Latest news with #RakanKKM
Malay Mail
2 days ago
- Health
- Malay Mail
Health Ministry struggles to cope with chronic underfunding — Chan Chee Khoon
JULY 18 — Speaking at a public forum in Kuala Lumpur in 2023, a senior officer from Ministry of Health's (MOH) planning division denigrated the UK National Health Service as a poor example to emulate given its current sad state. Unfortunately, he seemed unaware of how the NHS had been ravaged in the preceding decades by both Tory as well as Labour governments, and what lessons MOH could draw from that decline (given the shared legacy of our Bevan–Beveridge institutional architectures). Just as we shouldn't unduly blame NHS for the service failures emanating from its subjection to an 'internal market' regime, we shouldn't blame MOH for its desperate resort to RakanKKM to monetise its (contested) inpatient spare capacity for supplementary revenues. Without supplemental taxes and substantial increases in federal allocations, MOH is desperately trying to cope with chronic underfunding by spawning a 'private' non-profit subsidiary. This was envisaged to generate some margins beyond cost recovery, from user charges for medium-cost services provided on a priority basis, by physicians of choice. The supplementary earnings were intended as cross-subsidies for MOH's regular patients, as well as incentives for MOH staff retention. Citizens' Health Initiative would like to offer a context and narrative that weaves together various strands in the continuing public discourse following the recent hikes in health insurance premiums. We do not present this necessarily as the unfolding of a premeditated strategy. It is more a descriptive chronology of contingent circumstances that nonetheless interacted in a manner that is gradually re-balancing the system towards healthcare provided on the basis of ability to pay, rather than on the basis of need. Why Malaysia needs to double its public sector healthcare spending Our post-Merdeka improvements in life expectancies at birth were internationally acclaimed, all the more remarkable given our very modest government healthcare expenditures (rarely exceeding 2 per cent GDP). The Rural Health Service's initiatives in village midwifery (bidan kampung), vaccine-preventable childhood ailments, tandas curah ('Jitra bowl'), the Applied Food and Nutrition Programme (AFNP), potable water supply, and control of communicable diseases were very well-chosen low-cost interventions which markedly reduced mortality among young children and mothers. Commendable increases in life expectancy at birth however mask a much less satisfactory trend in life expectancy in late adulthood, in comparison with Singapore, Taiwan, Hong Kong and other developed countries in the Asia-Pacific region: This poor adult life expectancy largely reflects Malaysia's burgeoning epidemics of Non-Communicable Diseases (NCDs), along with the highest prevalence in Southeast Asia of risk factors like obesity and being overweight. Meanwhile, the prevalence of diabetes mellitus had almost tripled from 6.3 per cent in 1986 to 11.6 per cent in 2006 to 17.5 per cent in 2015 (Yap et al, 2019; Safurah Jaafar et al, 2013). Malaysia's well-distributed primary healthcare system might have performed well for acute, episodic, self-limiting diseases in our early decades, but we are currently in new territory amidst escalating epidemics of NCDs. This epidemiological-cum-demographic transition requires multi-sectoral promotive as well as comprehensive primary health care, and the commensurate financial, staffing, and material resources to deliver it. We should not be captive to historical health budgeting practices whose modest annual increments are no longer adequate for the scale of effort that is now required—the prevention, detection, and oftentimes lifelong treatment of NCDs, with referral linkages and continuity of care at multiple levels, provided in a timely manner at adequately staffed and equipped facilities. Chronic underfunding of Health Ministry has obliged many Malaysians to prepare for contingencies – Picture by Raymond Manuel MOH's chronic underfunding At a public forum in September 2019, Tan Sri (Dr) Abu Bakar Suleiman (DG Health, 1991–2001) attributed the chronic underfunding to a developmental strategy premised on large inflows of FDI attracted through competitive lowering of corporate and income tax rates, which hobbled the fiscal capacity of states. This however was not the sole reason for MOH's chronic underfunding. There was concurrently active encouragement of for-profit healthcare, with tax incentives and subsidies, to cater to 'market-capable' segments of society. Tun Dr Mahathir Mohamad (PM 1981–2003) unwisely chose not to expand the public sector to meet increasing healthcare needs, preferring instead to allow space for the rapid growth of for-profit healthcare. Seductive logic of targeting Faced with this chronic underfunding, a succession of health ministers argued that Malaysians who could afford it should patronise the private sector (suitably encouraged thus with income tax rebates) so that the government could conserve its modest resources for the 'truly deserving poor'. This intuitively appealing rhetoric of targeting will more likely hasten the arrival of a two-tier