Makmor Bin Tumin

Privatising Healthcare in Malaysia: Power, Policy and Profits

Abstract This article examines the hypothesis that interest groups are behind the increasing privatisation of healthcare services in Malaysia. The evidence supports the instrumentalist argument that powerful interest groups seeking profits, rather than real concerns for allocative efficiency, have been the prime drivers of healthcare privatisation in Malaysia . Not only have private healthcare expenditures risen more swiftly than government healthcare expenditure but, from 1982, public funds have also been used to purchase private services from public hospitals However, unlike simple class analyses, class contention manifesting through alliances between politicians, bureaucrats and capitalists has been a major force behind healthcare privatisation in Malaysia. The source of these developments can be traced to power wielded by the government to quicken the creation of a Bumiputera capitalist class that began to gain momentum from the late 1970s.

Demographic and Socioeconomic Factors Influencing Public Attitudes Toward a Presumed Consent System for Organ Donation Without and With a Priority Allocation Scheme.

Abstract The influence of demographic and socioeconomic factors on the publics attitude towards a presumed consent system (PCS) of organ donation was estimated in 2 scenarios: without and with a priority allocation scheme (PAS). Self-administered questionnaires were completed by 775 respondents. Using multiple logistic regressions, respondents’ objections to donating organs in both scenarios were estimated. In total, 63.9% of respondents would object to donating under a PCS, whereas 54.6% would object under a PCS with a PAS. Respondents with pretertiary education were more likely to object than were respondents with tertiary education, in both the first (adjusted odds ratio [AOR] = 1.615) and second (AOR = 1.728) scenarios. Young respondents were less likely to object than were middle-aged respondents, in both the first (AOR = 0.648) and second (AOR = 0.572) scenarios. Respondents with mid-ranged personal monthly income were more likely to object than were respondents with low income, in both the first (AOR = 1.994) and second (AOR = 1.519) scenarios. It does not seem that Malaysia is ready to implement a PCS. The educational level, age, and income of the broader public should be considered if a PCS, without or with a PAS, is planned for implementation in Malaysia.

Non-organ donors' attitudes toward incentives

Malaysians indicating that they did not intend to become organ donors upon their death were surveyed regarding interest in non‐fungible financial incentives to be granted to surviving family members. Among the 730 (56% of the total sample of 1311) indicating unwillingness to be donors, 29.6% (216/730) subsequently indicated that they would be willing donors if the government introduced policies that, upon their death, “rewarded your (their) family with incentives for your (their) deeds.” Among the 69% (504/730) who insisted that they would not become organ donor even with incentive, nearly 80% (404/501) of them were able to identify relevant incentives they thought should be provided by the state to those who make organ donations upon death. The majority of both groups preferred the state provide medical benefits to a surviving family member, suggesting this may be an attractive policy option for the state to raise the deceased organ donation pool.

Strategies Targeted at Motivating Unrelated Living Kidney Donation

BACKGROUND This paper aimed to assess the willingness of Malaysians with post-secondary education to be living kidney donors. MATERIAL AND METHODS From the total of 1,310 living kidney donor respondents in Kuala Lumpur and its suburbs, we focused on 688 respondents with post-secondary education. These 688 respondents were asked whether they were willing to become living kidney donors if the government provides a reasonable amount of financial incentive. Those who were not willing to be donors (490) were then asked the reasons for their unwillingness. Six options were given and respondents can choose more than 1 option. RESULTS Malaysians with post-secondary education remain unconvinced to be living donors even when provided with monetized incentives. The main reason cited was they are not convinced that individuals can live with just 1 kidney. CONCLUSIONS There is a need for the government to develop new ways to promote organ donation. These include strengthening government coordination of medical procedures and creating public awareness about the safety of living with 1 kidney. Setting up new institutions such as donor clinics, creating a living donor registry, and having independent donor advocates are also instrumental.

Factors Associated With Medical and Nursing Students' Willingness to Donate Organs.

AbstractMalaysia suffers from a chronic shortage of human organs for transplantation. Medical and nursing students (MaNS) are future health professionals and thus their attitude toward organ donation is vital for driving national donation rates. This study investigates MaNS’ willingness to donate organs upon death and the factors influencing their willingness. A cross-sectional design was used with a sample of 500 students (264 medical and 236 nursing) at the University of Malaya. A self-administrated questionnaire was used. The responses were analyzed by using descriptive statistics and multiple logistic regression. Of all respondents, 278 (55.6%) were willing to donate organs upon death, while the remaining 222 (44.4%) were unwilling to donate. Only 44 (8.8%) had donor cards. The multiple logistic regression revealed that the minorities ethnic group was more willing to donate organs than Malay respondents (adjusted odds ratio [aOR] = 1.98, P = 0.010). In addition, medical students were more willing to donate than nursing students (aOR = 2.53, P = 0.000). Respondents who have a family member with a donor card were more willing to donate than respondents who do not (aOR = 3.48, P = 0.006). MaNS who believed that their religion permits deceased donation were more willing to donate than their counterparts (aOR = 4.96, P = 0.000). Household income and sex were not significant predictors of MaNS’ willingness to donate organs upon death. MaNS have moderate willingness, but low commitment toward deceased organ donation. Strategies for improving MaNS’ attitude should better educate them on organ donation, targeting the most the Malay and nursing students, and should consider the influence of family attitude and religious permissibility on MaNS’ willingness.

