Are private interests encroaching into Malaysia’s public hospitals through Rakan KKM?

Sivarajan Arumugam

It is troubling that our public healthcare system has been subject to continual attacks ever since neoliberal policies were ushered in by Dr Mahathir Mohamad’s administration in the 1990s.

Anwar Ibrahim’s “Madani” (compassionate) government today clearly falls short of offering any progressive reforms. Instead, it appears to allow the private sector to encroach further into the public domain.

The proposed introduction of the ‘Rakan KKM’ (Friends of the Ministry of Health) initiative enhances the dual-practice model within public hospitals. Rakan KKM is an extension of the ‘Full-Paying Patient’ (FPP) scheme introduced by the Barisan Nasional government in 2007.

Dual-practice models enable specialist doctors in public hospitals to serve in private healthcare settings. They were designed to increase the retention of specialists in government service.

Health Minister Dzulkefly Ahmad said that Rakan KKM was not a privatisation move. Rather, it was a key policy intervention to retain medical specialists within public healthcare.

However, Rakan KKM is slated to be implemented through a corporate entity known as Rakan KKM Sdn Bhd, wholly owned by the Ministry of Finance Incorporated. The pilot project in Cyberjaya Hospital will involve setting up a ‘private patient unit’ within the public hospital. The unit will have four beds, one operating theatre and two specialist clinics.

The minister added that revenue generated from private-paying patients using the Rakan KKM facility will be pooled and used to upgrade public healthcare.

The FPP scheme, Rakan KKM’s predecessor, did reduce the brain drain of specialists from public to private healthcare. Resignation trends fell from 6.4% in 2000 to 3.5% in 2016, but migrations persisted (Muhammad Nur Amir AR1, 2020). The percentage of specialists’ resignations from the 10 FPP scheme-implementing hospitals from 2015 to 2017 averaged 31.8% (Malinda Mohd Fadzil, 2022).

This could plausibly be attributed to earnings limitations. Participating specialists’ incomes were limited to no more than three times their public service salary, which was still lower than their counterparts in the private healthcare sector. Additionally, specialists were found to leave due to governance and work processes, such as lack of promotions, training support, poor work environment and inflexible work times in government hospitals (Muhammad Nur Amir, 2020).

Studies on dual practice, such as the FPP scheme in 10 public hospitals, have been inconclusive. They show that while it “renders certain benefits”, it comes with “multiple conundrums” (Malinda Mohd Fadzil, 2022).

Hence, Rakan KKM’s anticipated success in retaining public healthcare specialists raises doubts.

More importantly, dual-practice schemes within public healthcare have caused adverse impacts, especially for non-paying public patients.

A study, Implications of Dual Practice on Cataract Surgery Waiting Time and Rescheduling: The Case of Malaysia, was revealing. It found that private-paying patients had seven times shorter waiting times for cataract surgery than non-paying public patients in a pioneer hospital of the dual-practice scheme (Weng Hong Fun, 2021). While private-paying patients had their cataract surgeries on schedule, non-paying public patients had their surgeries rescheduled, citing various patient health issues.

Similarly, studies in Australia and the UK have found comparatively longer waiting times for public patients when dual-practice schemes are implemented in public healthcare (Daniel McIntyre, 2020; Queensland, 2014; Walpole, 2019).

In the UK, healthcare professionals noted various administrative issues when private-paying patients are treated under the same roof as non-paying public patients. These include patients segregated based on having medical insurance and not on their health condition; over-diagnostics for paying patients; private-paying patients pushed back to the public system if they cannot afford treatment and vice versa when public patients seek quicker treatment (Walpole, 2019).

Public utilities were used to provide diagnosis and treatment for private-paying patients. However, the equipment in private patient units was not accessible to non-paying public patients.

When private patient units expand to cater to more paying patients, they will procure more facilities. But will the corporate entity Rakan KKM Sdn Bhd allow these facilities to be used by non-paying patients in public hospitals?

Economist Prabhat Patnaik cautions that capital accumulates not only through expansion but also by encroaching on the public sector (Patnaik, 2021). It does this not by investing but by taking up labour time and services that were once within the public domain.

The dual-practice scheme is conceived as a measure to benefit healthcare personnel in public hospitals. However, it opens the door for market logic to encroach on public health. This lies in sharp conflict with the responsibility of preserving healthcare as a fundamental right for all, irrespective of socioeconomic status.

Sivarajan Arumugam is a central committee member of the socialist party PSM.

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