Healthcare Gains Need Stronger Retention, Access Reforms

Budget 2027 increases funding for outsourcing patient treatment to RM200m and expands public-sector access to private facilities

by AKMAR ANNUAR

MALAYSIA’S move to offer permanent appointments to more than 9,000 contract doctors under Budget 2027 has drawn support from healthcare professionals, who say the commitment must be matched by stronger specialist retention, rural access and financing reforms to improve patient care.

Malaysian Medical Association (MMA) president Dr Sivanaesan Letchumanan said the announcement addresses longstanding concerns over employment security, but further investment is needed to tackle a shortage of nearly 11,000 specialists as an ageing population and non-communicable diseases (NCDs) increase demand.

“Permanent appointments are an important step forward, but they must be supported by a comprehensive workforce retention strategy.

“Ending the contract doctor system must not be the end of our efforts to strengthen the healthcare workforce,” he said in a statement.

The reactions place implementation at the centre of the healthcare debate, with higher spending expected to address shortages that affect treatment capacity, waiting times and access outside major urban centres.

Prime Minister (PM) and Finance Minister (MOF) Datuk Seri Anwar Ibrahim announced an increase in the Health Ministry’s (MOH) allocation to RM47.7 billion from RM46.5 billion when tabling Budget 2027 on Oct 9.

The government committed to offering permanent posts to more than 9,000 contract doctors in 2027 and subsequently providing permanent medical officer appointments to doctors who successfully complete housemanship.

Post-basic incentives for 47,000 nurses and paramedics also increased from RM100 to RM200 monthly.

MMA welcomed greater career certainty for young doctors. However, it had hoped for more substantial commitments to retaining experienced personnel and expanding specialist capacity.

Its recommendations include wider specialist and subspecialist training opportunities, better career progression, fair remuneration and improvements to working conditions that drive doctors out of public service.

Retaining the Next Generation of Specialists

Subang Jaya Medical Centre (SJMC) consultant anaesthesiologist and critical care physician Dr Gunalan Palari Arumugam identified the departure of experienced medical officers and junior specialists as a weakness in the workforce pipeline.

These clinicians form an important link between house officers and senior consultants, supporting service delivery while developing the expertise needed to succeed retiring specialists.

“The healthcare ecosystem is currently experiencing a critical structural gap: The loss of mid-tier medical professionals (experienced medical officers and junior specialists/ consultants) who sit between house officers and senior consultants,” he told The Malaysian Reserve (TMR).

Dr Gunalan pointed to migration to Singapore and Australia, where compensation, career progression and long-term prospects attract this group.

He proposed clearer, merit-based promotion pathways, dedicated subspecialty funding and protected research time to strengthen professional development within Malaysia.

Sponsored overseas fellowships could allow clinicians to acquire expertise without leaving the local system permanently, while limits on on-call hours, improved workplace conditions and institutional childcare could help address burnout.

His recommendations extend to rural services, where additional buildings alone cannot overcome the absence of personnel qualified to provide specialised treatment.

“Furthermore, rural communities continue to face severe access barriers driven by a dual deficit in both physical facilities and the specialised human resources required to operate them,” he said.

Dr Gunalan proposed tele-oncology and tele-cardiology platforms linking rural clinics with urban tertiary specialists for consultations and second opinions.

Point-of-care testing kits and mobile screening vans could support earlier assessment of patients at risk of cardiac disease and cancer, reducing the need for some initial transfers to urban centres.

He also suggested incentivised rural rotations for junior specialists, supported by subsidised accommodation and faster career progression.

Funding Must Reflect Sabah’s Needs

Sabahcare Fertility & Specialist Centre CEO and consultant obstetrician and gynaecologist Dr John Teo said healthcare funding needs to account for Sabah’s geography and differences in patients’ circumstances.

He highlighted the urban–rural divide, socioeconomic conditions, education levels, beliefs and legal status as factors affecting access and healthcare delivery.

Dr Teo questioned whether a state-by-state approach adequately reflects Sabah’s needs compared to smaller states where patients can reach services more easily.

He pointed to calls for national funding to be considered on a regional basis, treating Sabah as one of Malaysia’s three regions rather than solely as one of its 13 states.

For remote communities, the benefits of greater hospital capacity also depend on reliable roads, air services and river transport.

Private hospitals and specialist day care centres already operate in Kota Kinabalu, Sandakan and Tawau.

Dr Teo said experience during the Covid-19 crisis demonstrated that outsourcing public medical services could reduce waiting times, providing a foundation for wider cooperation.

MMA similarly called for better staffing incentives and working conditions in Sabah and Sarawak, including restoration of the previous percentage-based Regional Incentive Payment, known as BIW.

The association welcomed the increase in the air healthcare service incentive from RM30 to RM100 but said the revised payment remains inadequate relative to demanding conditions and safety risks.

It urged further review alongside investment in aircraft maintenance, operational safety and personnel protection.

