Malaysia: Growth of Private Health and Social Sector



Malaysia’s private healthcare and social work services sector has been growing by leaps and bounds, the Department of Statistics 2016 Economic Census revealed.
The country has some 14,930 private establishments providing general and specialised medical services, dental services, hospital services, dialysis centres, child day-care, residential care and maternity homes among others, in 2015.
These establishments contributed RM16.8bil to Malaysia’s economy in 2015, compared to RM10.4bil from 9,152 such establishments in 2010.
Some 121,088 people were employed in this sector in 2015, out of which 88.5% are full-time employees, 2.2% are paid part-time employees while the remaining 9.3% are owners or unpaid family workers.
Female workers outnumbered male wor­kers in all qualifications, except at the post-graduate level where more men (5,000) were employed than women (2,874). 
Most health and social workers possessed at least an SPM or SPM (V) certificate (26.5%), diploma qualification (28.7%) or advanced diploma or Bachelor’s degree (23.8%). Only 2.6% or 3,222 of the workers had below SPM or SPM (V) qualification.
Overall the workers took home RM3.68bil in salaries and wages in 2015, compared to RM2.1bil in 2010.
Employees in private hospital services topped the salary list at RM1.84bil in 2015, followed by employees in general medical services at RM737mil and specialised medical services at RM300.6mil.
The average monthly salary in the private health and social work services sector in 2015 was RM2,795.
Employees serving in specialised medical services recorded the highest average monthly salary at RM3,352, followed by hospital services at RM3,317 and medical laboratories at RM3,065.
Selangor has the highest number of esta­blishments providing health and social work services at 3,883, followed by Kuala Lumpur at 2,299 and Johor at 1,713 in 2015.
Women-owned establishments in this sector also increased from 3,122 in 2010 to 4,699 in 2015.
The highest increase in the number of women-owned outfits between 2010 and 2015 was recorded in child day-care activities (784), other human health services (172) and residential care activities (138).
theSTAR 19-10-2017

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Hovid Bhd: Privatisation



Major shareholder David Ho Sue San, working with private equity (PE) firm TAEL Two Partners Ltd, have made a general offer for Hovid shares at 38 sen apiece in a bid to take the company private.

The exercise sees a special vehicle called Fajar Astoria Sdn Bhd, set up by TAEL to undertake the offer with Ho. TAEL is part of the TAEL Partners group, established in 2007 as a South East Asian-centric PE firm.

The takeover offer will also involve Ho and Fajar Astoria buying up the group’s outstanding five-year warrants at 20 sen per warrant.

Based on Hovid’s announcement on Monday, Ho, who is also the chairman and managing director, holds a 33.72% stake or 276.80 million shares and 43.57% or 140.39 million warrants in Hovid.

The offerors are proposing to buy 181.84 million units of the outstanding warrants, which represents about 56.43% of the total warrants.The warrants expire on June 5, 2018 and have an exercise price of RM0.18 per warrant.

Going back to the buyout offer, the condition of 90% acceptances means this: Ho will need acceptances of 90% of the 66.28% of Hovid shares he does not own. This translates into a total of 59% holding of the company (which works to around 484 million Hovid shares) accepting Ho’s offer.

Hence the takeover offer will fail, if Ho does not achieve this level of acceptances. However, it is interesting to note that the offerors have also stated that they reserve the right to review the level of acceptance to less than the 90% level. It will be interesting to see if they lower the condition at some point during the life of the offer.

Ho, a pharmacy graduate, is also the founder of Hovid. He took over his father’s herbal tea business. The business flourished until he bought over a building in Ipoh and named it Ho Yan Hor Medical Hall. This was later renamed as Ho Yan Hor Sdn Bhd and today it is known as Hovid Bhd.

Aside from generic drugs and dietary supplements under its own Hovid brandname, the company also does contract manufacturing for other drugmakers. About 95% of its revenue is said to be derived from the Hovid brand name.

He later founded another company called Carotech Bhd, which went public on Bursa Malaysia’s Mesdaq market, now known as ACE Market, in 2005.

The Ipoh-based Carotech specialised in extracting tocotrienol (vitamin E) from crude palm oil and became well-known globally, conquering about 80% of global palm vitamen E market share. But Carotech’s fortunes dwindled and was delisted on May 11, 2012 for failing to submit its regularisation plan to Bursa Securities for approval within the stipulated time.

A series of events took place after this where Ho and other directors at Carotech and Hovid were publicly reprimanded by the authorities for breaching listing requirements with regard to both companies’ financial results.

So why does Ho want to privatise Hovid? The offerors did not indicate the rationale for the privatisation.

Nevertheless, it is pertinent to note that Hovid had slipped into the red in financial year ended June 30, 2017 (FY17).

The company posted a net loss of RM1.53mil from net profit of RM17.9mil, against a 10% drop in revenue at RM169.94mil from RM189.03mil. It has RM15.9mil in cash, with debt of RM65.6mil as at June 30, 2017.

The earnings, according to Hovid, was dragged by the disruption in manufacturing activities arising from the revocation of its manufacturing licences of two plants. This subsequently affected its sales volume and led to higher operating costs from improvements on quality systems and production processes.

Hovid’s manufacturing licences of two plants were revoked after an audit by the National Pharmaceutical Regulatory Agency (NPRA) revealed that its Pharmaceutical Quality System were not in compliance with the latest Good Manufacturing Practice. The revocation of licence was linked to Hovid recalling its hypertension pills, Ternolol 50mg on Jan 5, which triggered the audit by the NPRA.

Hovid’s earnings before interest, tax, depreciation and amortisation (Ebitda) margin also suffered for the fourth quarter FY17, shrinking to a mere 4.2%, from fourth quarter of FY16’s 13.5%.

