1. INTRODUCTION
Malaysia currently has a dichotomous public-private
system of health care services. From what was largely a
government-led and funded public service enterprise since
the time of independence, our healthcare service has over
the decades (since the 1980s), transformed into a buoyant
dual-tiered parallel system, with a sizable and thriving
private sector. But, we have not approached a unified
system that is a declared national healthcare policy of
offering universal access to every citizen.
There appears to be strong ambivalence as to whether
to fully tap into the free market system for healthcare
provision and funding or to resort to a single payer publicly
controlled system where universal healthcare access is
assured. Some mix of these two disparate systems seems to
be in play at the current moment.
On the one hand, there has always been an
overarching concern for the common citizen, especially the
poorer segment of Malaysian society, where there is an
implied social contract and acknowledged ‘right’. There is
a deep-seated commitment of the Malaysian government to
eradicate poverty and develop human capital.1 It is
expected that the government guarantees a comprehensive
provider function at greatly subsidised rates or at token
sums—that taxes and other contributions should provide
adequately for most if not all its citizens, with the
government taking up the shortfalls for unexpected costs
due to catastrophic or chronic ailments.
On the other hand however, there appears to be a
covert if unannounced shift in thinking that eventual
corporatization of the public sector facilities and services
should be allowed to unfold, where market forces dictates
the price, extent and quality of the services offered. The
ultimate aim is that the government should play only a
regulatory, monitoring and facilitator role to safeguard the
welfare of its citizens, while at the same time encouraging
growth of the less-bureaucratic, better-run and more
competitive private sector.2
Thus, despite public dissent, over the past 20 years or
so, there have been sporadic if partially successful attempts
to privatize or corporatize various components of the public
health sector, e.g. the government’s drug procurement and
distribution centre (to UEM’s subsidiary Southern Task,
later renamed as Remedi Pharmaceuticals, then as
Pharmaniaga); and the divestment of its support services