Healthcare as a Bottomless Pit

Abstract

As a young surgeon at the General Hospital Kuala Lumpur in the 1970s, I remember pleading with Tan Sri Majid Ismail, then Director-General of the Ministry of Health, for funding of my research project. A distinguished clinician turned policy maker, Tan Sri Majid was professionally interested in my proposal. Nonetheless he politely declined it, but not before offering me a comforting explanation. Between funding me and building a Klinik Desa (rural clinic) in Ulu Kelantan, the choice was clear, he gently told me. Besides, he assured me, I would have minimal difficulty securing funding elsewhere while those poor Kelantanese had no choice. Tan Sri Majid said something else that reverberates in me today. “Healthcare is a bottomless pit,” he advised me, “but the resources to meet those literally endless worthy needs are limited, so society must set its priorities and draw the line somewhere.” The job of government is to ensure a minimal acceptable level of care for all, he added, and beyond that it is for individuals to set their own limits with their own resources. Malaysia does this with its dual public and private healthcare systems. Tan Sri Majid was adamant in maintaining this clear separation lest there would be confusion in the respective missions and objectives.