The company managed to obtain the license for its Chemor plant in May, but the other plant requires some physical changes, according to reports.

At the current share price of 36 sen, just two sen short of the offer price, Hovid is trading at a forward price-to-earnings ratio of 21.18 times.

Hovid’s 52-week high of 38 sen was about a year ago on Oct 14, 2016, while its 52-week low was on Jan 10, 2017 at 24 sen. However, its highest was last seen on April 21, 2015 at 53.7 sen. The stock has risen 16.13% from Oct 3rd’s 31 sen, before Hovid’s privatisation announcement.

In terms of assets, Hovid has about 16 properties and land worth some RM33mil, with the bulk last valued in June 2016. Of these, the ones valued the most include its Chemor plant and research and development centre worth RM27.15mil, a RM13.22mil pharmaceutical factory and office building in Ipoh and seven parcels of vacant land also in Ipoh worth RM11.5mil.

A month ago, CIMB Research maintained its “hold” rating on the stock, with a higher sum-of-parts based target price of 34 sen. The house cut its FY18-19 estimates by 16.3%-27.6% to account for lower production volume and further delays in the Chemor plant extension. The research house said Hovid was facing labour shortages that resulted in its less than optimal production volume.


theSTAR/14-10-2017

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Hep C: Time bomb - only about 10% of carriers identified



Only about 1in 10 Malaysians who carry the Hepatitis C virus (HCV) has been diagnosed with the potentially fatal liver disease.


“The diagnosed cases are only the tip of the iceberg,” said Prof Dr Rosmawati Mohamed, hepatologist at University Malaya Medical Centre (UMMC). 

She said that worldwide, only about 15% of HCV cases are diagnosed, compared with 10% in Malaysia. 

The majority of cases go undiagnosed because of the asymptomatic nature of the disease, where symptoms do not show themselves, she said at the launch of the At the Edge of a Miracle: The Hepatitis C Epidemic in Malaysia report on Thursday.
  




The report by the Malaysian Aids Council (MAC) was launched in conjunction with World Hepatitis Day which falls on July 28 every year.  

It is estimated that 435,000 to 500,000 Malaysians carry the virus, a number derived by MAC’s modelling of data provided by the Ministry of Health.  

MAC honorary secretary Hisham Hussein said the prevalence of HCV among those who inject drugs was estimated at 50% to 67%. 

“Given the overlapping modes of transmission, HIV-HCV co-infection – particularly among those who inject drugs – is a significant public health concern,” he said.  

He said that a study in 2009 conducted among 552 drug users, who were not undergoing treatment, found that 65.4% of them had HCV.  Out of those, about 40% of them were also diagnosed with HIV.  

According to the World Health Organisation, a significant number of those chronically infected will also develop liver cancer.


/theSTAR 27-07-2017
 
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Hepatitis C: Generic licensing agreement to Malaysia



More Hepatitis C patients will soon be able to afford treatment..

Gilead Science, an American research-based biopharmaceutical company, announced its decision on August 24, 2017 to expand its HIV and Hepatitis C generic licensing agreement to Malaysia, Thailand, Ukraine and Belarus.

Hailing the development, local think-tank Galen Centre for Health and Social Policy said it would be a “game changer” in the fight against Hepatitis C in the country.

Its chief executive officer Azrul Mohd Khalib said more than 400,000 Malaysians between 15 and 60 years old are currently estimated to be living with Hepatitis C.





“With Hepatitis C treatment currently costing as much as US$30,000 (RM128,115) per person, this granting of a Sofosbuvir voluntary licence by Gilead Sciences will mean that it will be possible for lower-cost generic versions of this life-saving drug to be made available in Malaysia. It will allow for the drug to be used in combination with others. Most importantly, it will be possible for thousands of lives to be treated and cured of this disease,” he said.

Sofosbuvir is the innovator drug owned by Gilead Sciences.

Azrul also hoped that with access to the drug, the Health Ministry would be in a better position to work together with non-governmental organisations, patient groups and the pharmaceutical sector towards achieving its goal of ensuring that those in need of Hepatitis C treatment “can get it and afford to do so”.

Previously, The Star reported that it may cost up to RM300,000 for patients to have a full course of treatment. This was because Malaysia was not given special pricing for the drugs by pharmaceutical companies as it is considered as a middle-income nation.

In July, the Health Ministry acknowledged that the treatment for Hepatitis C is very expensive and it was collaborating with other partners to find an affordable cure. It was previously reported that the Health Ministry has teamed up with the Drugs for Neglected Diseases Institute to come up with an affordable cure.
/theSTAR 05-09-2017

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Medical and Dental Clinics - Numbers



The closure of over 600 private general and dental clinics in Malaysia since 2014 is not solely due to lack of business or poor reception from the public, the Health Ministry said.

Deputy Minister Datuk Seri Dr Hilmi Yahaya said only 78 of 9,155 registered clinics and three of 2,435 dental clinics had shut down due to economic reasons.

Between 2014 and June 2017, 643 private general clinics and 139 dental clinics have been deregistered.

However, 1,289 new private general clinics and 527 dental clinics were registered in the same period, so this means there was no issue of too few private clinics.

As per the law, registered private clinics must apply to the Ministry if they wish to deregister, and must also state the reason for the application.

Dr Hilmi said 39.5% of private general clinics and 53.3% of dental clinics which applied for deregistration said they were changing the location of their premises.

/theSTAR 10-08-2017

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CCM: "De-gear" & Demerge



Chemical Company of Malaysia Bhd’s (CCM) defended the company’s demerger exercise as one that will not result in any losses to shareholders.

