Malaysia is not an exception to the hurdles and challenges faced by a nation that provides its citizens with universal healthcare. Our nation operates a two-tier healthcare system, which consists of the public healthcare system, which is run by the government and is universally available to all Malaysians, and the private healthcare sector.
When we discuss healthcare in terms of public policy, we usually shine the light on access and the availability of healthcare to a population in a nation. Indeed, Malaysia is a signatory party to numerous international conventions and covenants on access to healthcare, but they are population-specific and do not guarantee what the International Covenant on Economic, Social and Cultural Rights (ICESCR) calls the right of everyone to the “enjoyment of the highest attainable standard of physical and mental health”.
The Imbalance
According to data published by the World Health Organisation (WHO), we have around 22.72 doctors per 10,000 people, which is significantly higher than our fellow SEA neighbours1. Therefore, the problem is not that we don’t have enough doctors2, but who is employing them.
Generally speaking, there are two types of doctors: a general practitioner (GP), who is a doctor you visit for minor illnesses and complaints, and a specialist, who is a doctor specialising in a specific area of interest, such as cardiothoracic surgery. Specialist doctors differ from GPs in that they have undergone additional years of training and education, and usually only tend to patients who require their specialist care.
Both public and private hospitals employ both types of doctors, but the patients who get to see them are different. Public healthcare is subsidised by the government (which means it is funded by taxes), and patients usually only have to pay for administration fees of RM5 to see a doctor and receive treatment and medications. According to the statistics released by the Ministry of Health (MOH) in 2025, about 95% of outpatients (patients who don’t need to stay in hospital for treatment) were processed in public health institutions3, compared to the remaining 5% in private institutions4. The reason is not hard to understand: the majority of the population relies on the government-subsidised health system as it is way more affordable. However, they still pay a cost: time.
Here’s another shocker: although the public health system absorbs 95% of the population when they need medical treatment, only 39% of all hospitals in Malaysia are public; whereas the remaining 61% are private. Indeed, the public health system has far more beds than the private sector, but the availability comes down to the number of hospitals available and whether or not large portions of the population can reach them.
Another imbalance is the employment of healthcare professionals, as we discussed earlier. A hospital or clinic without doctors, nurses or other allied health professionals simply does not function. According to an article by Hirman Ismail in the Malaysian Journal of Medical Sciences in 2023, the public sector employs roughly 70% of doctors in Malaysia, while the private sector employs about 30%.
However, the situation becomes inverted when we look at the figures involving specialist doctors. The public sector employs only 15.7% in this instance, and the private sector employs the rest of the workforce, which usually consists of more senior and experienced specialists who have left the public sector.
This might not seem like a major issue to patients who can afford private specialist care, but what about those who can’t? The two-tiered healthcare system supposedly defines the private sector to complement the public sector, but it is now more than a complementary system, but more of a concentrated and highly dense sector of specialists. In this case, affordability and accessibility somehow creep back into the equation, even though universal healthcare exists.
Oversupply, No More
We can think of the government’s retention of healthcare professionals as a bucket of water. The bucket is clearly leaking, but in two directions: doctors are moving to the private sector, further imbalancing the system, and some are moving overseas. Previously, the issue was that the faucet was releasing too much water into the bucket at once, and as a result, it had to be poured over. But now, the issue is that we are losing too many professionals at once. So, where is the problem?
The Faucet
The Malaysian Medical Association (MMA) said that the MOH isn’t the only problem here. The association suggests that it is the pipeline through which doctors are introduced to the system that is the problem. Medical students are admitted into universities following requirements set by the Ministry of Higher Education (MOHE). The recruitment of medical graduates is controlled by the Public Services Department (JPA). And finally, the MOH deals with the registration process of the new doctors, which can take months, while hospitals run short of manpower.
So who’s to blame? Clearly, no one is taking responsibility. Instead of spending time we don’t have arguing about which part of the faucet is broken, why not just replace it with a new one? We need a strong central figure (which should probably be the MOH themselves) to decide on the requirements, selection and finally the registration altogether. Streamlining it, instead of further fragmenting it.
The Leak
The medical industry in Malaysia is not the only sector facing the loss of talent. Previously, we discussed brain drain in Malaysia in a general sense; now, let us look at it specifically in the medical sector. The main leak currently is from the public health system to the private one, which all makes sense when we assess the working conditions our doctors are working with.
