In my last blog posting, I commented on the surplus of house officers and many who opt to change their profession.
The Malaysian Health Services has achieved remarkable progress in reducing maternal and infant mortality rate. We have succedeed in providing basic healthcare which are easy accessible even in rural area. More commendable is that it is highly subsidized by the Government -nearly 98 percent of the healthcare in the public health services is subsidized.
However, looking at the rapid expansion both in manpower and services in the health sector plus the changing pattern of diseases, there is a need to relook at our health services.
Health has never been a major political issue in Malaysia as compared to the developed nation such as U.S. or the UK. However, today we see more problems cropping up and if they are not addressed, it will definitely be an issue in future. Hence, within the medical fraternity, many feel that there is a need to set up Malaysia Medical Commission to relook into the total health services in Malaysia for the next 20 years.
1. Medical education and over supply of doctors
The WHO has set a doctor: population ration 1:1600 for Malaysia. In 2010, we had a ration of 1:800, with 33,000 doctors. Looking at current production, we would achieve a doctor: population ration of 1:600 by 2015, with 50,000 doctors serving a population of just over 30 million.
The United Kingdom, with a population of 63 million, has 32 Medical Schools. Australis, with a population, of 23 million has 18 Medical Schools and Canada with a population of 34 million has 17 Medical Schools.
In 2009, the number of Medical Graduates/100,000 population in UK was 9.3 (5,600 graduates); Australia had a figure of 10.8 (2,500 graduates) and Canada 7 (2,400 graduates).
Malaysia with a population of 29 million has currently a whopping 33 Medical Schools (11 public and 22 private). In 2009, number of Medical Graduates per 100,000 population is 11.2 and in the year 2012, it was 14.6 (4,067 graduates).
So are we producing more doctors than the developed countries? Are we compromising quality in order to get the quantity we think we need? With this rate, we expect Malaysia (local and overseas) will be producing a total of 6,000 graduates per year.
Presently, we have more houseman than patient in a lot of hospitals. Houseman do not have adequate training. Some houseman see only 1-3 patients per day where they should clerk more than 10 patients per day in order to get adequate training. In the long run we will be producing half-baked doctors.
Presently, MOH has 132 hospitals and the total number of hospital beds in the public sector is 38,394. Currently we are short of 15,000 public hospital beds.
Hence, there is a need to relook into a more holistic solution of medical education, houseman-ship training and expansion of public hospital especially in semi urban areas.
If we delay we soon have unemployed doctors and inadequately trained medical officer.
3. Training for Specialist and Sub-Specialist
The training for specialist and sub-specialist should be planned at more coordinated manner to meet the need of the nation for the next 20 years.
For the last few years, we see a significant shift of disease patterns as Malaysia is developing towards a high-income nation. We are seeing more and more non-communicable diseases e.g. hypertension, heart disease, diabetes, cancer etc.
Hence, the distribution of public hospital bed, allocation of budget and man power need to be reviewed. Presently, we are training more than adequate doctors and medical officers but we are acutely short of specialist and sub-specialist. Semi urban and rural areas are inadequately serviced by specialist and sub-specialists. This may be a hot political issue that will find traction to the rakyat.
4. Ensuring quality of care and standards of medical services.
With the mushrooming of private hospital and its emphasis on bottom line, there is a need to ensure proper supervision of doctors and patient safety in private hospital.
5. Changing role of allied health professional especially nurses
There is a need to replace Diploma with Degree programs in Nursing following the world trend. Presently it is estimated there are more than 15,000 unemployed nurses.
Present group of nurses should be further trained for added value e.g. Advanced Diploma / post basic in specific areas such as diabetic foot, emergency care, coronary care etc. The training can be carried out in 6 months and can be conducted in private universities as public universities or MOH are unable to cope.
There is a need to introduce and support a proper career structure and pathway for allied health professionals.
6. Health Care Financing
Presently, this can be a very sensitive issue but we should not be in denial. Malaysia is one of the few countries in the world without some form of National Health Financing Mechanism. 98 percent of the cost of the treatment in public hospitals are subsidized by the Government and it is not sustainable. We should revisit this issue before it is too late.
7. Health Tourism
Health Tourism should be promoted and involved by not only the private hospitals but some selected public hospitals as well. We should consider:
· Hospital involved should strive for international accreditation.
· Revamp National Health Travel Council
· Credentialing of specialists vital to avoid mishaps
· Record keeping to keep track progress and performance
Right now we are getting increased number of patients but not the money since a lot of them come for low cost treatment e.g. cosmetic, dentistry.
8. Integrating Public Health Sector with the Private
· Begin with Primary Care: Integrated out patient services
· Decrease waiting time with integrated health care system
To promote local pharmaceutical manufacturer to produce generic drugs which is more affordable and good quality. This may includes:
· Contract manufacturing: branded drugs manufactured in Malaysia and ensure good quality generic drugs and to be exported.
· Create jobs, transfer of technology and research
· Facilitate development of bio-similar drugs
It takes many years to train a competent health worker. If we are not committed to address these issues now, we may be overwhelmed by them.
目前在许多的医院里，实习医生的人数是比病人多。实习医生也未获得充分的训练。一些实习医生每天只问诊1到3名病人，而实际上他们每天必须问诊超过10名病人，这样才能得到足够的训练。这种情况长远下去， 我们将会栽培更多“半生熟”医生（未达标 。