CCM group managing director Leonard Ariff Abdul Shatar acknowledged that it would take time for the market to digest the recently announced corporate exercise to de-gear and demerge from its profit-making pharmaceutical unit CCM Duopharma Biotech Bhd.

“We believe it will take time for the market to fully comprehend the corporate exercise because it involves a lot of moving parts. But our message is, shareholders will not lose out,” he said.

However, CCM’s shares fell 12 sen, or 7.1%, yesterday to close at RM1.57, effectively wiping out RM54.5mil from the company’s market capitalisation. CCM Duopharma’s shares, on the other hand, closed unchanged at RM2.11 yesterday.





A dealer reckoned that some shareholders did not like the dilutive aspect of the deal, as it involves a placement exercise. Others, the dealer said, could be selling on a knee-jerk reaction to the share consolidation element in the proposal.

Leonard Ariff pointed out that under the demerger exercise, entitled CCM shareholders – institutional and retail – would effectively get CCM Duopharma shares for free. The subsequent exercise to consolidate CCM shares from three to one, on the other hand, would ensure that the value of the company’s share remains intact.

“For investors who buy into CCM before the close of our book-building exercise, they will be getting CCM Duopharma’s shares for free,” he said.

On that note, he pointed out that shareholders who had previously bought into CCM for “cheaper” exposure to CCM Duopharma would now benefit through direct shareholding in the latter. “This means the dividend from CCM Duopharma will flow directly to them post-demerger without dilution through CCM,” Leonard Ariff said.

“The exercise to subsequently consolidate CCM shares from three to one is to ensure that they don’t lose any value, as the shares will effectively be based on the net asset of the reduced size of the company following the demerger exercise,” he added.

At present, Permodalan Nasional Bhd (PNB) owns about 70% of CCM, which, in turn, has a 73.4% stake in CCM Duopharma.

The proposed demerger announced on Wednesday would see CCM distribute its entire 73.4% stake in CCM Duopharma to its shareholders.This exercise would also involve a capital reduction in CCM’s share capital by about RM462.9mil. CCM announced that it would consolidate its shares on the basis of three to one. This exercise is expected to be completed by January 2018.

In addition, CCM also announced a de-gearing initiative, involving a plan to raise up to RM257.6mil through a private placement of up to 10% of its share capital and the disposal of three parcels of land measuring 70.93 acres in Shah Alam, Selangor. The proposed disposal of the Shah Alam land was deemed a divestment from its non-core assets.

According to Leonard Ariff, CCM expects to raise another gross proceeds of around RM65mil from the sale of its two other identified non-core assets, namely, the Nilai Industrial Land and the group’s 8.45% equity stake in Korea-listed PanGen Biotech Inc.

He said the imminent sale of the Nilai Industrial Land, which could raise about RM20mil based on the current book value, would be conducted through a tender process. Further announcements on the sale would be made by year-end.

As for the proposed sale of CCM’s stake in PanGen, which could raise about RM45mil, Leonard Ariff conceded that while the group had yet to identify a potential buyer, a deal could be concluded by next year.

He pointed out that the sale of the company’s non-core assets is part of a continuous de-gearing exercise to strengthen the group’s balance sheet.

“We will continue to divest from our non-core assets, which we define as those that do not give us revenue of income or dividends, until we achieve a healthy gearing... in absolute terms, our target is to reduce our total loans down to around RM100mil from the current level of RM440mil,” he added.

Under the proposed corporate exercise announced on Wednesday, CCM would undertake a private placement of up to 10% of its issued share capital and dispose of its three parcels of leasehold land measuring up to 70.93 acres in Shah Alam, Selangor, as part of a de-gearing exercise.

Leonard Ariff said CCM’s de-gearing exercise would result in substantial savings for the company.

“At present, we pay RM21mil annually in interest costs to service our debts; post de-gearing exercise, our interest costs would only be a quarter of that,” he pointed out.

CCM’s proposed private placement, which is scheduled to complete in October this year, is expected to raise up to RM67.6mil, while the disposal of land in Shah Alam, which is scheduled to complete in March 2018, to an independent third party would be at a cash consideration of RM190mil.The total proceeds from the fund-raising exercise and land sale would mainly be used to repay CCM’s borrowings.

Meanwhile, CCM’s proposal to distribute its entire 73.4% stake in CCM Duopharma to its shareholders - a move that would result in the demerger of the two companies – would allow the group to focus on managing the growth of its chemical products and polymer coating businesses. The exercise would benefit CCM’s shareholders by enabling them to participate directly in the equity of CCM Duopharma at no cost.

“The initiatives are a continuation of our strategic review which commenced in 2015 to house all of our pharmaceutical businesses under the CCM Duopharma umbrella, to exit from non-performing business segments, and strengthen our balance sheet to enable ample agility to pursue our capital expansion and a sustainable growth strategy for the future,” Leonard Ariff said.

“The proposed initiatives will lighten the balance sheet for CCM and give shareholders direct ownership in both CCM and CCM Duopharma, and participate directly in the growth of the two separate entities. It is expected that the restructuring will enable us to utilise our resources more effectively and efficiently, and promote strong growth for our chemicals and polymer businesses. It is part of CCM’s continuous effort to strive towards sustainability and achieve optimum development in moving forward and growing within a competitive business environment,” he added. 

/theSTAR 04-08-2017

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KPJ: To Expand locally before going Abroad



KPJ Healthcare Bhd will cap future dividend payouts at maximum of RM 80mil of its net profit to allocate more cash for the repayment of its borrowings, executive director Aminudin Dawam said.

