by Hashwinni Kerbanathan
Since 1957, there has been a major shift in Malaysia’s healthcare system. It has expanded from traditional remedies to meet the emerging needs of the population. In the early days, healthcare services were largely led by the government and funded by the public service enterprise. After the country's independence in August 1957, it grew into a dual-tiered parallel system over the decades. Public healthcare is a cheaper option compared to the private sector as it is funded and subsidized by the government.
Citizens in a country are entitled to several important rights, and one of them is access to medical healthcare. There are many types of medical care that has been set up to fulfil citizens' medical necessities. Different types of primary healthcare is provided, such as curative, preventive, promotive and rehabilitative services. Curative services in Ministry of Health Clinics include: basic medical care, minor surgery, circumcision, care of chronic conditions, detection of malaria and tuberculosis, detection and early intervention of diabetes cancer, sexually transmitted diseases and HIV.
Despite the range of medical healthcare provided to citizens, a majority of elderly people, women and the LGBTQ community face major barriers in relation to medical accessibility. Malaysia’s elderly population currently stands at an estimated 3.5 million people, which contributes to about 7% of the country’s population. With charges between RM1 and RM5 for outpatient and specialist care respectively, Malaysians are able to access treatment and care at government clinics and hospitals. However, the ‘cheap’ nature of these charges has led to several other problems. For instance, medical insurance does not provide coverage to former employers who are retired. Elderly people from B40 and M40 groups are not able to afford nursing homes. The cost required for surgery for the elderly suffering from severe illness comes to about RM100,000 and above. The elderly are also denied medical accessibility due to transportations barriers such as high transportation costs for regular check ups.
Women are the larger group of the population that has been deprived of necessary medical healthcare. For instance, women’s right to contraception is determined by the nation’s policies depending on their age, marital status and other factors that may not be relevant to the woman herself. Furthermore, healthcare staff in clinics and hospitals are required to report any ‘illegal’ act or procedure when women come to seek treatment, although they are at their most vulnerable state. At the very least, healthcare professionals should not impose their own values in deciding when women should start their families and how they plan them.
In addition to contraception, women also tend to face difficulties in accessing subsidised mammogram screening programmes. Under the Private Healthcare Facilities and Services (Private Hospitals and other Private Healthcare Facilities) Order 2013, a mammogram investigation may cost RM 230 or more and this amount approximates to about 40% of median monthly income for the urban population (RM 5,156) or 7.0% of median monthly income of rural population (RM 3,123). This cost does not include the registration fee, doctor’s consultation fees as well as the travel cost incurred.
On top of that, abortion comes with an extremely immense restriction. Section 312 of the Malaysia Penal Code provides that a pregnancy can be terminated only when a registered medical practitioner deems that the continuance of the pregnancy would pose a risk to the woman’s life or cause injury to their physical or mental health. Nevertheless, abortion is considered illegal regardless of the circumstances; be it rape, under-age pregnancy, cases of foetal impairment or for socio-economic reasons. Essentially, women do not have the freedom of choice unless their life is explicitly in danger, that is if the continuance of the pregnancy poses a greater health risk than if it was to be terminated.
Another community that has been severely neglected in terms of medical accessibility would be the LGBTQ community. Based on recent findings, transgender people have been one of the main victims deprived of medical accessibility. The reason behind such treatment towards them is due to discrimination based on social stigma and personal views upheld by medical practitioners. For instance, medical practitioners who are more fearful and hateful towards transgender people express a greater tendency to discriminate against transgender people whereas medical practitioners who believe that transgender people deserve equal healthcare are less likely to discriminate against transgender people. In order to improve medical accessibility for the LGBTQ community, necessary education about the community must take place so that medical practitioners can enhance their knowledge and change their perception about transgender people and the rest of the LGBTQ community.
In conclusion, the quality of national healthcare plays a huge role in keeping our country safe, preventing diseases and improving the quality of life. The Malaysian Ministry of Health (MOH), being the main provider of health services, should manage and mobilize better healthcare services by providing necessary healthcare financing mechanisms.
Accessibility to medical healthcare is a right that everyone should be entitled to regardless of differences in identity, background and social status.