healthcare system of deluxe priority care for the rich, and a rump, underfunded public sector for the rest. RakanKKM to the rescue of market failures? Chronic underfunding of MOH has obliged many Malaysians to prepare for contingencies they will likely face when seeking urgently needed inpatient care at congested public hospitals. For those without deep pockets, such contingency plans invariably look to commercial hospitals and the requisite insurance coverage for urgent critical care if and when its need arises. When large segments of the 'market-capable' middle class get entangled however in a tug-of-war between profit-driven health providers and profit-driven health insurers, the government is compelled to intervene, in this case with a 'premium economy' option RakanKKM in publicly owned hospitals. It is far from clear that MOH has enough spare capacity to scale up proof-of-concept trials to cater to policy holders abandoning unaffordable premiums. This could exacerbate existing backlogs of regular MOH patients even as neighbouring Singapore is aggressively recruiting Malaysian doctors and nurses for their own envisaged non-profit MOH hospitals. Unkept promises and a proposed Tabung Kesihatan Negara Meanwhile the Madani government continues to ignore electoral promises and calls for increased allocations and expanded capacity for publicly provided healthcare. This would require a dedicated ring-fenced Tabung Kesihatan Negara which could be funded by a supplementary progressive health tax, corporate taxes, property and capital gains taxes, Tobin-type taxes, 'sin' taxes, (zakat?), with credible stakeholder representation, accountability, and transparency. This however seems to be off the radar screen currently, hobbled in part by public scepticism over the stewardship of public financial resources. Will the Madani government live up to its name, or will we need to elect a government which keeps electoral promises, and which we can trust with the management of public monies? * This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
Yahoo
2 days ago
- Health
- Yahoo
Two-tier healthcare or public lifeline? Unpacking the debate over Rakan KKM
KUALA LUMPUR, July 15 — The Ministry of Health's (MOH) plan to launch its 'Rakan KKM' programme has ignited a fierce public debate. On one side, detractors warn it would create a two-tiered healthcare system that favours wealthier patients using public facilities. On the other, supporters argue the programme could help alleviate the financial strain on government hospitals and clinics while retaining specialist talent. What is Rakan KKM? The programme is a paid-for service envisioned by the MOH to offer 'premium economy' healthcare, encompassing elective procedures and personalised care. According to Health Minister Datuk Seri Dr Dzulkefly Ahmad, Rakan KKM will operate within the public healthcare ecosystem but provide services evocative of yet cheaper than commercial hospitals. The ministry aims to launch Rakan KKM by the third quarter of this year at four pilot locations: Hospital Cyberjaya, Hospital Putrajaya, Hospital Sultan Idris Shah Serdang, and the National Cancer Institute (IKN). Why the controversy? Criticism primarily centres on the argument that Rakan KKM amounts to a 'backdoor privatisation' of healthcare facilities and services funded by taxpayer money. Critics argue this will create a two-tiered system, allowing those with money to 'skip the line' for access to public healthcare services and bypass the long waiting lists that currently plague government hospitals under severe cost and manpower strains. They have also homed in on the salaries offered by Rakan KKM, with many top posts advertised with five-figure pay. Detractors have used this to question the MOH's stated inability to absorb thousands of contract health workers into permanent positions. Rakan KKM has so far received an allocation of RM25 million under Budget 2025, with a second phase of funding expected to come from government-linked investment companies (GLICs). The ministry's defence: Public interest, not profit Responding to the backlash, Dzulkefly has stressed that Rakan KKM's conception is underpinned by public interest. He rejected claims of privatisation by highlighting that Rakan KKM Sdn Bhd will remain fully owned by the Ministry of Finance Incorporated, which would keep the entity aligned with government objectives. 'When a GLIC investor comes in, the GLIC may take an equity stake in Rakan KKM Sdn Bhd. Ownership of Rakan KKM remains with the government, directly or through GLICs, throughout its operations,' the minister said on the social media platform X on Sunday. He then urged the public to look at the programme's key objectives, which he outlined as: Making healthcare more affordable than fully private options. Using any profits to cross-subsidise regular public healthcare services. Providing better income opportunities for specialists to retain them in the public service. Dzulkefly argues that these goals demonstrate that Rakan KKM is rooted in public service, not profit maximisation. Recommended read:Dzulkefly explains government ownership of 'premium economy' Rakan KKM scheme amid privatisation fears
Malaysiakini
2 days ago
- Business
- Malaysiakini
Rakan KKM public or private initiative?