These concerns complement Dr Gunalan’s position that Flying Doctor Services remain necessary while rural facilities and specialist staffing are strengthened.

Making Private Capacity Work for Patients

Budget 2027 increased funding for outsourcing patient treatment to RM200 million and expanded public-sector access to private facilities, including operating theatres.

It also provided for more flexible sessional arrangements involving retired government specialists and private specialists, with the maximum duration extended.

The programme’s scope includes expanded newborn screening, prenatal genetic testing and rehabilitation.

Dr Gunalan considers outsourcing necessary in specialised fields such as cardiology, cardiothoracic surgery and neurosurgery while Malaysia develops sufficient clinical expertise.

He proposed including teaching and mentorship requirements in outsourcing contracts so that private providers help train public-sector registrars alongside delivering treatment.

Government-funded subspecialty positions tied to return-of-service commitments could strengthen the pipeline, while a state-level patient registry could support coordination and monitor outcomes.

More extensive day care and ambulatory services could also reserve inpatient resources for patients requiring intensive treatment.

“Because inpatient admissions are inherently resource-intensive, transitioning eligible patients to outpatient management for simple surgeries and targeted therapies (such as oncotherapy and radiotherapy) optimises hospital capacity,” he said.

He linked the approach to advances in anaesthesia and surgery, including better postoperative pain control and fewer adverse effects.

His recommendations include standardised patient assessment, outpatient nursing hotlines and appropriate remote monitoring after discharge.

Community treatment hubs could accommodate routine chemotherapy and radiotherapy outside main hospital buildings.

Budget 2027 identified nine new facilities, including a Specialist Clinics and Day Care Centre Complex at Hospital Sultanah Aminah in Johor, a specialist dental centre in Kuching and integrated health complexes in Gerik (Perak) and Rembau (Negri Sembilan).

Separately, Dr Gunalan highlighted indemnity costs and litigation exposure in obstetrics. His proposals include specialised facilities with robust super vision and staffing, emergency simulation training and consideration of state-backed or capped indemnity arrangements.

Affordability Beyond Transparent Bills

The introduction of MediAsas in January 2027 adds another dimension to healthcare financing, with hospital payments based on diagnosis and treatment.

Dr Teo said its viability depends on approval times, coverage, reimbursement amounts and prompt, sustainable payments that allow private providers to meet operating costs.

“It remains to be seen how effective the project will be in the implementation phase,” he said.

Private hospital bills are also set to use standardised, transparent charge categories from 2027.

However, Dr Teo argued that clearer billing needs to be accompanied by examination of the factors driving prices, including regulatory compliance, workforce requirements, insurers, third-party administrators and competition between providers.

“Comparing costs alone will do little to make any difference to patient access,” he said.

Better transport connections remain necessar y for Sabah patients travelling for treatment.

Dr Teo added that improved road and air links with neighbouring countries could strengthen medical tourism, although significant connectivity gaps persist.

Calls for Structural Reform

Galen Centre for Health & Social Policy chief executive Azrul Mohd Khalib welcomed permanent appointments and higher allowances but called for a funded, multi-year recruitment and retention programme.

The centre distinguished converting existing doctors to permanent posts from increasing the number of professionals delivering services.

It renewed its proposal for an independent Health Services Commission to oversee workforce management.

“The government has acknowledged the workforce crisis but continues to avoid reforming the very system responsible for managing healthcare personnel.

“A Health Services Commission is not an optional administrative improvement. It is essential to modernising recruitment, deployment, remuneration, occupational safety, welfare and career progression,” Azrul said.

On financing, Galen Centre opposed allowing Employees Provident Fund (EPF) members below 55 to use Akaun Sejahtera savings for MediAsas premiums, arguing that healthcare protection should not undermine retirement security.

It also questioned affordability after the RM200 first-year premium subsidy for eligible SME employees expired, highlighting exclusions, premium increases, co-payments and remaining out-of-pocket costs.

The centre welcomed postnatal care tax relief but called for accessible public services, including maternal mental health support, breastfeeding assistance and follow-up care for lower-income mothers.

For older people, it proposed a National Aged and Long-Term Care Framework covering home-based care, community nursing, rehabilitation, respite, residential and palliative services, supported by sustainable financing.

The centre also criticised what it identified as the absence of further cigarette excise increases and a commitment to remove subsidies supporting sugar manufacturers.

Meanwhile, MMA called for greater use of private general practitioners in prevention, early detection and long-term disease management to reduce avoidable admissions.

It said the RM1.2 billion maintenance allocation remains unchanged from 2026 despite ageing facilities and growing needs, and renewed its call for a workforce distribution dashboard showing shortages at individual public facilities.

“Ultimately, the success of Budget 2027 must be measured not merely by the allocations announced, but by improvements in patient care, waiting times, workforce retention and access to healthcare,” Sivanaesan said.

• This article first appeared in The Malaysian Reserve weekly print edition

The post Healthcare gains need stronger retention, access reforms appeared first on The Malaysian Reserve.