What is the dynamic between private and public healthcare provision in Malaysia?
THOMAS: We are very fortunate in Malaysia because we have an excellent healthcare system. Both the public sector and the private sector are looked upon as key players and they complement each other. 70% of the healthcare in the country today is governed by the public sector and it is heavily subsidized by the government. Whereas the remaining 30% is held by the private sector, which is fee for service. Both the sectors have continued to develop. The government today looks at the private sector as being the sector that will continue to grow. Thus, it is promoting its expansion. Back in the 1980s we only had 50 hospitals in the private sector, whereas today there are more than 220 hospitals. The government buys services from the private sector too. We have certain disciplines in the private sector, which are not available in the public sector. The government purchases these services from the private sector. Similarly there is certain equipment, which is not available in the public sector and often the government sends patients to us to have these operations performed. We also have doctors in the public sector who come to practice in the private sector part-time. Also, we have experience with senior consultants from the private sector who offer their services in the public sector. The arrangement that we have between the public and the private sector has developed into a model, which is followed by the rest of the world and we are proud of our achievements. The government is also pushing the private sector to be the provider of healthcare for those who come from abroad, especially when we talk about medical tourism. The government looks at the private sector as a vehicle from which the country can gain some economic benefits, as many foreign people come over and spend money to purchase the services offered by our private healthcare sector. So various promotions have been done by the government to make sure that the private sector is well known internationally, allowing patients from various countries, not only in the region, but also from far away, to come and make use of our services in Malaysia.
Which areas of medicine are the most active in Malaysia?
THOMAS: Today, we have patients coming to the private hospitals for various kinds of treatments. The most popular treatments are for orthopedics, cardiac surgery, plastic surgery, and neurosurgery. More recently, because of the development and excellence achieved in the various areas of oncology, we find that many patients also come for the treatment of cancer. Thanks to these achievements, you find that many centres in Malaysia have developed quickly in these areas and that Malaysia is able to provide quality care, similar to what you can get in some of the most developed countries in the world. The doctors are also well trained and not just locally. In fact, most of them have international experience and postgraduate degrees from countries like the UK, the US, and Australia. This has enabled not only patients from the countries in the region, but also patients in the countries from further away, to come and have confidence in our healthcare system.
How competitive is Malaysia’s healthcare sector compared to the rest of the region?
THOMAS: Malaysia is a late comer in the field of medical tourism. Countries in the region, such as Singapore and Thailand, have been in the picture for quite a long time. However, Malaysia has been rising in the last 5 years and has strengthened its capabilities in many areas. One is that we are able to deliver care. Another important element is the financial aspect, as the cost of care in Malaysia is much lower than the neighbouring countries in the region. That has been our major selling point for people coming over to be treated in our hospitals. The other very important aspect is the language spoken here. Malaysia is a multicultural, multiracial, and multi-religious centre and that is an attraction in itself. English is widely spoken and Chinese and a host of other languages are also spoken. This has enabled people from the region and beyond the region to come to us, because they feel at ease. It does not matter if you are of a particular ethnic group or a particular religious sect, because everyone is welcomed in Malaysia. This country is a melting pot of various customs, religions, and races, so we find that patients would comfortably come here. Also the people that accompany the patients feel comfortable and at ease, not just because of the treatment the patient gets, but also because Malaysia is an affordable and friendly destination.
How would you describe the level of tertiary and specialist care available in Malaysia today?