MP SPEAKS | Strictly, the question of whether an initiative or entity is public or private comes down to questions on ownership, control, sources of funding, distribution of profits, and purpose. Rakan KKM Sdn Bhd is 100 percent owned by the Minister of Finance Incorporated (MOF Inc). When a government-linked investment company (GLIC) investor comes in, the GLIC may take an equity stake in Rakan KKM Sdn Bhd. Ownership of Rakan KKM remains with the government, directly or through GLICs, throughout its operations. As for control, the Health Ministry is the "kementerian kawal selia" responsible for critical decisions over the management of the company. Seed funding of RM25 million from the Finance Ministry was announced in the budget. Additional scale-up funding from GLICs will be explored in Phase 2, which will be repaid through the revenues/profits of Rakan KKM operations. In all cases, sources of financing remain government or government-linked. Profit distribution is to the shareholders/owners of Rakan KKM - ie MOF Inc or GLICs. Rakan KKM's purpose As a public initiative, Rakan KKM serves five key objectives which are in the public interest: (a) In the environment of high medical price inflation, Rakan KKM provides premium economy value-based healthcare services to raise the ceiling, (b) Excess revenue from Rakan KKM will be used to cross-subsidise the services for all public patients, thus raising the floor, (c) Support the retention of ministry health workers by providing opportunities to increase their income considerably, (d) Serve as a price benchmark, including for services provided by private hospitals, to moderate medical price inflation for all, including patients who do not directly use Rakan KKM services, and (e) Provide appropriate returns for our GLIC shareholders and their members. Act 586 But why is Rakan KKM licensed under the Private Healthcare Facilities and Services Act 1998 (Act 586)? Does that make it a private initiative? The experts who drafted Act 586 had the foresight to anticipate the possibility that the government would provide health services through a corporate body. This is important to ensure a level playing field with the private sector, especially if Rakan KKM is to play a role as a price benchmark. The Act clearly states that a government corporate body should be regulated under this Act. DZULKEFLY AHMAD is Kuala Selangor MP and health minister. The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.
CNA
2 days ago
- Health
- CNA
Pay more for ‘premium' care: Malaysia public hospitals' new scheme under spotlight amid fairness concerns
KUALA LUMPUR: Private wings in public hospitals. Personalised care for patients who can choose a doctor while staying in a more private ward. But at a price much lower than what a private hospital would charge. This is what Malaysia is offering with its latest dual practice healthcare initiative, known as Rakan KKM, or Friends of the Ministry of Health (MOH). The government has insisted that Rakan KKM will help bump the salaries of healthcare workers in the public sector and retain talent, with excess revenue going towards cross-subsidising healthcare services for all public patients. But the programme has stirred polarising views among proponents and detractors, who argue that Rakan KKM should not use public healthcare resources. Experts urged the government to give more details on how it will ensure Rakan KKM does not further burden an already strained public healthcare sector. MOH should also allay public concerns that the programme could create inequities in access to care, and amount to a privatisation of public healthcare, the experts told CNA. Despite that, some said it is a necessary shot in the arm for Malaysia's public healthcare sector, which currently charges unsustainably low medical fees and is unable to offer salaries that can compete with the private sector. For instance, outpatient consultation and specialist fees are RM1 (US$0.24) and RM5 per visit respectively, according to the health ministry's website. "It's not a perfect system, but we have to make sure that our doctors are paid well enough - they are in the job of saving lives," said Manvir Victor of Vital Signs, an organisation that aims to improve public health in Malaysia. "But the government cannot come up with the idea without coming out with the details, because everyone is criticising the idea." Rakan KKM was first announced by Prime Minister Anwar Ibrahim during his Budget 2025 speech last October, when he stressed the need to make the public health service more self-reliant and sustainable. An initial RM25 million will be allocated to Rakan KKM, with implementation to start at government hospitals with 'high demand and suitable infrastructure', he said then. The initiative will involve government-linked investment companies (GLIC) to 'provide affordable paid healthcare