“Our dividend payouts have always been around 40%-50% of net profits, so our Board has advised us to put a cap in absolute terms of up to RM 80mil payout,” Aminudin said on the sidelines of the Invest Malaysia conference.

“Now we are paying about RM 70mil to RM 80mil a year and we will continue with this.“If our net profit is more than this, then it will still be capped at up to RM 80mil and the excess profit, which we are confident of growing, will be used to offset our debt,” he added.

The largest public-listed hospital group by bed-count in Malaysia said the employment of a high gearing strategy is to help it to grow further.

“This is how we expand and we have done this before. There have been some lean years too. For the last seven to eight years, dividends have been around 50% although there is no formal dividend policy by the company,” its general manager of investor relations Khairul Annuar Azizi said.

KPJ also plans to spend some RM 1.4bil in capital expenditure (CAPEX) within the next five years to increase its bed-count from 3,000 now.

“Our plan is to add another seven hospitals and these will add another 1,000 beds to the group. Meanwhile, some of our existing hospitals will expand their capacity and this will add another 500 beds,” Aminudin said.

The seven new hospitals will be located in Perlis, Johor, Sarawak, Negri Sembilan and Selangor.

“We are in the midst of an aggressive expansion in Malaysia and we don’t want to overstretch ourselves (abroad) at the moment,” he said.

Overseas expansion, if any, would be through brownfield acquisitions, with Indonesia being the main target market.

Total capex allocated for this year is RM350mil, he added.

On the weak ringgit, he said KPJ had to pass on the additional costs arising from higher prices of imported equipment to its patients.

“As a private profit-generating company, we have to do this but we also have economies of scale, so this amount is controlled. We are doing our best to be more efficient in other areas – in how we do business and in other processes,” he added.

/theSTAR 27-07-2017


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Patients moving to Public Hospitals



Private hospitals have seen about a 30% drop in the number of patients as they turn to the already over-stretched public hospitals, said Association of Private Hospitals of Malaysia (APHM) president Datuk Dr Jacob Thomas.
He said patients turned to public hospitals as there was no GST and treatment was almost free, making them an affordable and attractive alternative.
Dr Jacob urged the Health Ministry to collaborate with the private sector since patients faced long waiting times for MRIs, and CT and PET Scans, while most private hospitals had excess capacity.
“We understand that 25% of patients seen in public hospitals have access to private healthcare insurance. We can manage them in our private hospitals,” he said.
He added that some hospitals offered the ministry the services at reduced prices.
Health Minister Datuk Seri Dr S. Subramaniam said that when patients were unable to afford private hospitals, they fell back on public hospitals.
“Because of the co-existence, the issue of affordability to a great extent, has been met although there are challenges,” he said.
“For the long term, the ministry is formulating voluntary health insurance”, he said.
Previously, Dr Subramaniam said that the scheme was voluntary and aimed at ensuring that the cost of private medical treatment in the country was reasonable and affordable.
/theSTAR 27-07-2017
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Infectious Diseases on the Rise



Every year, more people die of tuberculosis (TB) than from dengue and HIV-related complications.

There were 1,945 TB deaths from 25,739 cases last year, a 14.7% increase over 1,696 deaths from 24,220 cases in 2015, according to the Health Ministry.

In comparison, there were 237 dengue fever deaths from 101,357 cases last year and 336 deaths from 120,836 cases in 2015.























Malaysian health authorities are now concerned because infectious diseases such as TB, leptospirosis and rabies, which the country managed to successfully curb in the past, are making a comeback, said former Institute of Respiratory Medicine director Datuk Dr Abdul Razak Muttalif.





TB is responsible for the most deaths among all infectious diseases reported in Malaysia, he added.

Malaysia managed to bring down TB cases from more than 30,000 in 1960 to fewer than 6,000 cases in the mid-1980s but Dr Abdul Razak said the cases gradually increased again from the mid-1990s.


It was initially fuelled by the increasing number of HIV cases (from weakened immune systems) and a little by migrant workers in the late 1990s, he said.

Dr Abdul Razak said one factor contributing to the high numbers currently was the delay in diagnosis and treatment, resulting in the disease spreading.

One reason for the late diagnosis could be traced to patients seeing doctors for coughs in clinics.
Without laboratory facilities, some doctors did not get a chest X-ray done to detect it early, he added.

Other groups could pick up TB because of risk factors such as those with diabetes and HIV, as well as prisoners, drug users and migrants. Dr Abdul Razak said Malaysia was detecting more cases also because more people were being screened.

Meanwhile, leptospirosis, commonly known as rat urine disease, remains a concern in Malaysia, as the number of cases has steadily increased from 2,268 in 2011 to 8,291 in 2015, although the figure dropped last year to 5,284. Statistics show that in 2011, 55 people died of the disease, 78 in 2015, and 52 last year.

Universiti Putra Malaysia professor of veterinary bacteriology Datuk Dr Abdul Rani Bahaman said it was not easy to diagnose leptospirosis as there were more than 40 serovars, or strains of Leptospira bacteria and more are expected to be discovered.

Leptospirosis could easily be misdiagnosed because its symptoms are similar to those of malaria, influenza and dengue. They include headache, diarrhoea, body ache, muscle pain and jaundice, which can cause it to be mistaken for these viral diseases, Dr Abdul Rani said.

However, those returning from jungle trips or recreational areas with high fever should be screened for leptospirosis and treated with antibiotics as a treatment or preventive measure before the infection becomes critical, he added.

Encouragingly, statistics showed that leprosy – which spreads through inhaled droplets of moisture – is on the decline. There were 206 new cases last year, compared to 210 in 2015. In 2012, there were 325 new cases.

