The PSM is extremely disappointed to hear from the Minister of Health, Dato Seri Dr Dzulkefli Ahmad, that the Madani Government is thinking of opening private wings in government hospitals around the country under a new program termed “Rakan MOH”.

The previous avatar of this retrogressive plan – then termed the Full Paying Patient scheme (FPP) – was first announced by the then BN government in 2007. The PSM then rallied a coalition of NGO and activists to object to this plan by organizing a series of protests including at the four government hospitals (in 2011) that had been selected to expand this scheme.

These PSM-Civil Society protests resulted in the deferment of the further implementation of the scheme for a couple of years, but after that, the government implemented the Full Paying Patient scheme without fanfare in 11 General Hospitals across the country.

The PSM rallied people against the Full Paying Patient scheme because we genuinely felt that it would be bad for the ordinary citizen. The problem with our government hospitals is that we do not have enough senior, experienced specialists to treat the more complicated cases and to train the younger specialists. Approximately 75% of the specialists with more than 10 years of experience post specialization, are in the private hospitals that have mushroomed across the country, leaving only 25% of this group of senior specialists in the government hospitals where, up till now, more than 75% of the in-patients are being treated, and the new generation of specialists are being trained.

The chronic lack of experienced specialists translates into very long waiting times for patients with complicated conditions, delays in diagnosis and treatment, misdiagnoses, inadequacy of training programs for younger doctors trying to specialize, and more stress for the junior doctors who have to handle the heavy patient load without adequate backup. This is why we protested the FPP scheme back in 2011.

It’s surreptitious implementation in 11 hospitals in the years that followed has demonstrated very clearly that our apprehensions about the FFP scheme were largely correct. The FPP scheme allows senior doctors to see private patients “after office hours” in government hospital premises, and charge them private rates. Many senior government specialists partook in the FPP judiciously, and limited their private patient time to less than 10 hours per week. But there were a significant number who expended excessive time to seeing their private patients. These over-enthusiastic specialists were able to earn more than twice their government salary through this scheme. But this had a deleterious effect on the morale of the other specialists who had to bear the responsibilities of looking after ordinary “non-paying” patients. It also affected training of young specialists.

If you dig a little deeper, the FPP scheme actually creates a serious conflict of interest for the specialists who participate in it. Patients will only come to the FPP clinics if the waiting list in the free public clinic is too long and the service there a little “suspect”. One of the responsibilities of senior government specialists, who are mostly heads of their respective departments, is to improve their unit’s performance – in terms of waiting time, competence of the junior specialists in their department, etc. But a better run, efficient public clinic would mean less patients for the FPP clinic.

We know, with certainty, that the Ministry of Health has asked the hospitals implementing the Full Paying Patient scheme to carry out internal audits regarding the impact of the scheme on patient care, junior doctor training and morale of government doctors. We have heard that many of these internal audits are quite critical of the scheme, having identified numerous shortcomings. Has the current Minister of Health taken a look at these internal audits? Perhaps he should, and if they aren’t as bad as the PSM has been told, release them for public viewing before implementing the avatar of the FPP scheme – the Private Wings scheme.

The PSM would like to remind our friends in the Madani Government that they came in with the promise of reforming the government to benefit the common man. We totally understand that they are concerned about the RM 1.2 trillion sovereign debt that the government is facing, and their desire to reduce the budget deficit from its current 5% of GDP to 3% or lower. We get that. But what we strongly disagree with any measure that in effect transfers resources away from the ordinary man is the street. Our health care system is struggling with a shortage of senior specialists. Any measure that reduces the availability of specialists for the rakyat is totally unacceptable. We consider it extremely irresponsible.

Why irresponsible? Because you, Madani, are the government. You have much more power that we had when we were together in opposition criticizing the BN government. You must use your position and power to address the difficult questions like, how is it, in a country whose GDP in real terms has increased 25 fold in real terms (ie after discounting for inflation) in the past 50 years, government revenue has dropped from about 30% of GDP 50 years ago to its current 14%. For this is the crux of the problem isn’t it? An increasingly smaller portion of the income this country is generating is accruing to government.

That is why the government does not have enough funds to spend on health care, start an old age pension scheme, accelerate the transition to green energy, rehabilitate our rivers and forests, and upgrade our management of municipal waste. All of these are not profitable ventures, and thus will be not be undertaken by the private sector. In a properly functioning economy, a reasonable proportion of the wealth collectively generated by society must be channeled to government to fund all the programs and services that the private sector is not interested in.

Unfortunately, in Malaysia, as well as in many other countries, the proportion of societal wealth that is being allocated to make life better for all the citizens is diminishing over time. Why is this so? Can it be reversed? These are the crucially important issues that Government must look into? Are you guys in the Madani government even addressing these issues? That would be a responsible exercise of the powers that the people have entrusted to you.

If, instead of looking to address the misallocation of the income of the country, the Madani government persists in poorly thought-out policies that affect the well-being of the rakyat, do not expect the PSM to look the other way. Our public health care system is a concrete expression of our people’s desire to create a caring inclusive society premised on the solidarity of all the people living in this country. Our public health care system, in a very real way, defines the “soul” of the nation. Any measure that degrades our public health care system is a bright red line for not only the PSM but also for many civil society groups. Please do not cross it.

Jeyakumar Devaraj
Chairperson
Parti Sosialis Malaysia

25/9/24