services for patients', he added. Rakan KKM will be run by a private limited entity wholly owned by the Minister of Finance Incorporated, the Finance Ministry's (MOF) corporate body. This means that throughout its operations, Rakan KKM will be owned by the government directly or through GLICs, which may choose to take an equity stake in Rakan KKM Pte Ltd. Rakan KKM's services will be 'priced above cost' for added income flow into the public healthcare system, but 'below existing private hospital offerings', MOH said on its website. The programme is reportedly expected to be launched in the third quarter of this year at four hospitals: Cyberjaya Hospital, Putrajaya Hospital, Sultan Idris Shah Serdang Hospital, and the National Cancer Institute. Criticism of Rakan KKM reached a fever pitch earlier in July, when Health Minister Dzulkefly Ahmad said patients under the programme could cut the queue for elective procedures in public hospitals. 'For elective cases in hospitals, people have to wait long, reportedly six to seven months. If they want to get it faster, they go into our healthcare facilities (under Rakan KKM),' he said on Jul 7 as reported by healthcare policy news site CodeBlue. While Dzulkefly caveated his comments by saying emergency care will remain equally accessible to everyone in the public healthcare system, the backlash was swift. USING PUBLIC HEALTHCARE RESOURCES FOR PRIVATE PRACTICE? The Malaysian Medical Association said on Tuesday that a 'key concern' is whether the initiative may inadvertently create inequities in access to care. 'There is growing apprehension that wealthier patients could be given faster access to services through this model within public facilities,' its president Kalwinder Singh Khaira said in a statement. 'Another pressing issue is regulatory oversight … As this is a government initiative, to be regulated by another arm of the government, public trust in its transparency, accountability, and compliance with healthcare standards must be assured.' Netizens on social media slammed Rakan KKM for creating a two-tier system for the wealthy, while accusing its ownership structure of muddling what they feel is essentially privatisation. 'Rakan KKM (was) designed by boffins at MOF,' X user Jaafar Ismail wrote on the platform. 'These guys have no understanding of social dynamics at these public facilities where capacity (is) stretched. And they expect paying patients to precede poor citizens.' Azrul Mohd Khalib, chief executive of the Galen Centre for Health and Social Policy, a Kuala Lumpur-based research and advocacy organisation, said quicker access for a few will impact access for the masses. 'If public patients are having to compete with private paying patients who are paying premium rates for quicker access to the same facilities, services and care, that is inequality and undermines equity,' he told CNA. 'The only way to prevent that is to ensure that Rakan KKM has its own infrastructure, services and staff which run parallel to the public pathway.' Ilyana Mukhriz, a research associate at Khazanah Research Institute who studies public health, said it 'cannot be denied' that Malaysia's public healthcare facilities face a severe shortage of manpower and an overworked healthcare workforce. In 2024, Malaysia is projected to face a shortage of over 130,000 nurses, with some states having a nurse to population ratio of 1:417 compared to the national average of 1:282, she told CNA. "In the face of the limited capacity of our workforce, it is a worry as to whether we will be able to meet the demand for Rakan KKM patients,' she added. It is worth noting that Rakan KKM is an expansion of Malaysia's full-paying patient (FPP) programme, a dual practice initiative introduced in 2007 that has failed to take off due to limited capacity in public hospitals. And while the FPP is still running, the programme has been scaled back. What is the full-paying patient programme? Malaysia's full-paying patient programme (FPP) has been introduced in public hospitals since 2007 to help reduce the loss of government medical specialists to the private sector. The fees collected are divided between the specialist and the government, Khazanah Research Institute research associate Ilyana Mukhriz wrote in a commentary published by several local news outlets last year. Under FPP, patients are fully charged for the treatment they receive, while having the option to choose a specialist and enjoy full access to first-class facilities in the public hospitals. However, the costs would still be significantly lower than those in the private sector. For example, FPPs pay between RM3,000 and RM5,000 for a caesarean section birth at Selayang Hospital. In contrast, this would cost between RM6,000 and RM15,000 in a private hospital. A non-FPP local patient in Selayang Hospital would generally pay RM100 for a third-class ward, RM400 for