 /theSTAR19-07-2017

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Towards Medicine Prices Disclosure and Standardisation



The Health Ministry will hold a meeting with the National Pharmaceutical Regulatory Agency and the Pharmaceutical Industry players to discuss the implementation of price-listing medicines before the proposal is tabled in Parliament.

Minister Datuk Seri Dr S. Subramaniam said the prices of medicines, which varied in different hospitals and places, needed to be standardised in order for them to be disclosed.

“We want patients to have access to medicines at reasonable cost and it should be standardised,” he said.

Dr Subramaniam was commenting on the front page report on Sunday Star that the Government was proposing to compel pharmaceutical companies to declare the prices of medicines to the Health Ministry.

The move is still at an early stage, but is in line with the Ministry’s plan to compel medicine price disclosure under a proposed amendment to the Sale of Drugs Act.

Noting that the meeting would be held soon, Dr Subramaniam said the Ministry’s concern was to en­­sure affordable medicines for Malay­­sians.

“Although it is a suggestion, we are going to sit down, address the issue and work out a mechanism to do this. The Ministry, the Agency and Industry players will discuss the implications of the implementation to make sure it is done in a way that is acceptable. At the end of the day, it is very important that those who will benefit from this are the patients,” he added.

Asked when the proposal would be brought to Parliament, Dr Subramaniam said this would happen only when all those concerned reached a common understanding.
/theSTAR 19-06-2017

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Changes to Professional Medical Practices: July 2017



Doctors must have indemnity insurance and attend continuing education courses if they wish to renew their Annual Practising Certificate (APC) from now on.

Health Minister Datuk Seri Dr S. Subramaniam said the change from automatically renewing APCs was to ensure patients’ safety, and to see that doctors continually update their knowledge and skills.
He said ample time would be given to comply with the conditions to be imposed on all renewals from Jan 1, 2019.

According to the ministry yesterday, 41,101 APCs have been issued in total, of which 27,417 are in the public sector and 13,684 in the private sector.

Asked if making professional indemnity coverage mandatory would raise the cost of medical care, Dr Subramaniam said it was a negligible cost for doctors as many already have such insurance, especially specialists in hospitals, while doctors in the public sector were already covered by the Government.

“A lot of litigation has been coming lately. The sum involved is phenomenally huge in such lawsuits,” Dr Subramaniam said, adding that it was in the doctor’s best interest to be covered.

These are among several changes made to the Medical (Amendment) Act 2012 and Medical Regulations 2017, which will come into force today, 1st July 2017.

Under the new rules, specialists would also have to register with the Malaysian Medical Council (MMC) to be recognised as such, in 20 fields of medicine including paediatrics, neurosurgery and psychiatry.

Specialists have until December to register, though those already recognised by the MMC would automatically be placed in the National Specialist Register.

Dr Subramaniam said the MMC would work closely with the Academy of Medicine and specialists fraternity in establishing standards, while the Medical Regulations 2017 provides for the setting up of a Medical Education Committee which will identify the institutions and qualifications to be recognised.

The third change was to corporatise the MMC, giving it more autonomy in managing its secretariat and funding.

Dr Subramaniam said the MMC’s daily activities would be managed by a chief executive officer, supported by a secretariat that would be able to hire its own employees and generate funding from services rendered to the medical community, in addition to receiving government funds.

MMC secretary Datuk Dr Azmi Shapie told The Star that the secretariat would now be made up of 17 elected members, nine appointed members from public and private medical schools, and three representatives each from private and public centres, all led by its president, the Health Director General.

The change to a corporate entity would also amend certain job titles, with Dr Azmi’s position now becoming CEO.

Asked how many specialists were not registered, he said most already were, with 9,898 listed on the National Specialist Register. “It’s very important to register. Patients will be able to check online that you’re legitimate. This would also ensure only those with recognised training can practise as specialists,” he said, adding that registration costs RM1,500 and was valid for five years, with renewal for a similar period costing the same.

Dr Azmi also added that doctors who were not recognised and not registered as spe­cialists would be considered general practitioners.

/theSTAR 01-07-2017

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Malaysia: Towards an Ageing Nation



Statistics show that Malaysia is marching towards an ageing nation.

An ageing society is defined as having a minimum 7% of its population aged 65 and older, while an aged nation has 14% or more in that age group.

The United Nations Economic and Social Commission for Asia and the Pacific’s 2016 population data sheet shows that as of last year, Malaysians aged 60 and above comprise 9.5% of the population.
This is projected to increase to 14.4% in 13 years’ time and nearly a quarter of the population (23.5%) by 2050.

Malaysia’s march towards this milestone is an accelerated one. Most developed nations took almost a century to reach this mark.

France, for example, took 115 years to move from being an ageing society to an aged one. For Malaysia, it should take us just 25 years.

In effect, such numbers reflect one of Malaysia’s success stories – healthcare.

It has been 60 years since independence and during that time, Malaysia managed to increase the lifespan by about 20 years.

Improvements in primary public healthcare such as sanitation, food safety and protection against infectious diseases via vaccination have all contributed to this increased life expectancy.

As of last year, the average life span of a Malaysian is at 74.7 years; in 2000, it was 72.2 years.

Unfortunately, living longer has not translated to better quality of life.

The rates of infectious diseases may have gone down, but the number of those afflicted with lifestyle/non-communicable diseases such as diabetes, hypertension, obesity and cancer has risen and more worryingly, continues to rise.

The National Health and Morbid­ity Survey 2015 revealed that obese Malaysians make up 17.7% of the population, while those categorised as overweight make up 30%. The obesity rate for 1996 was 4.4%, and 14% in 2006.

The same survey found that about 3.5 million or 17.5% of Malaysians aged 18 and above have diabetes. In 2006, this figure was 11.6%; it was 15.2% in 2011.