According to a press statement by the Malaysian Medics International (MMI), doctors work for 65 to more than 85 hours weekly on average, with a maximum continuous shift of around 24 to 36 hours if on-call. According to MMI, other nations such as the UK and Ireland have legal precedents that mandate the allocated rest hours and compensation of doctors who work long shifts. As a direct response to the statement released by MMI, Health Minister Dzulkefly Ahmad said the next day5 that the MOH would issue new circulars on the working hours of doctors and “supplementing flexi-work arrangements”.
But haven’t we heard of this before? The health ministry (of the same administration) tried to implement Waktu Bekerja Berlainan (WBB, “Different Working Hours”) programme last year, but it completely imploded on its own. What seemed great on paper, to raise the weekend on-call claims to RM25 from the current RM9.16 per hour rate, turned out to be another policy slashed with cost-saving measures, where doctors working weekday shifts for 18 hours wouldn’t even be compensated at all6.
The irony in WBB is that the proposed solutions require more staff to run the shift system. Let us remind ourselves once more why the public health system is facing this inherent issue of a lack of manpower. Depressingly, there are several reasons:
1. Workplace Toxicity and Burnout
Reports of a toxic workplace culture in different public health institutions nationwide perpetuate acts of bullying, combined with extreme exhaustion from the long, continuous shifts, have created what the MMI calls a ‘significant deterrent’. In addition to the long hours, there exists the toxic practice of “faham-faham sendiri” (silent understanding, literally meaning “understand yourself”), where junior doctors are expected to arrive early for ward rounds and to stay late to complete their tasks, compounding their total shift hours to an additional 10 to 15 hours weekly, which they are unpaid for.
In the past 5 years, our nation has also been continuously shocked by headlines of doctors suffering from “sudden deaths”, but we all know it’s not sudden and it’s not abrupt, is it? At the beginning of this year, a junior doctor was found dead in her dormitory in Kelantan; last year, the head of the chemical pathology unit in Hospital Lahad Datu was found dead in her home, and four years ago, another junior doctor fell to his death from his apartment in Penang.
Doctors are humans too. Shouldn’t they deserve the same amount of care they provide for us? What’s always so repetitive about these incidents is that the words “sudden death” or “no criminal element found” are always around the wavelengths when they occur. To quote Dr Muhammad Yassin writing to CodeBlue, we don’t need another “no criminal element found”; we need legitimate layers of protection for our healthcare professionals.
2. Capped Professional Growth
In Malaysia, any medical graduate who has just completed their degree in university for 5 years must go through the housemanship program in public hospitals for 2 years7. This is mandatory for any doctors who wish to practice in Malaysia. After completing the housemanship program, doctors can choose to remain in public hospitals or to migrate towards the private sector or overseas.
As for doctors choosing to stay, most of them become contract doctors for the MOH. Beginning in 2016, the contract doctor system was the government’s solution to addressing the manpower shortage. Doctors would be on a five-year contract with the government, instead of receiving traditional permanent positions. The major issue with the system is that contract doctors receive lower pay, have limited leave and face troubles advancing their careers professionally, compared to those who have a permanent position.
As we discussed earlier, GPs who wish to advance their career to become specialists have to undergo additional years of professional education and training. The government gives out scholarships for doctors to specialise through the Hadiah Latihan Persekutuan (HLP) program. Under the current system, any doctors seeking to specialise through local masters’ programmes or parallel pathways through Royal Colleges are required to apply for the HLP scholarship, regardless of their decision. Applying for the HLP is a lengthy process, as it takes time to meet the prerequisites and it takes up to four years before doctors even enter specialisation training.
A Kedahan medical officer wrote that passing the examinations required to enter specialist training itself is not sufficient to be chosen for HLP. Another systemic issue they highlighted with HLP is that the barriers preventing doctors from receiving it are too systemic. For instance, how can doctors be expected to have departmental experience when they aren’t able to transfer to the appropriate departments in the first place?
As it is mandatory for doctors seeking specialisation to apply for the HLP, the MMA says that this system is too rigid, with limited openings and long mandatory bond durations of 7 years, which in turn dissuades doctors from continuing their service with the government, choosing to move abroad to advance their careers instead.
3. Poached
The issues discussed thus far in this article are not unknown to most health professionals and to those who are seeking a career in the medical sector within Malaysia. Its depressing reality is not inspiring hope and is actively deterring them from the public sector. Sensing blood in the water, Singaporean agents have been reportedly ‘poaching’ Malaysian medical students before they even graduate. As discussed, brain drain is significant in the medical sector in Malaysia and is not limited to the top universities. Universities such as IMU University are also providing transfer programmes where students could choose to study elsewhere as part of their 5-year degrees, further incentivising the trend.
