Dear fellow Malaysians, 

Being in a hospital gown in an ICU reduces one to nothing but a pack of flesh and bone. 

Only in that state of complete helplessness that we realise the importance of a good healthcare system. 

This petition aims to galvanise all Malaysians to change the outdated Akta Fi 1951 by revising registration fees at major government hospitals from RM1 to RM10 for the sustainability of the public healthcare system.

Before protesting that this marks another increase in costs of living, I beg you hear me out first.

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I used to think that having medical insurance would protect us from nasty surprises when an unexpected emergency strikes.

To avoid long waiting times and insufficient healthcare professionals at public hospitals, our insurance medical cards provided assurance of access to healthcare at any private hospital.

This could be true in some cases, but not for someone with multiple comorbidities, typically the triple trio of diabetes, hypertension and heart disease. 

When my diabetic husband had a heart attack and multiple organ failure following a string of foot amputations last year, we hit the limit of our insurance coverage and was transferred to a government hospital. 

It was a blessing in disguise.

He spent 3 weeks in ICU and multiple procedures including another surgery on the leg, all of which would have cost us a princely six-figure sum at a private hospital. 

Upon his demise, imagine our surprise when we saw the bill was ZERO. Fully paid by the government of Malaysia. 

It struck me how fortunate Malaysians are to have top-notch facilities and truly dedicated healthcare professionals at public healthcare facilities. 

We were the lucky ones. 

Too many other Malaysians were forced to use private hospitals when public hospitals run out of beds, raking up medical bills that result in distressing family disputes.

We’re also fortunate to be located just 12 kms from an over 1000-bedded hospital offering secondary and tertiary services, which is also a centre of excellence for several specialities. 

Not everyone is as lucky – people in remote areas who travel 8 hours to the nearest hospital, people who need immediate care but hospital beds are full or wait three days for an ICU bed. 

Clearly something needs to be done so that this ‘luck’ does not run out. 

Trouble brewing 

In the recent months, the media has been awash with reports of medical professionals leaving government service. Key reasons cited were low remuneration and poor working conditions such as lack of career progression. One key underlying reason is insufficient budget, leading to healthcare workers being overworked and underpaid. 

The recently mooted Rakan KKM offers hope for some of these issues to be resolved, with moderate fees that are lower than private hospitals and within range of the average Malaysian’s insurance coverage. This will help MOH boost its financial resources and resolve issues of brain drain among healthcare professionals. 

While we await its roll-out and maturity, it would be pertinent to explore other future-proof options to guarantee the financial sustainability of Malaysia’s public healthcare. 

Taken for granted

The Akta Fi, first released in 1951 and revised in 2017, comprises a comprehensive list of public healthcare fees for inpatient and outpatient treatments. 

This Act provides assurance to patients and families of Universal Health Coverage (UHC), where everyone can access public healthcare services nationwide. The miniscule fees charged, however, has caused Malaysians to take healthcare for granted. Consider these:

1)    Poor adherence to treatment and medication. 

This results in poor treatment outcomes, which increases burden of disease. As medicines are given free of charge, their value goes unappreciated.

The MyMediSAFE programme which encourages safe disposal of medicines saw an alarmingly high number of medicines being disposed (some still unopened!), including costly medications such as insulin, biologics, even innovative cancer medicines. Public health events where returned medicines are collected have recorded medicine value up to RM40,000 in a single day.

Paying a nominal fee motivates patients towards a sense of shared responsibility for their own health.

2)    Changed social economic status 

In Dec 2024, the Khazanah Research Institute (KRI) reclassified household income categories to Bottom 20 per cent (B20), Middle 50 per cent (M50) and Top 30 per cent (T30). 

While general inflation impacts spending power, increasing registration fees to RM10 would make little difference in their monthly expenses. The level of affordability is linked to the affordability of travel and lifestyle options. This has even resulted in increased incidences of patient/parent abandonment during major public holidays at public hospitals while families go for holidays or balik kampung. 

3)    Ageing population and rising NCDs

The 2024 National Health & Morbidity Study bears alarming statistics of the prevalence of diabetes, hypertension, heart disease and obesity. 

Without strategic planning for a robust public healthcare system, the country is at risk of being crushed by increasing healthcare burden when Malaysia achieves aged society status in 2030.

4)    Pandemic preparedness

The COVID-19 pandemic bore evidence that the country’s healthcare system cannot withstand another public health crisis. Strengthening our public healthcare system via a reasonable increase in registration fees will help lay the foundation for future medical emergencies. 

5)    Politician-agnostic 

Increasing the registration fees empowers Malaysians to share the financial load of the healthcare system, so that it can continue providing Universal Health Coverage (UHC) to more, if not all, Malaysians, regardless of changes in government of the day. 

Here is a rough math, based on Admissions at Public Health Facilities in Health Facts published by MOH:

RM5 per visit; B40 maintained at RM1

Revenue: RM2.6 billion (5.7% of MOH allocation in 2025 Budget)

 

RM10 per visit; B40 maintained at RM1

Revenue: 5.1 billion (11.2% of MOH allocation in 2025 Budget)

 

We have heard and seen enough about the public healthcare system to know this cannot wait another day. 

Join me on the #DemiMalaysiaSihat campaign to bring this to the attention to the powers that be!