Malaysians are having to live longer in ill health or putting in another way "ageing unhealthily".

All this takes a toll on the healthcare system, with the Government having to allocate increased financial resources to help provide treatment to people living with such conditions.

The proposed Aged Healthcare Act is a start, which aims for better regulation and monitoring of aged healthcare centres in the country.

There is also a need to look at the delivery of healthcare to the aged with support services, infrastructure, laws that safeguard the elderly and community engagement prog­rammes, age-friendly culture that embraces the elderly instead of isolating them.etc as additional considerations.
 
Thus it is of importance to educate and implement "preventive healthcare" and  "wellness programmes" to the population at an early age so that on-ageing, the aged do not end up living the last 20 to 30 years of their lives saddled with multiple diseases that burden not only their respective families but also the community and country.

 /theSTAR 24-05-2017

Disclaimer: Views or opinions expressed are solely those of the Author and should be used with discretion. The Author shall not be held liable for any acts or omissions arising from the use of the information. The user will be personally liable for any damages or other liability arising hereof.

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Women and Children's Hospital: To be Opened in Q3, 2017



The new Wo­­men and Children’s Hospital within Hospital Kuala Lumpur (HKL) will be ready as early as August, 2017.

Health Minister Datuk Seri Dr S. Subramaniam said the facility is 99% completed and will open its doors in August or September, 2017.

“All maternity and children’s services will be moved there,” he said during a visit to HKL’s emergency department yesterday.

The RM848mil complex for women and children will have 600 beds and help ease congestion at the existing Paediatrics’ Institute.

Another project that has been approved is a new operating theatre complex, which will have an intensive care unit and additional wards. “The tender process for the project will be called in a few months,” he added.

Another RM40mil to upgrade the emergency department. has also been committed.

The outpatient, non-emergency clinic in Jalan Flet­cher, built at a cost of RM50mil, was opened last month, April 2017, to ease the congestion at the emergency department.

An MRT station would be built for HKL, scheduled for completion in 2022. Meanwhile, DUKE Highway had also been requested to build an access road to the Hospital.
/theSTAR 19-05-2017


Disclaimer: Views or opinions expressed are solely those of the Author and should be used with discretion. The Author shall not be held liable for any acts or omissions arising from the use of the information. The user will be personally liable for any damages or other liability arising hereof.

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Rubber gloves: Great market potential for Growth



Malaysian rubber gloves are highly sought after by many countries and for the first quarter of 2017, the country exported more than RM4bil worth of product. This is a 26% increase compared to the first quarter of 2016, which recorded RM3.2bil in sales.

Plantation Industries and Commodities Minister, YB Datuk Seri Mah Siew Keong said Malaysian rubber products are currently exported to more than 195 countries. Exports have increased more than threefold from RM5.4bil in 2000 to RM18.2bil in 2016.

He said that out of the total exports for rubber products, RM13.3bil, or 73%, was contributed by rubber gloves.

“Malaysia has remained a world leader in rubber glove exports for the last two decades, capturing over 60% share in the global market.

“Between 2012 and 2016, the export of rubber gloves increased at an average rate of 6% annually.

“The growth momentum is expected to continue in 2017 to reach RM14.1bil in exports,” Mah siad.
 
He also said the per capita consumption of gloves in Asia is relatively low at about 5.5 pairs per year on average, compared to 75 pairs in the United States and 50 pairs in Europe.

Consumption per capita of medical gloves in China is currently at three pairs while in Malaysia, it is about 10 pairs per year for one consumer, he added.

“The market potential in Asian countries for the products, especially China, is huge.

 /theSTAR 22-05-2017


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IHH: Earnings for Q1, 2017 soared to RM470mil



IHH Healthcare Bhd’s partial divestment of its stake in Apollo Hospitals, has led the world’s second largest healthcare group’s net profit for the first quarter of financial year 2017 ended March 31, to nearly double to RM470.05mil on a year-on-year comparison.

IHH announced that its net profit doubled following a RM313.4mil gain from the group’s divestment of a non-core 6.07% stake in Apollo Hospitals.

The partial sale of stake was done in March this year, as part of IHH’s plan to consolidate and rationalise its investment in India to its two recently acquired hospitals – Continental Hospitals and Global Hospitals. 

To note, IHH further disposed its remaining 4.78% stake in the Apollo Hospitals for RM551.1mil on 19th May 2017.





Top line grew by 8.5% to RM2.68bil, compared to the preceding year corresponding quarter. IHH’s revenue growth was achieved on the back of operational expansion and sustained growth in inpatient admissions.

“The acquisition of Tokuda Group and City Clinic Group in June 2016, also contributed to the increase in the group’s first quarter revenue.

Moving forward, IHH is optimistic for commendable financial results, underpinned by the sustained demand for quality private healthcare in its home markets and key growth markets of India and Greater China.

In the year ahead, IHH expects to face cost pressures on several fronts. These include continued competition for talent, pre-operational and start-up costs from new operations, and higher purchasing costs with the stronger USD. It intends to mitigate these through prudent cost management, taking on higher revenue intensity procedures and ramping up new facilities to achieve optimum operational efficiencies.

/theSTAR 20-05-2017



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Cataract - A great Concern



Malaysians can expect a cataract “tsunami” come 2050, with many of them possibly ending up blind if their condition is not detected early and treated ac­­cor­­dingly, said the Health Minis­try.

Its deputy ophthalmology service head Dr Mohd Aziz Husni said there were currently 120,000 cataract patients, and the number was expected to triple in 33 years as the country ages.

A cataract is a condition in which the lens of an eye becomes cloudy.