a second-class ward and RM1,200 for a first-class ward. This kind of dual practice system can also be found in other countries such as Australia, France and the United Kingdom. In Singapore, certain doctors in public hospitals can choose to see patients in private clinics or hospitals. While the system reduces brain drain to the private sector, increases patient choice in public facilities, and generates additional revenue for the healthcare sector, it is not without its challenges. A 2023 study in Malaysia highlighted that hospitals implementing FPP faced challenges in balancing resource management and serving the public masses. One of the main issues was the limited capacity of public hospitals to meet increased demand for FPP services. Patients also reportedly did not receive a quality of care matching the payment they made. Healthcare policy news site CodeBlue reported last October that at least three of 10 FPP government hospitals have stopped offering the services, with the remaining hospitals either in the Klang Valley or the Borneo states of Sabah and Sarawak. Ilyana noted that in 2019, FPPs accounted for only 0.13 per cent of MOH's total patient encounters, indicating that the 'burden of care may not be significant to detract from other public patients'. One woman, who only wanted to be known as Aresha, told CNA she opted to pay a few thousand ringgit more for FPP when giving birth to her third child via caesarean section (C-section) at Sungai Buloh Hospital in 2017. Being under FPP meant she could stay in a private ward with a family member, choose her doctors and get better services. 'As a mum or a woman who was emotionally not stable knowing there could be many complications, having that ward was really helpful,' the 44-year-old homemaker said. Like FPP, Aresha believes Rakan KKM will give more options for patients who are willing to pay more for specific needs but not at the eye-watering rates of private hospitals. But she said public hospitals should have policies in place to ensure normal-paying patients are not neglected, and not use poor service standards as an excuse to push patients towards Rakan KKM. 'Like if you really concentrate on the (Rakan KKM) ward, and you cut down on the service other patients are supposed to get. If that is (avoided), then I think it shouldn't be a problem,' she added. While Khazanah Research Institute's Ilyana noted that Rakan KKM has considered and attempted to address issues faced by FPP, it is hard to definitively say if the latest initiative would have more success. The fact that Rakan KKM - unlike FPP - has the backing of MOF and GLICs will ensure that some money is channelled back to the healthcare facility and benefit those who are not paying the premium charge, she said. Rakan KKM also ensures that all healthcare staff are paid. Under FPP, only the specialists are paid, while the rest of the money goes back to a consolidated fund without being earmarked for healthcare. "However, there is a need to be wary that the chase for profits does not overshadow the public healthcare system's longstanding mandate of providing universal healthcare,' Ilyana added. "It is key that strict regulations or policies are put in place to ensure that there are quotas or limits to the capacity of Rakan KKM.' With that said, Ilyana believes one of Rakan KKM's main benefits is its potential to retain specialists, something she said could be seen in other countries that have a dual practice model, such as Australia, France and the United Kingdom. 'Currently, specialists within the public sector in Malaysia are already using their free time and flexi hours to perform locum work to supplement their income in the private sector,' she said, referring to an arrangement that allows specialist doctors to work four days a week with the additional day off used for work in the private sector, in a bid to reduce attrition rates. 'Through Rakan KKM, there is now an avenue for them to utilise their skills in the public system during their non-working hours. This would also not only provide side income for these specialists but also the other auxiliary staff such as nurses who assist in the procedures.' MOH clarified that healthcare workers who choose to spend their 'extra time' on the Rakan KKM programme stand to earn additional income, while those who choose not to participate in the initiative will not be disadvantaged in any way. MOH needs to explain what this extra time comprises, Manvir from Vital Signs said, noting that some cardiology specialists were already working until as late as 10pm each day to clear a backlog of cases. Still, Manvir said Rakan KKM is 'necessary' to retain public healthcare talent, highlighting that Malaysia has some of the best medical specialists in the world who cannot earn more in the public sector due to consultation fees that go as low as RM1. "They get the most