Civil Society Organizations in Opposition to Healthcare Commercialization: Protecting Access for the Poor and Middle Class in Malaysia:

This article examines the role of civil society organizations (CSOs) in contesting healthcare commercialization in Malaysia. The article uses a novel framework to analyze the emergence of CSOs to protect the interests of the disadvantaged against commercialization initiatives. CSO action has expanded following the formation of social networks and election into parliament of individuals who share their views to oppose healthcare commercialization in the country. Against the odds, the evidence suggests that a significant presence of CSOs has emerged to challenge healthcare commercialization. Political changes have also given CSOs the opportunity to campaign for the protection of the interests of the disadvantaged in Malaysia’s healthcare development processes.

Muslim Women’s Marriage, Pregnancy, Abortion and Spacing of Children: Evidence from the United States, Iran and Malaysia

Background: This study investigates the decisions on marriage, pregnancy, abortion and spacing of children among Muslim women (MW) residing in the United States, Iran and Malaysia to explore the occurrences as well as socio-demographic characteristics associated with the likelihood of making an independent decision regarding sexual and reproductive health rights. Methods: A total of 1140 MW in Washington, D.C. (the United States), Tehran (Iran) and Kuala Lumpur (Malaysia) participated in this study, and the number of respondents were equally distributed across the three cities. To examine the occurrences of sexual and reproductive rights violation, we report the descriptive statistics from the responses given by MW in these cities. Results: On the decision to solemnize marriage, 84.5 per cent of MW in Malaysia reported that the marriage decision is made jointly with their husbands, but this figure stands at only 30 per cent in Iran and 47.9 per cent in the United States. More than 80 per cent and 72 per cent of MW in Malaysia and Iran, respectively, make decisions on pregnancy, abortion and spacing of children jointly with their husbands. Conclusions: Policymakers should promote jointly made (made by wife and husband together) decisions among Muslims, which accords with Islamic teachings and is considered as good practice among Muslims.

Health Issues and Challenges among Indian Urban Poor

In the last 60 years since independence, India had achieved considerable improvements in the health of its population as reflected in their life expectancies which have doubled within this period. This article aims at explaining pertinent health-care issues and challenges based on some health indicators in India by using the literature review method that involved collection of material from the online sources, which included government documents, articles and publications related to healthcare, healthcare indicators, poverty, financial burden and coping strategies. To avoid premature deaths among adults, children and maternal mortalities, greater attention should be given to prevention and treatment of non-communicable diseases, and women and other social determinants of health. More attention should also be given to the reduction of births among teenage girls in order to avoid premature morbidity and mortality. To protect the vulnerable and poor, the government should provide more resources since financial burden of curative care is higher among lower income groups. However, in poorer states, the government tends to have relatively low ability to raise their own resources and the people in these states have a lower ability to pay for private insurance. Therefore, it is worthwhile and pertinent that the government initiates social insurance.

Transport Policy in the Klang Valley, Malaysia: The Sustainability Agenda

There are many definitions of sustainable transport system, but generally it takes into account the three elements of sustainable development: the economy, the environment and the social well-being when deciding on policy that is affecting transportation activity. This paper examines the urban transport policy and its implications on sustainable transport agenda in the Klang Valley, Malaysia. The research utilizes a combination of primary and secondary data. Interview was employed to gather the primary data, while scholarly works, government documents and archival records are the instruments used for gathering the secondary data. The findings shed light on the implications of transport policy on sustainable transport agenda in the Klang Valley. The main challenge seems to be the lack of holistic measures in tackling transport issues that are in conflict with the objectives of sustainable transport. This main factor stems from a combination of several other issues such as decision-making based on short-term result that are mostly driven by economically viable alternatives, transport policies that are focused on technology and structural improvement and the lack of political will to influence development processes that could bring forward sustainable transport agenda. To achieve sustainability, transport policy in Malaysia, particularly in the Klang Valley, must include the wider systems in which transportation activity is rooted.