Age-related cataracts typically oc­­cur in older people, but this condition is usually treated by replacing the cloudy lens with an artificial lens.

“We are becoming an ageing nation and we will have more age-related diseases such as cataract and macular degeneration,” Dr Mohd Aziz said at the closing ceremony of the Sayangi Mata Vision Clinic project at the Tun Hussein Onn National Eye Hospital here yesterday.

The National Eye Survey 2014 found 216,000 Malaysians became blind because of delays in cataract surgery.

It also found that the condition caused 272,000 others to be visually impaired, an outcome Dr Mohd Aziz blamed on lack of awareness about cataract, diabetes and glaucoma.

While cataract remains a main cause of preventable blindness, he pointed out that doctors were also seeing a lot of patients with advanced diabetes-related eye diseases due to the high prevalence of diabetes here.

On complaints about long waiting times at government-run eye centres, Dr Mohd Aziz said not all centres were like that, although he agreed that patients at some centres might have to wait up to six months for surgery.

He said the ministry performed 50,000 cataract surgeries a year, while private hospitals as well as university and army hospitals shoulder another 50,000 and 20,000 surgeries respectively.

The ministry’s surgeries were performed in 45 eye departments in hospitals throughout Malaysia, as well as mobile services in the peninsula’s east coast and Sarawak, he said, adding that northern Sabah would get a centre soon.

The ministry also teamed up with NGOs to conduct community cata­ract screening so that people may be referred for further assess­ment.

Besides that, the 1Malaysia Cata­ract Clinic has an ongoing programme, while mobile clinics on board buses operate almost every day to serve areas without ophthalmologists.

/theSTAR 06-05-2017

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Ayurvedic Chair in UTAR



Universiti Tunku Abdul Rahman (UTAR) is setting up an Ayurvedic Academic Chair within its institution in a bid to widen the range of medical treatments in the country.

A Memorandum of Understan­ding (MoU) was signed between the higher learning institution and the Central Council for Research in Ayurvedic Studies (CCRAS) from India’s AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) Ministry.

Under the MoU, the Ayurvedic Academic Chair will serve to raise awareness and quality of Ayurvedic education while broadening students’ learning experience in Ayurvedic science.

UTAR president Prof Datuk Dr Chuah Hean Teik said the chair will also look into developing a syllabus for a degree in Ayurveda besides undertaking related academic and research activities.

“Most importantly, this collaboration will lead to a credible source of AYUSH-related information in Malaysia,” he said during the signing ceremony at UTAR’s campus here yesterday. Prof Chuah also said the partnership was timely as the institution is working to build its own hospital in Perak.

“We will be unique in the sense where we have Western, traditional Chinese medicine as well as Ayurvedic medicine for patients to choose from, once it is up and running,” he said.

Present at the signing were Indian Deputy High Commissioner Nikhilesh Chandra Giri, Indian First Secretary (Commerce and Informa­tion) Bramha Kumar, UTAR Inter­nationalisation and Academic Deve­lopment vice-president Prof Dr Ewe Hong Tat, and UTAR Research, Development and Commercialisa­tion vice-president Prof Dr Lee Sze Wei.

/theSTAR 06-05-2017

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Chronic Kidney Failures & Treatments



THE signs aren’t obvious in the beginning. And that is why some call it a silent disease.

But it isn’t a time to keep quiet about chronic kidney disease (CKD), which strikes nine out of every 100 Malaysians.

The overall number of patients – from stage one to five – is currently between two and three million, but the numbers are expected to rise. Most patients in stage five, known as end stage renal disease or kidney failure, depend on dialysis to carry on with life.

But while there are 40,000 dialysis patients now, the number is projected to more than double to a whopping 106,249 in 2040 if no effective remedies are in place, based on a recent study.

The large number of dialysis patients has made Malaysia the top seventh country with the highest dialysis treatment rate in the world, based on the study titled “Forecasting the Incidence and Prevalence of Patients with End-Stage Renal Disease in Malaysia up to the Year 2040”.

However, many kidney patients in Malaysia are still hoping for the alternative solution – a kidney transplant.

In fact, most of the 20,000 people on the organ transplant waiting list are in need of kidneys.

The problem is that while organ pledges remain low, the number of medical professionals, including surgeons and supporting staff, that can conduct transplants are less than ideal.

Calling it the ideal solution for kidney patients, he says transplants are also cheaper in the long run compared to dialysis.

“The main challenge when it comes to transplants is the need to increase the number of specialists, including transplant surgeons, pathologists and other supporting medical professionals.

Malaysia is looking into roping in foreign and local experts to train more specialists in this area so that more transplants can be conducted and in a safe way too.

Dr Jeyaindran points out that while only 1% of the Malaysian population had pledged their organs after death, it was still the “greatest gift” a person can offer.

“As such, we need to strengthen the mechanism to support such a gift of life to another in need,” he adds.

One plan is to double the number of “organ retrieval” teams, or teams of medical staff in charge of retrieving organs from those who have pledged their organs upon death.Currently, Malaysia has only two dedicated teams – one from Hospital Kuala Lumpur (HKL) and another from Selayang Hospital.

Dr Jeyaindran explains that increasing the number of teams would help make the process of transplantation more efficient. He says the limited number of staff available to retrieve organs presents a challenge, especially when the deceased donor is located far away.

“We want to double the number of such teams so that they can reach more locations quickly and cover wider areas like Sabah and Sarawak,” Dr Jeyaindran says.

Transplants can also be done involving living donors, who are often family members of the patient.
But for cases where the organ is from an unrelated deceased donor or cadaveric donor, there is also another hurdle – whether or not the organ is compatible with the patient.

