Health crisis in Southeast Asia

The number of patients coming to the hospital doubled every day, causing her and her colleagues to work hard.

“The number of patients increased, so did the cost of living, but my salary remained the same while the pressure of work was heavy. This is not an ideal place to work,” Fah said.

She said recruiting more manpower is not feasible. Newly graduated nurses quit their jobs after a few short years because they found equivalent positions with higher salaries in private hospitals.

Fah’s story is not uncommon, it reflects the broader health crisis in Southeast Asia. The region struggles with an aging population and persistent consequences from the pandemic. The public hospital system is under pressure from treatment delays and increasing patient demand.

Health inequality

Wealthy patients will go to private hospitals, or pay more to be given priority for early examination at public facilities. This raises concerns that privatization is gradually creeping in, while state facilities are overloaded and lack funds to maintain operations. The consequences of this situation weigh heavily on poor people – those who are struggling to make a living.

Across Southeast Asia, Ministries of Health repeat a familiar refrain: “Protecting the health care system is an urgent need for the future, as countries face increasing challenges.” Clinics, private hospitals, and insurance companies are ready to take advantage of this golden opportunity.

According to a recent report by DKSH Healthcare Group and market analysis company FrontierView, healthcare spending in the region is expected to increase by 68% in the next five years, a figure far exceeding that of most developed markets. developed and developing.

Bijay Singh, head of global business at DKSH Healthcare, said budget constraints are “impeding quality healthcare services”.

This condition makes treatment options for children of human parents Malaysia like Mila Aziz the more narrow. Even though she lives near a government public hospital, she still has to take her 11-year-old son, who has autism, to be examined at a private hospital. She said that if examined at a public hospital, her child would have to wait 6 to 12 months.

In rural areas or on the outskirts of the capital, patient waiting times are even longer. Cardiovascular disease, cancer and women’s health screening services are concentrated in urban areas such as Kuala Lumpur, creating a significant gap in healthcare.

The Malaysian state of Pahang has an area similar to Taiwan, but the terrain is mountainous and densely forested. A doctor at a public hospital recounted that his female cancer patient could not receive radiotherapy because he could not afford the trip to Kuala Lumpur, 600 km away.

“Hospitals in Kuantan (the capital of Pahang state) only provide chemotherapy. Patients who want radiotherapy have to go to Kuala Lumpur. This patient just had surgery, only has enough money to go to the doctor every three months and cannot What else can we do?” the anonymous doctor recounted.

According to the 2024 report of the Malaysian Journal of Medical Sciences, the country trains more than 800 medical professionals annually, but mainly concentrated in urban areas. Rural patients have severely limited access to medical services.

In addition, Malaysian patients must pay part of their medical expenses themselves before insurance takes effect. This raises concerns that the era of free, effective public health care in Malaysia may be coming to an end. Meanwhile, people’s needs are increasing.

Healthcare challenges are most acute for densely populated countries, where demand overwhelms supply. With a large area of ​​islands and archipelagos, Indonesia faces the daunting task of closing the healthcare gap for 275 million citizens. Large disparities, high non-insurance spending, and rising rates of tuberculosis and maternal mortality have brought the health system to the brink of crisis by 2024.

Before the pandemic, Indonesia allocated 113.6 trillion rupiah (7.3 billion USD) for health. This number jumped to 312.4 trillion rupiah during the peak of the pandemic in 2021, falling to 188.1 trillion in 2022. This year, the proposed health budget is 187, 5 trillion.

In this context, access to healthcare becomes a mirror of money and status. Observers warn the health care system could erode and decentralize. In particular, hospitals with few resources, with low-paid medical staff, struggle to meet the needs of people from disadvantaged classes in society.

Malaysian doctors spoke up about the same issue. They are concerned that the dilapidated hospital with leaky roofs will affect the quality of patient care.

At a public hospital in northern Malaysia, doctors had to use plastic bags to store patient samples due to lack of funding. They reuse disposable supplies as a way to manage difficult situations.

“All public hospitals here do that,” one person said.

Struggling to maintain public health insurance

For decades, universal health care has been the foundation of Southeast Asia’s social security.

In Thailand, the pioneering “30 Baht Insurance” program launched in 2002 promises to help the most disadvantaged people access medical services at affordable prices (less than 1 USD). However, as demand skyrockets, the government faces pressure to maintain the initiative over the long term.

Indonesia has the largest population in the region, but the number of doctors per capita is low. In 2014, the country launched a national health insurance program. Five years later, officials enacted a universal health care law.

However, tens of millions of people in both countries still struggle with social security, leaving health care budgets in a precarious state.

Malaysia currently maintains a nominal fee of one ringgit (23 cents) for a visit to a public hospital. However, due to concerns about medical cost inflation, Central Bank Malaysia is about to issue a co-payment plan in medical and health insurance products. Experts worry that this poses risks to poor people’s ability to access and pay. This is a burden for many families, especially those struggling with high living costs.

“Such additional costs may discourage individuals from seeking necessary medical care, potentially leading to worsened health outcomes and higher long-term costs,” said Dr. Muhammad Yassin Ikbaal, International Islamic University Malaysia (IIUM), said.