00:10Hello and good evening, I'm Melissa Idris. Welcome to Consider This. This is the show
00:15where we want you to consider and then reconsider what you know of the news of the day. Budget
00:202027 raises the Health Ministry's allocation to RM47.7 billion, an increase of about 2.5%,
00:28which is the smallest in five years. But the government has also pledged that permanent
00:34positions for more than 9,000 contract doctors next year will be made available. But will all
00:40of these measures be enough to address some of the pressures that have been building in public
00:47healthcare? Well, joining me now to discuss this further, I have Dr Sivanesan Lechumanan, who is
00:53the President of the Malaysian Medical Association, better known as MMA. Dr Siva, thank you so much
00:59for joining me on the show. Now that you've had some time to digest the announcements in Budget
01:052027, can we begin with the overall allocation? I think there has been some concern that the
01:13budget expenditure still isn't moving towards that global standard of 5% of GDP for the health
01:21sector. Tell me, how do you see the allocation that has been provided for the healthcare sector?
01:29Thank you, thank you, Melissa. Generally, the WHO expects the developing country like Malaysia to
01:35spend approximately 5% of the GDP. Currently, Malaysia spends approximately about 2.4%, 2.5% of
01:44GDP on its health. But in 2024, we saw an increase of approximately more than 10% increase in the
01:52health
01:53budget for Malaysia. If we have kept to that percentage of increase annually, probably we will
01:59move slowly towards the 5% GDP. To move it from 2.5% straight to 5% is definitely
02:06a fiscal disaster. It's
02:08going to be hard for the country. Of course, there's an increase now from 46.5% to 47.7%.
02:16We welcome the
02:17increase looking at current Malaysian financial tightness at the moment. But we hope whatever
02:24budget that is allocated will be used in the right manner and it really reaches the riot for its services.
02:30Okay. Are you worried or concerned about the balance around operating expenditure and
02:36development expenditure in healthcare? Maybe you can talk to me a little bit about what you think
02:43where the healthcare budget should go looking at the challenges in this sector?
02:50Yeah. Traditionally, if you look at our budget, traditionally we spend about 15% on the development
02:56and 85% on operational costs actually. So the development, this includes the building of new
03:03hospitals, upgrading the clinical sehatans. Currently, we have to upgrade our digital facilities
03:09because we are moving towards one person, one record facilities and much more. But to balance it,
03:17whatever that we are building, we have to have enough manpower as well. So this is where the
03:23operational budget plays an important role, sustaining the healthcare workers, improving the healthcare
03:29care, delivery costs. All this is very, very important. So when we increase the development
03:36allocation per se, we must remember to run these facilities, we need a human being, we need manpower
03:43as well. Therefore, it should be a balanced diet, not only just increase in the development, but the
03:49increase in development must be followed with larger portion of budget for maintenance, that is the
03:55operational costs. Okay. Well, let's talk about manpower because I think that's been, healthcare
04:00workers has been a real concern around the pressures facing the public healthcare sector. When we look
04:08at some of the announcements, particularly around the permanent appointments, do you think, Dr Siva,
04:14that this will finally resolve the contract doctor issue? Is it as it seems on the surface?
04:20Okay. First, let me just thank the Prime Minister and also the Minister of Health, who actually worked
04:28hard to bring this contract doctor issue to an end. MMA has, for the last few years, have been working
04:35very hard to find a solution for this contract doctors. As you know, since the introduction of contract
04:41doctors in 2016, we have faced lots of lots of issues, especially in terms of security of job, in terms
04:50of
04:50the progression, to do their masters, in terms of their transfer to other places. All this has caused
04:57lots of issues from the Ministry of Health. So, we thank the Prime Minister for his commitment to end
05:03this contact doctors issues. Now, contact doctors issues per se, when you end it, does not solve the
05:10problem. As you can see recently, for the posting in Sabah and Sarawak, though they were given permanent
05:15post and sent to places like Sabah and Sarawak, the uptake was very, very low. Therefore, the doctors
05:21don't just look at the job security as a permanent, but they also look at other things away from home,
05:28adequate incentives, the progression to do their specialization. All this is very important,
05:35should be taken into account when we want to retain our healthcare. Healthcare workers actually should be
05:42allocated and be paid in accordance to current time and not what they had said maybe 20 or 30 years
05:50ago.
05:51Right. Okay, I hear you when you say that maybe resolving the employment status doesn't actually
05:58resolve the broader workforce crisis. Can you talk a little bit more about that, Dr Siva? There's been reports
06:05about very high numbers of no-shows among medical offices for permanent positions. Maybe talk a little
06:13bit about what other areas the government can provide to support doctors entering the permanent
06:21service so that the healthcare workforce becomes a conducive place to work.
06:29Yeah, this is a very important question and thanks for asking this question, Melissa. First of all,
06:36the permanent appointment per se itself does not solve the problem. Doctor wants a better working
06:41condition. Currently, if you look at Malaysia, our doctors work approximately 65 to 80 hours per week
06:47compared to our peers in other countries, approximately they work about 45 to 55 hours. So, here itself,
06:55we have worked our doctors in Malaysia much longer compared to our colleagues in other countries.
