The Ministry of Health (MOH)’s role in the country’s healthcare system must be re-examined as it currently holds too much centralised power, said its minister Khairy Jamaluddin.
“We have to look at the role of the MOH itself. Our MOH is a very unique structure, many other countries do not have the kind of MOH that we have.
“We are the biggest payer, the biggest provider, and the only regulator (of healthcare in Malaysia),” he said.
Khairy (above) was speaking at the Health Policy Summit 2022 held at the World Trade Centre Kuala Lumpur.
Other speakers present included former health minister Dr S Subramaniam, Axiata Group chairperson Shahril Ridza Ridzuan, and Sunway University’s Sunway Centre for Planetary Health executive director Dr Jemilah Mahmood.
Khairy said this highly centralised structure has its advantages but also comes with a number of disadvantages.
“It has its advantages obviously. As Subramaniam said, if you want things done yesterday, you just send a circular and it’s done.
“But there are also disadvantages to this Leviathan. It becomes difficult to deliver services because you’re conflicted in many ways.
“You pay, you provide, you regulate yourself, and there is a risk of over-bureaucratisation and increased administrative costs,” he said.
Khairy believes the MOH should be focusing on policy, public health, research, and maybe regulation.
Business-minded CEOs
When it comes to service delivery, he proposed that some of the larger hospitals under MOH can have more autonomy, with their own governance structure, board, CEO, and “ability to retain savings”.
“Now there’s no incentive for hospital directors to retain savings because if there are any savings, it will be poured back into the consolidated fund… (so) there is no incentive for hospital directors to behave like CEOs.
“Of course, you have to put in safeguards to ensure that autonomous hospitals continue to serve the public good… otherwise they can be too business-minded as well,” he said.
Something else that could also be considered, he said, is whether to carve out regulatory functions from the ministry and set up a separate regulatory body.
For example, he said the UK’s National Health Service (NHS) does not have regulatory functions.
Meanwhile, Khairy said he wants his public healthcare officials to act more like “social justice warriors” in that they should care about social determinants affecting those under their care beyond the hospital.
He said determinants such as social, economic, and environmental factors can affect up to 80 percent of one’s health outcomes.
As such, he said he wants his public health officers to be “the busiest busybodies” in their health district.
‘I want busybodies’
“I want them to practice four letters: JTKO that is, jaga tepi kain orang (pry into other people’s business).
“Demand human rights for clean water, clean air, and access to education because all of these things have an impact on health outcomes.
“So that is the challenge, a new generation of public health officials who care about things beyond the clinic and hospitals and look at every single determinant to ensure all Malaysians are healthy,” he said.
Khairy pointed to a study by Stanford University saying Malaysians are the third laziest people in the world, but he noted the study only measured footsteps and obesity.
“It did not reflect on the fact that Malaysian cities are not very walkable cities. We do not have urban planning and the right environment that promotes a healthy lifestyle.
“We do not have a transportation network that promotes a sustainable healthy lifestyle,” he said.
It is easy for the MOH to lecture people on how to live and eat more healthily, he said, but there are real obstacles and limitations that people face in doing so.
Challenges to get healthy
He pointed out that Malaysians face stumbling blocks such as the price of nutritious food and lack of time to exercise while juggling more than one job.
“Some of it can be helped through promoting campaigns and behavioural science, but there are actually some very real structural obstacles and barriers for people to live healthy lives and that’s where MOH really needs to work with other ministries in accounting for health outcomes for all their policies,” he said.
Just like how every ministry now has to account for gender equality and climate change, Khairy said he would like every ministry to take into account what they are doing for health outcomes.
“When you draw up plans and policies at your ministry, think about how this has an influence on health outcomes for the public,” he said.
Khairy also said he thinks the MOH’s political status should be elevated, with the ministry “ideally having the heft and the gravitas of a very, very senior minister”. - Mkini
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