THOMAS: The standard of healthcare in the country, especially when we talk about medical education, is based on the UK’s model. We inherited the healthcare training as well as the healthcare system from the UK. The training of doctors, nurses, and other paramedical staff has followed the initiatives left behind by the English system. Today, our specialists are trained locally, regionally, and internationally in countries such as Australia, the UK, or the US. Most of the time, their postgraduate qualifications are from abroad and this has enabled the doctors who are here, especially the specialists, to be on par with their colleagues from anywhere else in the world where a good healthcare system operates. This is the situation in Malaysia under the training aspect. When we talk about credentials and qualifications, or privileges, every single medical practitioner who wants to practice medicine in the country needs to be registered by the Malaysian Medical Council, which is a government body. Without that registration, with the required qualifications, we would not allow anyone to practice as a doctor in Malaysia. When you become a specialist, we have a National Specialist Register, which regroups and registers you as a specialist in a particular field. If you have had experience as a specialist in a specific field, you will be allowed to practice and therefore register as a specialist. If you find that your training has not been adequate, you will not be registered as a specialist in that field. For example, a cardiologist might want to do angiograms and angioplasty, but if he has not received sufficient experience, he will not be registered. This is important because these specialists, who are registered and who deliver care services to the patients, are assuring safe care. Only the most competent doctors, with the right training and the right experience, will be allowed to take care of the patients. This is not a one off situation. Every year doctors that practice in Malaysia have to have an annual practicing certificate and certain criteria have to be fulfilled before the license to practice is renewed on an annual basis.
What is the doctor to patient ratio in Malaysia? How do you see this evolving in the future?
THOMAS: Malaysia has a population of about 28 million people scattered between the peninsula of Malaysia and the rest on the east side of the country, in Borneo. In the urban areas there are a lot of doctors. The ratio in Kuala Lumpur might be 1 doctor for every 400 citizens, but in some of the rural, more remote areas, it might even be 1 doctor for every 3,000 people. This is something that the government is trying to bridge and we are trying to achieve a ratio of 1 doctor for every 600 people across the country by 2020. We are getting closer to our goal. Medical education is easily available today. If I look back maybe 20, 25 years, there was only one medical school in the country. Today we have more than 50 medical schools and these are training doctors locally. We also have Malaysians that go abroad to the UK, Australia, and even to places like India and Saudi Arabia to be trained as doctors and come back to fill up positions within the healthcare sector. So the training of doctors is adequate, but the momentum has to continue for us to achieve the targets that the government has set. Only in this way can we be self-sufficient and have quality doctors, in the right numbers, by the year 2020.
Both the public sector and the private sector are looked upon as key players and they complement each other. 70% of the healthcare in the country today is governed by the public sector and it is heavily subsidized by the government. Whereas the remaining 30% is held by the private sector, which is fee for service. Both the sectors have continued to develop. The government today looks at the private sector as being the sector that will continue to grow.
How well suited are local medical education institutions to training world-class doctors?
THOMAS: We have many foreign universities who are doing dual programs with our local universities, which means that a person joining a local university can obtain a degree from either an Australian university or an English university, because part of the training is done in Malaysia and the second part is done abroad. Perdana University for instance has a US program with John Hopkins. White Marsh has come to set up a university in Malaysia, having the full curriculum, the training, and everything done locally. We find that the American way of teaching, the experienced lecturers who come from the US, and those who are attracted to come to Malaysia from the region to become great doctors, have helped the country to look forward. These are the doctors who will make a difference for the country. We feel that this is something that the government has welcomed. Many of the lecturers are from the US, but there are also some lecturers who come from Malaysian hospitals and universities and it is something that we are looking forward to promote and encourage.
What is your future outlook for Malaysia’s healthcare sector? Which indicators are showing the most positive trends and which remain challenges?
THOMAS: This is an exciting time for Malaysia’s healthcare sector. As I said at the beginning, the pubic-private partnership is getting stronger and stronger and both the public sector and the private sector are beginning to appreciate that. Those of us in the private sector are beginning to welcome the support and the recognition that the partnership entails. This is helping many private hospitals to expand not only the number of beds, services, and the general offer, but also the construction of new hospitals. We see private hospitals blooming around the country and this is something that we did not expect in such a short time. We foresee that the number of foreign patients will increase alongside the utilization of more expensive technology, as well as the healthcare services. These have already started to increase, enabling hospitals, especially in the private sector, to recover some of their investments and that has encouraged more hospital to come up. This has also benefited the local population. Any form of treatment and any form of technology needed is locally available, which was not the case in the past. Thus, there is very little reason for a Malaysian or anyone in the country today to travel abroad. This is really positive and recognized not just by the government, but by Malaysians too.