07:01Number one. Second, we also see when you send a doctor fine interior off, for instance, if you want to
07:07transfer a doctor from Penisla to a place in Sabah, Sarawak, deeper in Sabah and Sarawak, approximately the cost
07:13is about 8,500 to 10,000 ringgit. So, this is a cost of transfer per se. Third, we also
07:20see some of the places,
07:22especially the rural settings or interior places. We saw the accommodations are not well maintained.
07:30And fourth, of course, when you transfer the doctors to deeper inside, we expect them to be given
07:35incentives. Previously, we have something called Bayana Incentive Wilayah, which they pay by percentage of your
07:43basic salary about 12 to 13 or 15 percent of your basic salary. However, this has been reviewed the last
07:50three years and it has brought down a person who previously received approximately 900 ringgit,
07:55currently only receives about 360 ringgit as a Bayana Incentive Wilayah. As time goes by, I believe
08:01this intentive should be increased and not decreased as what has been happening. This definitely is not
08:08encouraging. Okay. Well, we've talked about the healthcare workers, we've talked about doctors
08:13specifically. I know there's an entire workforce of nurses and allied health workers as well that
08:20we can go into, but I want to look at the perspective from patients. How much of the healthcare budget
08:28that was announced in budget 2027 do you think will be beneficial for the patients? I'm looking at the
08:38reduced waiting times, outsourced patient treatments. How are you viewing the overall impact to the
08:44patient experience? Okay. Just let me give you a statistic. Currently, approximately 60 percent of
08:52government, sorry, specialist doctors are in the private sector. But 70 percent of Malaysian public are still
08:58relying on government hospitals. So there's a mismatch here. Therefore, the waiting period for you to get an
09:04appointment to see a specialist is definitely going to be long, first of all. But we thank the government
09:10because government recently announced that they are spending about 200 million dollars to buy services
09:16from the private hospitals. So this, in one way, can actually bring down the waiting time of the
09:22patients to see a specialist doctors. In other words, there's going to be something we call as a private
09:29public partnership. So this is also, this improves the waiting time. That's a very good idea that the
09:36government has done. But the proxy, I mean, apart from that, we also expect some other incentives also
09:42to be given for the government doctors. First, of course, as you say, to retain them. We have to really
09:47incentivize our workers to retain them. From what I heard, 2017, there were approximately 12,000
09:56workers' workers vacant, places vacant in the Ministry of Health. And in 2023, this has ballooned to
10:02approximately 55,000. I don't have the latest, exact latest data. But in 2023, it was expected roughly
10:08about 55 healthcare workers' positions are vacant. So this definitely has added the burden to the work,
10:16for the workforce which is left. For instance, if a doctor, if a hospital is supposed to work with a
10:21capacity of 10 doctors, and currently it is now working only in five doctors, you can see the
10:27doctors are going to be overworked and definitely it is understaffed. And of course, when you're overworked,
10:33you can't give the best services for the patients. Okay. Well, having said all of that, what did you wish
10:41was in the Budget 2027 that maybe didn't make the cut? Was there anything missing from your perspective?
10:48Is it? One of the things that I believe that we could really utilize here is I see in the
10:54country,
10:55we have approximately 11,000 general practitioners or GPs around. And they have a bigger capable and
11:02they have a bigger role to play. And they have played a very important roles during the pandemic.
11:07For instance, during the COVID time, where 80% of the vaccination was delivered or was given by the
11:13private practitioners. That shows the private practitioners have a big role to play. And
11:18currently their talents are not really been utilized by the Ministry of Health. So I wished that we could
11:24spend more, probably we could buy more services from the private practitioners, especially in terms of
11:31screening the NCDs. NCDs, as you know, Melissa, is a very big burden. Can I just throw you a question,
11:37Melissa? How much do you think the cost of NCDs for the country every year, approximately how much it
11:43costs us? Can I throw a question to you? I cannot imagine, but I can assume it's probably a lot
11:49more
11:50that we're spending to screen, to maintain, to treat the complications and the manpower loss is estimated
12:01approximately 60 billion a year for the country. So can you see it's a very big amount. So what we
12:08need
12:08to do is pick up all these NCDs patients as fast as we can, treat them exactly. Screening alone would
12:14not solve. Screening is just what we call as an activity. But then when we is able to screen and
12:20detect the people with NCDs, that is called the output. But the most important is the outcome. What
12:26is the outcome? We're able to screen somebody, we're able to detect who has the NCDs, we treat them and
12:33give continuous care so they don't reach the complications that happen to people who are not
12:38being treated. That should be the outcome. So this is very, very important. And we have to change
12:44as what is said in the Malaysian health care white paper, we have to change our delivery service from
12:52sick care to preventive care. Definitely. Dr. Siwa, thank you so much for joining me on the show. I
12:58appreciate your time. Dr. Siwa Nesan Lecimananda from MMA. We're going to take a quick break here on
13:03Consider This. We'll be back with more on Budget 2027. Stay tuned. We'll be right back.
13:14I'll see you next time.
13:14I'm
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13:17I'm
