The State of Our Secondary Healthcare: Part 2 by Dr Vivek Subramaniam


The Malaysian public health system follows a combination of the Beveridge and Bismarck models of healthcare financing. The Beveridge model, also known as the National Health Service (NHS) model, is a tax-funded system that provides universal coverage to all citizens and residents, with the government responsible for financing and organizing healthcare services. Countries that follow the Beveridge model include the United Kingdom, Canada, and Finland.

On the other hand, the Bismarck model, also known as the social health insurance model, relies on a combination of employer and employee contributions, private insurance, and out-of-pocket payments to fund healthcare. Countries that follow the Bismarck model include Germany, Japan, and the Netherlands.

Malaysia’s healthcare system is a combination of both models, with payment heavily subsidized by taxation and also some element of out-of-pocket, employer insurance, or private insurance.

Analysis and Statistics

According to the 2021 Malaysian budget, the financial allocation for the Ministry of Health (MOH) is 31 billion ringgit, representing 10.39% of the national budget. In terms of GDP, total healthcare expenditure in Malaysia is 4.73%. In the Malaysian Health White Paper it has been suggested to increase allocation of healthcare to 5% of GDP for next year.

In 2020, there were 146 government and special medical institutions in Malaysia, with 44,117 beds available. This is an increase from the 33,083 beds available in 2009. There were also 202 private hospitals in Malaysia in 2020, with a total of 17,371 beds, compared to 12,300 beds in 2009.

In 2020, there were 2,284,303 patients admitted to wards in public hospitals, 170,000 patients in day care wards, and 16,880,000 outpatient clinic attendances. In private hospitals, there were 916,294 admissions and 3,091,487 outpatient clinic attendances. These numbers show the importance of public hospitals in Malaysia’s healthcare system.


Despite the efforts to improve and expand the healthcare system in Malaysia, there are still several challenges facing the secondary healthcare sector. One of the major challenges is the shortage of trained healthcare providers, including doctors and nurses. This leads to overworked and overwhelmed staff, which can negatively impact the quality of care.

Another challenge is the insufficient funding for certain hospitals, which leads to inequities in access and the availability of proper equipment to provide high quality care. There is also a lack of interoperability, coordination, and integration between hospitals and primary care clinics, resulting in fragmented and inefficient care.

Overcrowding in hospitals, increased waiting times, and poor quality of service are also common issues, leading to inadequate attention for patients and a lack of patient-centered care. In addition, there is a limited emphasis on mental health care and specialized care for the elderly, despite the increasing number of patients in these categories. There is also a lack of emphasis on preventive care and poor coordination with primary care clinics on chronic disease management.

Overall, it is essential to ensure that the healthcare system in Malaysia is accessible and affordable for all, and that it provides high quality and equitable care to all patients.


In order to improve the secondary healthcare system in Malaysia, there are several recommendations that can be considered. These include a focus on promotive and preventive care, as outlined in the Malaysian Health White Paper. The use of technology can also improve integration and coordination between hospitals and primary care clinics, as well as increase accessibility and affordability.

Step-down care at home, using home monitoring to reduce hospital stays, can also be implemented. Empowering patients by giving them access to their health records or summaries can improve their understanding of their own health. Additionally, incorporating more specialized care into the primary care network can reduce the need for referrals to hospitals.

Another recommendation is to address the shortage of trained healthcare providers, such as doctors and nurses, which leads to overworked and overwhelmed staff. Increasing funding for hospitals, especially those in underserved areas, can improve access and the quality of care. Mental health care and specialized care for the elderly, both of which are increasing in demand, should also be given more emphasis.

Overall, improving the secondary healthcare system in Malaysia requires a shift towards a more person-centered, preventative approach to healthcare. By addressing the challenges and implementing these recommendations, the quality and accessibility of care can be improved for all Malaysians.


In conclusion, the state of secondary healthcare in Malaysia is facing numerous challenges, including shortages of healthcare providers, inadequate funding, and issues with access and quality of care. These challenges have led to a fragmented and inefficient healthcare system, with patients often experiencing overcrowding, long waiting times, and poor quality of service. However, there are steps that can be taken to improve the secondary healthcare system in Malaysia. By prioritizing preventive and promotive care, integrating and coordinating hospital and primary care services through the use of technology, and empowering patients to take control of their own health, it is possible to create a more efficient and effective healthcare system that better serves the needs of the Malaysian people.

“Healthcare is a human right, not a privilege. It is the duty of governments to ensure that everyone has access to the care they need, regardless of their ability to pay.” – World Health Organization (WHO)

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