Why do we need a Health Commission?

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.

2. Houseman-ship

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

9. Pharmaceuticals

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

Conclusion

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.

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为什么我们需要卫生委员会

我在上一个帖文中谈到实习医生过剩的问题，已导致其中的一些选择改行。

马来西亚的卫生服务一直获得世界卫生组织的高度评价。我国的卫生服务不仅在减低产妇和婴儿死亡率方面取得显著成绩，也让所有国民，包括内陆地区人民都有效接受基本医疗服务的便利。更让人称许的是国内约98％的医药服务是获得政府高额津贴 。

不过，随着卫生领域在人力和服务方面的迅速发展，以及各种病变，我们有必要重新检视国内的卫生服务。

与美国及英国等先进国相比，卫生领域在马来西亚从来就不是一个重大的政治课题。然而，今天我们看到越来越多的卫生问题浮现，如果当局没有及时重视和着手处理，未来或将演变成大课题。

因此，在医药圈子里，许多人认为我们需要成立一个独立的马来西亚医药委员会，来全面探讨未来20年我国的卫生服务发展。

1.医学教育和医生过剩

世界卫生组织为大马设定的医生和人口比例是1对1600。在2010年时，我们出现的比率是1对1800，当时我国拥有3万3000名医生。看看目前我们培训的医生趋势，我国在2015年的医生和人口比例已达到1对600。换言之，我国目前有5万名医生来服务3000万的人口。

英国的人口是6300万，拥有32所医学院；澳洲人口2300万，拥有18所医学院；加拿大人口3400万，只有17所医学院。

2009年，英国的医学生比例是没10万人有9.3名（5600名毕业生）；澳洲是每10万人有10.8名（2500名毕业生）；加拿大是每10万人有7名（2400名毕业生）。

马来西亚的人口是2900万人，但我们却拥有33所医学院（11所公立和22所私立）。2009年，，每在我国每10万人当中11.2名是医学毕业生，到了2012年，该人数比例增加至14.6名（4067名毕业生）。

所以，我们是比先进国栽培更多的医生吗？我们是否为了要达到我们认为所应需要的医生人数，而对医学系的素质妥协呢？以现在的培训比例而言，估计大马每年将栽培6000名医学毕业生（包括国内外大学）。

2.实习医生

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 。

目前隶属卫生部管辖的132所政府医院，拥有3万8394个病床，不过仍然短缺1万5000个病床。

所以，我们必须寻求全盘的解决方案，来检视医学教育问题、实习医生的培训计划，以及增建政府医院，特别是在半城市化地区。

如果拖延解决，很快的我们将面对医生失业和医务人员训练不足的问题。

3.培训专科和半专科医生

  

培训专科和半专科医生必须在周详和妥善的协调下进行，以应付未来20年的需求。

过去几年里，我国朝向高收入国目标迈进的同时，我们也发现大马人罹患的疾病也逐渐改变。我们看到非传染病显著的增加，如高血压、心脏病、糖尿病及癌症等等。

所以，政府医院的病床分配、拨款及人力需求等方面都必须重新检讨。目前我国是栽培过多的医生和医务人员，但却严缺专科和次专科医生。半城市地区和乡区缺乏专科和次专科医生驻诊，或将成为人民热切关注的政治课题。

4.保障医药服务的素质和水准

随着私人医院如雨后春笋般迅速增加，我们必须确保对私人医院的医生和病患的安全有适当的监管。

5. 医护辅助人员，特别是护士的任务变化

随着世界趋势的改变，护士课程应该从文凭资格提升至学位资格。 目前我国估计有超过1万5000名护士失业。

现有的护士应该给予更深层的训练以提升他们的专业和资历，例如在糖尿病足护理、紧急救护、冠心病医护等特别领域提供高级文凭课程。由于公立大学或卫生部无法应付需求，有关的训练可为期6个月，并在私立大学进行。

我们也必须为医护辅助人员的事业和前途，制定一套完整的职业架构。

6.医疗保健资援

在现今阶段这是相当敏感的课题，可以我们却不能否让这个事实。马来西亚是目前世界少数没有任何国民医疗资援制度的国家。政府医院98%的疗诊费用由政府津贴，这是难以维续的。我们眼下必须探讨这一课题，以免为时已晚。

7.旅游保健  

保健旅游计划必须加以推广，而且不应只限于私人医院，一些政府医院也应被遴选参与。我们应该考虑：

·      参与的医院必须致力争取国际认可。

·      重组全国旅游保健理事会。

·      鉴定专科医生的资历，以防发生医疗纠纷。

·      保存记录以便日后可做跟进和审视表现。

尽管我国从保健旅游计划中接待的病患人数增加，但从中赚取的收入却不多。这是因为到来求诊的多属于低治疗费病科 ，如整容和牙科护理等。

8.综合公共和私人的医疗服务

·      从基本保健着手——综合门诊服务

·      综合卫生保健系统以减少候诊时间

9.药剂服务

为鼓励本地制药厂生产优良品质及价格可负担的一般药物，可考虑采取以下的途径以达致目标：

·      合约生产：在马来西亚生产名牌药物和有品质的一般药物以供出口。

·      制造就业机会，同时达成科技与研究转移

·      促进研发治疗替代药物。

结语

我们需要花很多年的时间来训练一名能胜任工作的医务人员。如果我们现在不正视和解决这些问题，一旦恶化我们将无法招架。