by Dr PHUA Kai-Lit

The New Straits Times has been publishing a very interesting series of articles on rising health care costs in Malaysia. It was asserted that privatisation and corporatisation of health care will contribute to rising health care costs. I would like to add that there are other important factors which also contribute to the higher cost of health care.

A major factor is the increasing technological sophistication and capital-intensive nature of medical care. For example, new technology such as CT scanners, MRI scanners and PET scanners (which allow doctors to obtain images of the inside of the human body) are very expensive to purchase.These scanners are also expensive to maintain and require highly-trained staff to operate them. If Malaysia allows unrestricted import of the latest medical technologies, health care costs will definitely increase. Controlled clinical trials have indicated that certain medical technology may not be cost-effective in the treatment of diseases, e.g., coronary care units used in the treatment of heart patients.

Rising health care costs are also due to two transitions - the demographic transition (the ageing of the Malaysian population) and the epidemiological transition (the relative decline of infectious diseases and the increasing importance of chronic diseases, cancer and injuries as leading causes of sickness, disability and death). Cancer, heart diseases, stroke and injuries are not only more difficult to treat than infectious diseases, they also cost more to treat and may even require lifelong care. Good examples of the latter are diabetes and severe injuries/paralysis resulting from road accidents.

With rising affluence, the population expects higher minimal standards of health care. In the past, many Malaysians would have been satisfied with the services provided by their neighbourhood general practitioner. They would also have been satisfied with being hospitalised in a ward with multiple beds and without air-conditioning. However, today, many Malaysians prefer a paediatrician to treat their children or a geriatrician to treat their elderly parents. They also prefer to be warded in private or semi-private rooms with air-conditioning, colour television and other amenities. Increasing demand for health care because of the ageing population coupled with increasing demand for what the public perceives to be higher quality care (actually, GPs can treat 80 to 85 per cent of all illnesses at lower costs than specialists) will result in higher health care costs.

Another factor is the "medicalisation of social problems". This refers to the increasing tendency to regard what are essentially social problems as medical problems which need treatment by highly-trained medical specialists, for example, drug addiction, alcoholism and other forms of substance abuse. In the United States, it is common for people to visit the psychiatrist if they are suffering from work stress or domestic problems. There is even a clinic to treat "gambling addiction" at the world famous Johns Hopkins Hospital!

If policymakers and Malaysians want to tackle the problem of rising health care costs effectively, all these factors will need to be taken into account. A multi-pronged approach is necessary to combat rising health care costs. It would be wise for Malaysia to implement a programme to evaluate the cost-effectiveness and control the import of new, expensive medical technology. It would also be good to promote awareness of the benefits of preventive medicine (through healthy lifestyle campaigns, mass innoculations, proper nutrition) as first steps in the battle against rising health care costs.

(A different version of this article was published in the NEW STRAITS TIMES, October 26, 1996)

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