Could this be seen as an act to save oneself from the reality discussed? After all, who wouldn’t bail from a sinking ship while they can?
Is Private Healthcare Better?
Many are of the opinion that private healthcare is a net good; that it is more efficient, of better quality, and that it takes the burden off the public healthcare sector. However, things aren’t that simple. The private healthcare sector is first and foremost profit-driven. Coverage is not offered to all, as there is a need to limit risk and avoid loss-making services. Hence, there exists a category of patients deemed unprofitable or less profitable, such as those who have reached insurance limits. It is arguable then, that its provisions do not prioritise quality but rather focus on patients who can afford to pay upfront, and in favour of those with insurance status, which accounts for age and pre-existing conditions. The fact is simply that the moment money runs out, choice disappears for the patient.
The perceived efficiency of private healthcare is achieved through bill-able procedures over patient-centered care, which leads to shorter consultations with higher charges, which can put patients in medical debt. This fear of debt can then lead to patients delaying treatment, or only seeking treatment when their illness has reached a point of severity. Ultimately, efficiency for this system is achieved by shifting risk and cost to the patient and not through genuine interest in improving population health. The reason for quicker provision is also due to the exclusion of demand—high costs filter our lower-income patients, and fewer patients naturally lead to shorter waiting times.
This is not mere speculation or anecdotal. Research conducted has shown that not only is there no cogent evidence that transitioning from a publicly administered system to a privately dominated one enhances efficiency, findings point to the opposite Stronger government involvement in the funding of healthcare expenditure is associated with higher efficiency—the higher the share of public funds in the healthcare budget, the more efficient the system.
It goes without saying that over-privatisation will only foster larger inequality gaps. Malaysia’s two-tier health system has made it so that access to quality care is becoming increasingly determined by financial ability. The touted benefits of private healthcare being shorter waiting periods, personalised services and the ability to choose consulting doctors demonstrates the commodification of healthcare, as patient choice becomes a marketable service by having the focus shift to convenience and customer service rather than medical necessity.
Growing Concern
There exists a series of concerns that the Malaysian healthcare system is not prepared to face. Firstly, the ageing local population—over 15% of our population is predicted to be 60 years or older by 2030. A report by the Malay Mail states that “this demographic shift presents an unprecedented challenge to a healthcare system already stretched to its limits,” as with age, the risk of non-communicable diseases such as diabetes, high blood pressure and cholesterol, and obesity increases. This, paired with poor allocation of resources, a demoralised workforce, and lagging digital infrastructure, places the health and well-being of millions of Malaysians at risk of serious crisis if it does not step up and start preparing for the future.
Public policy surrounding healthcare has never been an easy question to answer. It is, like all other questions the government has to tend to, highly complex and multi-faceted. However, complex as it is, we should respond to this with the highest priority, given that our nation is rapidly ageing, which will only increase the demand for a stable healthcare system from now on. The next time you visit a doctor, a relative in a hospital or pass by a health institution, public or private, think to yourself: how will it affect you and your family in the future? Are you concerned with the rising cost of healthcare or waiting times? Perhaps someone you know is a healthcare professional; how does it affect them? These are the vital questions we as the public should seek to answer as well, for we are the main beneficiaries of the healthcare system designed for us in the first place.
Let us now begin to take care of our own caretakers by starting constructive discussions surrounding our healthcare system, and instead of politising issues as minute as including multilingual texts in a clinic’s appointment card, let us fill the headlines with advances for the system.
Written By: Sherman Yap & Sarah Tan
Edited by: Sarah Wong
Footnotes:
- Singapore leads the region with 26.7. Third highest in the region is Vietnam with 11.07. Thailand, Indonesia and the Philippines are 5.91, 5.59 and 8.69 respectively.
↩︎ - In the 2010s, there was actually an ‘oversupply’ of medical graduates as new local and foreign medical schools opened across Malaysia. The problem was inverted when the government introduced the contract doctor system, which leads us to today.
↩︎ - Public hospitals, special medical institutions and public health facilities.
↩︎ - Private hospitals, private maternity homes, private nursing homes and private hospices.
↩︎ - The day after the publication of MMI’s statement by CodeBlue.
↩︎ - You can read more about the WBB saga in this article by CodeBlue and this opinion article on MySinchew.
↩︎ - The MOH have been alluding to a proposal to revert the housemanship program to 1 year, but it is not implemented as of this article’s writingmaster’s,.
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