PETALING JAYA: Rural Malaysians are still being left behind in healthcare access, with funding and services lagging far behind urban centres, said Universiti Kebangsaan Malaysia public health medicine specialist Prof Dr Sharifa Ezat Wan Puteh.
Citing the Health Ministry’s 2023 Annual Report, she said development spending on rural public health services last year was RM137.2 million, with total expenditure at RM121.3 million. In contrast, urban public health services received RM257.9 million in development allocation and spent RM246 million.
“This shows the budget for rural healthcare is more than two-times lower than in urban areas. This may be due to fewer patients, less intensive treatment and lower severity of cases in rural settings. But it also means many patients are referred later to urban facilities for specialised care, which can lead to complications.”
She warned that delays in diagnosis and treatment often result in rural patients receiving only generic drugs, particularly in complex cases such as cancer, cardiovascular disease and mental health conditions.
While cost drivers for rural and urban patients are similar – mainly non-communicable diseases (NCDs) such as diabetes, hypertension and obesity – rural families face the added burden of access.
“The only difference is that urban patients may also spend on cosmetic services such as braces, plastic surgery and aesthetic procedures.
“For rural communities, the main burden still comes from NCDs and unhealthy lifestyles such as smoking and sedentary behaviour, which are strongly linked to obesity.
“Even though primary care clinics and general practitioners are available, many are not staffed by specialists and often lack facilities such as laboratories, operating theatres, anaesthetists or even blood banks.
“Radiological services like CT scans are also scarce. As a result, patients may receive care that is not optimal, increasing the risk of complications.”
Health systems specialist Dr Khor Swee Kheng said the barriers went beyond facilities.
“There are financial and non-financial barriers to healthcare access for rural families.
“Financially, their income may be lower than urban families. Geographically, they may live further away from hospitals that have advanced technologies such as MRI (non-evasive diagnostic machines) and specialist doctors.
“Culturally, rural families may have lower health literacy and seek healthcare only in later stages of a disease when the symptoms become unbearable.
“Therefore, improving healthcare access for rural families must include financial and non-financial policies.”
The government has introduced reforms, including strengthening primary care, placing specialists in district hospitals and creating hospital cluster initiatives.
However, Sharifa believes “these efforts are still not enough and can be improved”.
Although the incidence of catastrophic health expenditure (CHE) in the general population is relatively low – between 1.13% and 8% – the rates are much higher among vulnerable groups.
CHE incidence stands at 86.5% for oral cancer patients, 54.4% for cancer patients in government institutions and 23.6% for kidney transplant recipients.
“The elderly, lower-income households, and those in rural areas are more likely to experience financial hardship from healthcare costs,” she said.
To address these gaps, Sharifa called for greater investment in primary care and prevention rather than hospital expansion.
“Improving and upgrading rural clinics will help reduce the burden of disease and prevent conditions from worsening. Social protection should go beyond healthcare to include income, education, transport and other essentials for rural communities.”
She urged the government to increase the budget allocation for primary care and preventive measures, produce a higher ratio of clinical specialists to population and improve salaries and posts for healthcare professionals, particularly in rural areas. She also said the drug acquisition and distribution for rural healthcare facilities should be strengthened.
“The health budget is good, but more needs to be done for those outside the cities,” she stressed.