The uberisation of healthcare in Malaysia

Muslim boys awaiting circumcision at the National Mosque

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Technology and innovation will bring medical care right to your doorstep.

Not too long from now, citizens will be able to book a house call from a doctor, the way they hail a ride. And these doctors will be able to attend to a wide range of services — from immunisation to simple operations to chemotherapy.

My vision for healthcare in Malaysia starts with the patient. We need to empower the patient and from that one objective, we have developed an entire framework. Instead of patients having to come to clinics and hospitals, we want the doctor to go to the home and provide not just basic care, but even some things that you think can only be done in the hospital now.

Technology will enable this. There have been many innovations in the past few years, but we need to create a system where all this innovation can be brought together in a coherent manner to benefit the patients, whatever economic strata they come from.

Domiciliary care, or a doctor visiting the patient at home, is not a new concept. We already have various versions of it. For instance, we send nurses to visit mothers and their newborns at home to provide post-natal care. And we have also opened up homecare to stroke patients: doctors go to their homes to follow up with them and see how they are doing.

And you may have heard of an app called Doctor2U, which aims to create an entire healthcare ecosystem built into a single app. Its core feature is a doctor house call service that brings a doctor to a customer’s door within 60 minutes.

In future, I think, patients will first go to the internet or social media to check up on their condition and only go to the doctor for a second opinion to confirm their diagnosis. In fact, today, home tests are available for dengue, HIV, Hepatitis C and even typhoid.

We are taking healthcare back to the community. We will send doctors to the patients in their homes, rather than requiring them to crowd into hospitals for tests, treatment and care.

After all, which is the best bed? It is not the hospital bed, but your own at home. Which is the best food? It is not hospital food, but the food you get at home.

In the old days, doctors used to visit their patients at home. We are just reviving that concept, and adding a layer of digital health so that the doctors are more accurate and precise in their diagnosis and treatment.

They can do a lot of investigation using gadgets that enable them to measure precise heart rates, do mobile ultrasounds and even diagnose skin conditions by taking a picture on their phone and using artificial intelligence (AI).

And when you need medicine, the doctors can do an e-prescription and the pharmacist can do e-dispensing so that the medicine will arrive at your house in three to four hours.

We have already done this at the Putrajaya Hospital. You do not come to the hospital to collect your medicine. You call and the pharmacist prepares the medicine and couriers it to you — you just pay RM6 for the convenience. For RM6, you do not need to come to the hospital or pay for petrol, parking and tolls. Who wouldn’t be willing to do that?

And now we are looking at taking this further. Can we do wound-dressing at home? What about immunisation or even chemotherapy? Why should you go to the hospital to have blood tests? I can send a medical assistant and a nurse to your home to take your blood and you pay a fee for it, say, RM10.

So far, we have been doing this for VVIPs. Now, we want to extend it to the community at large. And because of technological innovations, we will be able to.

We would like to start a service similar to Doctor2U where we have a list of doctors registered with us who can answer bookings and take house calls. We do not give them a salary. Instead, they earn based on the number of calls they take, just like Uber or Grab drivers. If they want to earn more, they just need to work harder.

By doing it this way, I do not need to provide a driver and car, and I do not have to pay for the car maintenance and petrol to send the doctor to the home. Right now, we (the Health Ministry) have to provide all that. But if you uberise the service, the doctor pays for all this him or herself.

And they won’t lose out. If they are willing to work hard and see a certain number of patients a day, they can earn good money. Say you pay them RM100 to RM200 for a house call. (If it is a poor patient, the government can subsidise this fully and if it is a middle-class patient, we can subsidise it partially). If the doctor makes RM100 to RM200 for each home visit and they go to 10 homes a day, they could make up to RM2,000 a day, which works out to RM60,000 a month. That is more than what I earn!

So the question is, would you pay RM100 for a doctor to come and treat you at home?

That is the concept we want. Of course, we will standardise everything. So the doctors who want to be part of this service will register with us and receive training just like they would if they were an Uber or Grab driver.

And the patients will rate them after a service. If they like the doctor, they can give him or her five stars and then each time they call, they can get the same doctor. In this way, they can build trust and engagement with that doctor, who then becomes their family doctor — they know you, you know them. We want to reintroduce the family doctor concept — one doctor for one family.

If they do not like the doctor, they can give him or her one-star and if that happens a lot, we will terminate that doctor. If they give the doctor three stars, we will call that doctor up and see how their service can be improved. It is all about quality assurance.

And in the app, the patient can even identify the services they want, be it wound-dressing, immunisation or even chemotherapy. We are talking about services across the board. Yes, we are serious about taking healthcare back to the community.

The next question is, can we do surgery at home? And my answer is, why not? We have been doing surgery in the community for years. After all, what is ritual circumcision, if not a type of surgery?

I recently returned from Malaysia’s field hospital in Cox Bazar, Bangladesh, which caters for the needs of Rohingya refugees. The field hospital is in the jungle and we do not even have access to clean water. But we do have innovations to overcome these challenges. So, if we can do operations in the middle of the jungle, why can’t we do them in our homes?

We want to enhance the quality of care. So we need to look into smart innovations, creating the tools that we can package together in screening, in treatment, basically, in the provision of good quality services at the community level. We want to integrate things like wearables, that is the watches that measure your blood pressure and pulse rate, and even do an ECG, throughout the day.

To make this happen, we at the Ministry of Health are working with the Malaysian Communications and Multimedia Commission and we have formed four special interest groups (SIGs).

The first SIG is a sandbox that looks at existing regulations to see what needs to be improved or amended to develop some of these ideas that I have shared.

The second SIG looks at digital health, creative ideas and innovation. If a doctor has an idea for a technology or app, he may not know what to do about it. But through this SIG, we are working with the electrical and electronics sector in Penang, which has 40 years of experience. You tell them what you want and they can do it for you.

Once you have the idea and have come up with the prototype, you need to do clinical trials. That is what SIG 3 is for: to handle research and technical support.

SIG 4 is where the investor comes in to upscale the idea into the market place. So that has to do with the business side of things.

All this is a framework. We do not go into the details. We wait for every doctor, department, clinic and hospital to fill in the blanks for us.

We have looked at the challenges patients in Malaysia face, such as congested government hospitals and the rising cost of healthcare, and we are bringing together the best and brightest to come up with affordable, intelligent solutions that will not only match the level of care a patient receives presently but better it.

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