Quality use of medicine in a developing economy: Measures to overcome challenges in the Malaysian healthcare system

Abstract

Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients’ demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders are necessary to further strengthen the Malaysian healthcare system effectively.

What do we know about the needs and challenges of health systems? A scoping review of the international literature

“…The movement of doctors to private hospitals further exacerbated the manpower shortage in public hospitals. Consequently, one-third of the total number of physicians who remain in the public sector struggle to provide services for two-thirds of the total number of hospital beds in the country [ 21 ] .…”

Importance of medicine quality in achieving universal health coverage

“…Interventions aimed at ensuring medicine quality, such as good practices in manufacturing and distribution, or establishing an essential medicines list, strengthen institutions necessary for maintaining continued access to quality-assured medicines and quality services [ 45 – 48 ]. UHC financing schemes can create incentives for providers to prescribe and dispense medicines procured through systems or processes that ensure their quality.…”

Consensus among healthcare stakeholders on a collaborative medication therapy management model for chronic diseases in Malaysia; A Delphi study

“…lack of patient education and knowledge about how to use or store a medication appropriately, or how to avoid or recognise an adverse effect of a medication or what could be possible interactions with other medications or supplements or traditional medicine a patient is taking, [8,19].…”