to attach significance to it”.
Although this patient-centred standard has been around since 2006, many healthcare providers still do not understand their legal duties, with some of them having been held liable by the courts for their failure to inform.
Patients’ voices will become louder in 2018 as they are increasingly more informed, particularly from the electronic media – although the quality of health information on the Internet is variable.
The Malaysian Health Data Warehouse (MyHDW) was launched in April 2017 with the objective of using Big Data for analysis and decision-making, with the potential for reducing cost, reducing waste and optimising the use of limited resources.
The collection of personally-identifiable data is unavoidable. Questions about data security, its de-identification when released to users, and oversight of MyHDW have not been clarified.
With the reported leaks of the personal data of mobile phone subscribers, organ donors and members of medical organisations, patients need assurance that their health information is always kept confidential. Interestingly, the Personal Data Protection Act does not apply to the public sector.
Public trust in allopathic healthcare delivery systems continue to wane. Many people willingly entrust their healthcare to the non-health sectors with technology providing them the tools to do so, e.g. refusal to vaccinate, home deliveries by unregistered personnel, and purchase of unlicensed medicines unavailable locally through the Internet.
The public will increasingly demand to be treated as human beings with better patient experiences enhanced by providers, and not as entries in medical records. The demand for patient safety and quality of care will continue to pressure regulators and payers to ensure that the healthcare services provided are safe and of high quality.
Increasing Healthcare Expenditure
Healthcare expenditure will continue to rise because of the ageing population, the double whammy of non-communicable and infectious diseases, new technologies and increasing patient demands.
The need for long-term care and non-communicable disease management will increase for the senior population and an increasing number of young adults. This is inevitable as large segments of the population are unhealthy with diabetes, hypertension, overweight and obese.
Concomitantly, infectious diseases, especially dengue, will continue to plague the public. Despite vector control measures, dengue and malaria prevail with no cure for the former and increasing drug resistance in the latter. Some previously-eradicated diseases like rabies are also making a comeback.
There will be increasing out-of-pocket expenditure in the private sector, and even in the public sector, particularly with increasingly expensive medications and procedures. An increasing number of people will face financial ruin if they or their relatives get catastrophic diseases like cancer and heart attack.
Medical inflation will continue to exceed the increase in GDP (gross domestic product). Cost containment in private hospitals has not succeeded.
The Private Healthcare Facilities and Services Act regulates doctors’ professional fees, which comprise not more than 20%-30% of the private hospital bill, but hospital charges continue unregulated. A RM100,000 private hospital bill, which was uncommon at the beginning of this decade, is now common.
Concomitantly, charges in private clinics, and even in private hospitals, are increasingly being capped by managed care companies and third-party administrators. More general practitioner clinics will close, primarily because of financial unsustainability, and rarely because of retirement.
When middlemen take a share of the healthcare ringgit, compromises are inevitable, with consequent impacts on safety and quality of care. Studies about a national health financing scheme have been on-going since the 1980s. Although voluntary health insurance was announced in October 2017, details are yet to be disclosed.
Private practice for public sector specialists may or may not stem the outflow to the private sector, as the outflow is often due to service conditions and not just financial compensations. Would the care of public sector patients be affected by such private practice? Only time will tell.
There are too many medical schools, too many graduates, and too few house and medical officer posts. Over-production of the medical workforce continues although the public is wiser, with decreasing applications to private medical schools, which will lead to mergers, acquisitions and closures of some.
The crunch will come in 2021 when the four-year contracts of the initial cohort of junior doctors in the Health Ministry will end. Some will continue to be employed, but the rest will have to find their way in the saturated private sector or seek alternative employment.
Delays in the appointment of housemen after graduation from medical schools has led to some of our best and brightest doing their housemanship training in regional countries that provide certainty of appointments. Training doctors at taxpayers’ expense for other countries is, to say the least, illogical.
Healthcare has lagged behind others like telecommunications, transportation, retail etc, in utilising new technologies like artificial intelligence and virtual reality.
The smartphone, portable or at-home diagnostics, smart drug delivery mechanisms, digital therapeutics, genome sequencing, machine learning, blockchains (decentralised databases) and the connected community will begin to impact on multiple aspects of healthcare delivery, e.g. operations, workforce management, business models, patients’ confidentiality and security.
Staying healthy is critical to avoid receiving healthcare. A healthy diet, maintaining an appropriate weight, regular exercise, sufficient rest, safe sexual practices, avoiding smoking, moderate alcohol consumption and keeping vaccinations current are some of the measures to stay healthy. This requires some work, smart lifestyle choices and the occasional medical check-up.
Wishing all readers good health in the Year of the Dog!