Nephrologist suggests merit system to reward hospitals with good NCD programs

KUALA LUMPUR, October 21 – Two doctors and a group of doctors have urged political parties contesting the 15th general elections to address health care financing, primary care and testing for the non-communicable disease (NCD) crisis in Malaysia.

Regarding the funding of NCDs in public hospitals, Prof. Dr. Lim Soo Kun, Nephrologist and Associate Professor at the Specialized Center, University of Malaya, proposed that the government should consider a merit system to grant a larger budget. to public hospitals with good NCD programs.

“I think one aspect the government can consider is a well-designed merit system to give regional hospitals a larger budget allocation for running good NCD programs.

“We also need to reduce silos in the healthcare system. For example, MOH hospitals versus MOE (Ministry of Education). As you may know, MOE hospitals receive less budget and should generate revenue on their own,” Dr Lim said. Code blue.

A report recently released by the Ministry of Health (MOH) and the World Health Organization (WHO) revealed that the direct healthcare costs for diabetes, cardiovascular disease and cancer in Malaysia exceed 9.65 billion RM per year. Data for this figure comes from hospitalizations, medical tests, medications and primary care consultations in 2017.

The National Health and Morbidity Survey (NHMS) 2019 estimates that one in five Malaysian adults have diabetes, one third have high blood pressure and half are overweight or obese.

As Malaysia is an aging nation, the MOH-WHO report estimated an increase in the country’s health and economic burden due to chronic diseases.

Primary care to reduce the burden on the tertiary sector

Prof Dr Lokman Hakim Sulaiman, Pro Vice Chancellor for Research and Professor of Public Health at the International Medical University.

Dr. Lim also advocated for strengthening primary care to reduce overcrowding in the tertiary healthcare sector.

“If we can have better support for primary care, we can only reserve hospitals for real emergencies. This can ensure efficient use of healthcare resources. Of course, for this, public education is equally important.

Dr. Lokman Hakim Sulaiman, Pro Vice Chancellor for Research at the International Medical University (IMU) and Director of the Research, Development and Innovation Institute (IRDI) at IMU, spoke about the need for ‘establish more primary outpatient clinics in the community, such as GP/Klinik 1Malaysia’ type services and mobile clinics.

Overall, Dr. Lokman’s vision for primary care focused on community services and local government:

  • Care for the Elderly: Strengthen and expand care for the elderly, including home-based services and a community support system.
  • Mental Health: Improve and expand mental health services, including services in the community.
  • Strengthen the capacity of local government health departments to deal with dengue fever, food poisoning, zoonoses (leptospirosis and rabies) and environmental health issues. Empower them to take ownership of these health issues.

Dr. Lim also drew attention to the inequities associated with receiving a kidney transplant. According to the nephrologist, almost all kidney transplant centers are located in Klang Valley, which disadvantages patients from the east coast and East Malaysia.

“I would strongly suggest the establishment of regional centers to ensure equal access to transplant services. This is applicable to other organ transplants. For example, liver, heart-lung, etc.

Dr. Lokman made the following proposals for NCDs:

“Tackling the silent epidemic of NCDs and its risk factors – diabetes, cardiovascular disease, cancers and mental health:

  • Restructure the disease control program of the Ministry of Health – upgrade the NCD section to division (and formalize the creation of the National Center for Infectious Diseases [NCID])
  • Re-establish a (politically) independent health promotion council with funding from part of the “sin tax” – to empower non-governmental organizations (NGOs) and communities as partners in health.
  • Empower NGOs, civil societies, community and individuals towards healthy lifestyles.
  • Encourage healthy behaviors and discourage unhealthy behaviors.
  • End of the generational tobacco and vaping game – continue work to introduce the RUU (Control of Tobacco Product and Smoking Bill 2022).

Primary care is crucial for successful NCD screenings

Dr Steven Chow, President of the Federation of Private Medical Associations Malaysia (FPMPAM). Image from

The Federation of Private Medical Associations Malaysia (FPMPAM) felt that the platform for delivering mass health screenings should be doctor-led at primary care level, with a general practitioner or family doctor performing the screenings.

FPMPAM President Dr. Steven Chow Kim Weng said the right approach to a medical screening begins with taking a complete medical history, a complete physical examination and finally lab tests.

“The doctor’s duty of care does not stop at laboratory results. Screening should be followed by appropriate medical counseling and intervention if there is a clinically significant abnormality,” Dr Chow said. code blue.

Another reason why it is absolutely vital that health screenings be done at the primary care level is the “false positives and false negatives issue”.

According to Dr. Chow, doctors have reported cases of patients devastated and suicidal after receiving a false positive result, which later turned out to be normal.

This problem of “overdiagnosis” and “misdiagnosis” based on laboratory findings leads to many adverse effects for the normal individual, who could be subjected to “further investigative procedures, long-term treatment, risk of job loss and health insurance”. cover.”

“For health screening to be effective, there must be concurrent programs to improve health literacy. The message and implementation must also engage civil society and not just political rhetoric. »

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