It is troubling to note that our public healthcare system has been subject to continuous attacks since the rise of neoliberal policies spearheaded by the Mahathir administration in the 1990s. Anwar’s Madani government clearly falls short of offering any progressive reforms but seems to further enhance its march towards the continuous encroachment of the private sector into the public domain.

The proposed introduction of the Rakan KKM initiative, an extension of its previous avatar, the “Full Paying Patient (FPP)” scheme first introduced by the BN government in 2007, enhances the dual practice model within public hospitals (Devaraj, 2024). Dual practice models that enabled specialist doctors in public hospitals to serve in private healthcare settings were proposed to increase the retention of specialists in government service (Malinda Mohd Fadzil, 2022).

Similarly, the PH Health Minister, Dr Dzulkefly Ahmad, remarked that the Rakan KKM was not a privatisation move but rather a key policy intervention to retain medical specialists within public healthcare. However, Rakan KKM is slated to be implemented through a corporate entity known as “Rakan KKM Sdn Bhd”, wholly owned by the Ministry of Finance Incorporated. The pilot project in Hospital Cyberjaya will involve setting up a private patient unit (PPU) within the public hospital with four beds, one operating theatre, and two specialist clinics. The Minister further added that the revenue generated from private paying patients using the Rakan KKM facility will be pooled and used to upgrade public healthcare (BERNAMA, 2025).

While Rakan KKM’s predecessor, the FPP scheme, did reduce the brain drain of specialists from public healthcare to private healthcare—with resignation trends reducing from 6.4% in 2000 to 3.5% in 2016—migrations persisted (Muhammad Nur Amir AR1, 2020). The percentage of specialists’ resignations from the ten FPP scheme-implementing hospitals from 2015 to 2017 averaged 31.8% (Malinda Mohd Fadzil, 2022). This could plausibly be attributed to limitations in earnings, where participating specialists’ incomes were limited to no more than three times their public service salary, which is still lower than their counterparts in the private healthcare sector. Additionally, specialists were found to leave due to governance and work processes, such as a lack of promotions, training support, poor work environment, and inflexible work times in government hospitals (Muhammad Nur Amir AR1, 2020).

Therefore, studies on dual practice, such as the FPP scheme in ten public hospitals, have been inconclusive, remarking that while it “renders certain benefits but at the same time comes with multiple conundrums” (Malinda Mohd Fadzil, 2022). Hence, Rakan KKM’s anticipated success in retaining public healthcare specialists raises doubts.

More importantly, dual practice schemes within public healthcare have caused adverse impacts, especially for non-paying public patients. A study, “Implications of Dual Practice on Cataract Surgery Waiting Time and Rescheduling: The Case of Malaysia,” found that private paying patients had seven times shorter waiting times for cataract surgery compared to non-paying public patients in a pioneer hospital of the dual practice scheme (Weng Hong Fun, 2021). Furthermore, while private paying patients had their cataract surgeries on schedule, non-paying public patients had their surgeries rescheduled, citing various patient health issues.

Similarly, studies in Australia and the UK have found comparatively longer waiting times for public patients when dual practice schemes are implemented in public healthcare (Daniel McIntyre, 2020; Queensland, 2014; Walpole, 2019). Additionally, in the UK, healthcare professionals related various administrative issues when private paying patients are treated under the same roof as non-paying public patients, such as: patients segregated based on having medical insurance and not on their health condition; over-diagnostics for paying patients; private paying patients pushed back to the public system if they cannot afford treatment—and vice-versa when public patients seek quicker treatment (Walpole, 2019).

Furthermore, while public utilities were used to provide diagnosis and treatment for private paying patients, the equipment in private patient units was not accessible to non-paying public patients. Therefore, when private patient units expand to cater to more paying patients, they will procure more facilities; but will the corporate entity Rakan KKM Sdn Bhd allow these facilities to be used by non-paying patients in public hospitals?

Hence, as cautioned by Marxist economist Prabhat Patnaik, in addition to the accumulation of wealth through expansion, capital also accumulates by encroaching on the public sector (Patnaik, 2021)—not by investing but by taking up labour time and services that were once within the public domain. While the dual practice scheme is conceived as a measure to benefit healthcare personnel in public hospitals, it opens the door for market logic to encroach on public health, conflicting with the interest of preserving healthcare as a fundamental right for all, irrespective of socio-economic status.

Sivarajan Arumugam
Central Committee member,
Parti Sosialis Malaysia

REFERENCES

BERNAMA. (2025). “Rakan KKM Bukan Penswastaan, Fokus Kekal Pakar Perubatan Dalam Perkhidmatan.” KL: BERNAMA.com.

Daniel McIntyre et al. (2020). “Waiting Time as an Indicator for Health.” The Journal of Health Care, 57, 1–15.

Devaraj, J. (2024). “Private Wings in Government Hospitals: A Pathetic Knee-Jerk Response.” ThinkLeft.
Available at: https://thinkleft.net/2024/09/25/private-wings-in-government-hospitals-a-pathetic-knee-jerk-response/
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Malinda Mohd Fadzil et al. (2022). “Specialists’ Dual Practice within Public Hospital Setting.” Healthcare (MDPI), 10, 2097.

Muhammad Nur Amir et al. (2020). “Physicians’ Intention to Leave from Malaysia Government Hospitals with Existing.” Journal Public Health Policy Plann, 4(3).

Patnaik, P. (2021). “Imperialism then and now: Capital relocation, inequality, encroachment and protracted crisis.” MR Online, Sept.

Queensland Audit Office (Australia). (2014). “Right of Private Practice in Queensland Public Hospitals: Report to Parliament 1: 2013–14.” Queensland, Australia: Queensland Audit Office.

Walpole, S. C. (2019). “Health Professionals’ Insights into the Impacts of Privately Funded Care within National Health Service: A Qualitative Interview Study.” Healthcare Policy, 15(2).

Weng Hong Fun et al. (2021). “Implications of Dual Practice on Cataract Surgery Waiting Time.” Healthcare (MDPI), 9, 653.