complicated cases, but they don't get to earn more out of it, which is unfair because they have honed their skills over the years,' he said. "There is a huge gap ... I know so many doctors who were in public (hospitals) who just shut up shop and left for the private sector, and they earn five or 10 times more." Jason Chong, a healthcare manager, feels public healthcare in Malaysia is "too cheap" and is "killing our government doctors". Rakan KKM is one way of making the sector more sustainable, the 33-year-old told CNA. When asked about concerns of equity, Chong said "the richer are already getting better services", pointing to widespread claims that patients with the title of Datuk or Datin and those with high-level connections in public hospitals frequently skip queues in getting cheap public healthcare. But Chong said there must be mechanisms in place to ensure Rakan KKM does not lead the government down a slippery slope of privatising healthcare services in the public sector. 'I support the government in venturing into options for financial sustainability to ensure the needy are attended to, but full privatisation is no different than killing the B40 and senior citizens,' he added, using an official term for the bottom 40 per cent of earners in Malaysia. Manvir said the government must prevent abuse of Rakan KKM, such as if a VIP patient under the programme walks into a public hospital and requests a doctor to attend to his procedures first during normal service hours. For patients considering Rakan KKM, there must also be clarity on details like which procedures are covered, what the higher price quantums are, and whether this can be covered by insurance. Healthcare workers should know when they can perform Rakan KKM procedures, which facilities they can use, and how much more they are getting paid, Manvir said. He added: "So like I said, the devil is in the details. It needs to be very, very clear.' IMPROVING COMMUNICATIONS Khazanah Research Institute's Ilyana acknowledged 'a lot of uncertainty and doubt' surrounding Rakan KKM's actual mechanisms. The tagging of 'Pte Ltd' to Rakan KKM's operating company became 'an even bigger taboo' for the general public, reflecting what she claimed is a longstanding issue of poor communications strategy within MOH. 'There is a need to get the buy-in of the public, (through) hosting engagements and outreach events to properly educate them on the goals and mechanisms of Rakan KKM,' she added. "It is important that there is transparency in governance of the programme to ensure that it does not become a profit-driven vehicle for privatisation of healthcare services in the public sector. There also needs to be regular monitoring and open financial reporting to the public." Dzulkefly - the health minister - took to X on Jul 13 in a bid to quell some of these concerns, reiterating that in an environment of high medical price inflation, Rakan KKM provides 'premium economy value-based healthcare services'. The initiative will serve as a price benchmark, including for services provided by private hospitals, to moderate medical price inflation for all patients. It will also provide 'appropriate returns' for GLIC shareholders and their members, he wrote. But Azrul from the Galen Centre said it was 'incredibly optimistic, premature and unfeasible' to expect Rakan KKM to generate excess revenue that can cross-subsidise healthcare services in its first few years of implementation. The RM25 million seed funding for Rakan KKM will be drained 'quite quickly' as it is supposed to run in four different hospitals, he said. "It would be unethical and a conflict to share resources such as diagnostic facilities and medicines with the public pathway as this would imply that there is cross-subsidy from the public side to the private wing, which is the opposite to what is intended,' he said. "How much medical professionals will gain from service in the private wing is also dependent on what services are able to be provided there. Skilled personnel are limited. 'I don't think that Rakan KKM will have any impact in moderating medical inflation, especially if it provides limited services.' Azrul called on MOH to share the full details of Rakan KKM with the medical fraternity, civil society stakeholders and the media, and not "sporadically through social media posts and media scrums".
Malaysiakini
2 days ago
- Health
- Malaysiakini
NGO slams Rakan KKM as 'privatisation in disguise'
Gerakan Ekonomi Malaysia (GEM) has raised the alarm over the federal government's Rakan KKM pilot scheme, warning that the initiative risks ushering in the quiet privatisation of Malaysia's public healthcare system. In a statement today, GEM president Armin Baniaz Pahamin described the programme, which allows patients to pay for expedited treatment at public hospitals, as a betrayal of the fundamental principle of universal healthcare.