On dialysis treatment, Dr Jeyaindran says the ministry is focusing more on peritoneal dialysis, just like in Canada. The treatment involves the lining of the body’s abdomen and a solution to clean the patient’s blood.

In his Budget 2014 speech, Prime Minister Datuk Seri Najib Tun Razak had also announced the Government’s initiative in promoting peritoneal dialysis by providing free Continuous Ambulatory Peritoneal Dialysis (CAPD) kits costing RM19,000 per unit.

The initiative benefited over 1,000 patients who can use the kit at home.

Pointing out that Malaysia has room for improvement when it comes to transplants, Malaysian Society of Transplantation president Datuk Dr Ghazali Ahmad says the number of procedures done these days is a far cry from the past.

“In the 1990s, about 50 transplants were done in HKL itself. But last year, there were only 27 transplants from both living related donors and cadaveric donors in Malaysian public hospitals,” he says.

And only two Malaysian public hospitals performed such procedures last year, namely HKL and Selayang Hospital.

Although private hospitals only perform transplants involving living related donors, he notes that the total number of overall transplants is low and has been declining between 2009 and 2014.

“In 2009, a total of 141 transplants were conducted involving Malaysian patients in private, public and overseas hospitals. But this number steadily dipped over the years and in 2014, only 81 transplants were recorded,” says Dr Ghazali, who is a senior consultant nephrologist.

The dip is due to the overall drop in organ pledges, proliferation of dialysis centres and dwindling numbers of doctors qualified to carry out transplant procedures.

Malaysia is in critical need of more organ transplant surgeons but even if there were, there is a lack of medical teams to retrieve the organs from deceased donors.At present, the country has fewer than 10 such surgeons, said the Malaysian Society of Transplan­tation.

Dr Ghazali points out that Malaysia has a long way to go when it comes to organ pledges, compared to countries like Spain and Belgium.

In 2015, Spain recorded 39.7 actual deceased organ donors per one million population, compared to Malaysia which has about 0.6 per one million population.

Concurring that cases of CKD are on the rise, Malaysian Society of Nephrology council member Dr Lily Mushahar attributes the spike to the increase in elderly population in Malaysia.

“With better healthcare in Malaysia, the population now has a longer life expectancy. This leads to an increase in non-communicable diseases (NCDs) such as hypertension and diabetes that relate to long-term complications like kidney disease,” she says.

As such, the rise in NCDs over the last two decades, especially diabetes and hypertension, has led to the corresponding hike in kidney failure. “Sixty per cent of end stage renal disease in Malaysia is caused by diabetes. Unhealthy lifestyle and diet among Malaysians also give rise to obesity and NCDs,” Dr Lily says.

Another factor is the lack of awareness among Malaysians, as many do not go for regular medical screening.

While Malaysia has enough nephrologists – about 120 for the country’s population of 30 million – Dr Lily finds it worrying that there are so few dedicated transplant surgeons.

“Most transplants are being done by general surgeons who are also involved in other daily duties.

“Malaysia needs a dedicated transplant team that comprises dedicated transplant surgeons, anaesthetists, nephrologists, nurses, psychiatrists and nutritionists that do not juggle their work with other non-transplant duties,” she says.

The National Kidney Foundation is also doing its part to help kidney patients by developing centres in underserved areas, especially in East Malaysia, to provide treatment for poor patients.

“We are also introducing another programme to help those with early kidney disease from progressing to advanced kidney failure.  We hope to kick off this pilot project this year,” says its chairman Datuk Dr Zaki Morad.
/theSTAR 09-04-2017

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Body Language in Communication



When it comes to communication, body language counts a lot more than speaking the right words.

An American psychology, Professor Albert Mehrabian, stated that 7% is from the actual word, 38% tone of voice and 55% body language.

This means that no matter how hard one tries to convince others about his ideas, with his words, he may not be able to. However, if the individual leverages his words with his body language, it can help him to level up for success.

Thus the following should be considered for the effective use of body language:

1) Maintain Eye Contact 2) Have a genuine smile  3) A firm hand shake  4) Not fidgeting eg hair twirling, stroking your tie

5) Manage facial expression  6) Good posture eg standing confidently by looking up and straightening up

7) Use effective hand gestures to support ideas. It is to convey clear thoughts and descriptions to the other party.


/08-04-2017

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Dengue Vaccine given conditional approval



The Malaysia Health Ministry has given conditional registration for the world’s first dengue vaccine to be used in Malaysia. Pharmaceutical products are approved for five years period.

Health Director General Datuk Dr Noor Hisham Abdullah said that the Ministry approved the vaccine in October last year. "We have made a stand that it will not be in our National Immunisation Programme. In other words, the immunisation will not be given free in government health facilities."



The Drug Control Authority (DCA) said the vaccine was approved for a post-registration (phase IV) clinical study for two years involving volunteers aged 9 to 45, which, means that only those who participate in the study will be able to obtain the vaccine, which will be made available within the next six months.

The DCA also said that those who got the vaccination, which consists of three injections six months apart, would have to pay for the vaccination.

The study is to assess the vaccine’s effectiveness and safety.

It will be conducted jointly by the vaccine’s producer, French pharmaceutical company Sanofi Pasteur, and the Health Ministry.

In a statement, Sanofi Pasteur Malaysia said it welcomed the ministry’s decision to approve conditional registration of the vaccine.

“With this approval, Malaysians across the country will now have access to an additional form of protection against this debilitating, and sometimes, deadly disease,” it added. The vaccine gives an overall average of 66% protection against dengue infection, 93% against severe dengue and 80% against hospitalisation for dengue, for those aged between 9 and 16.

This is according to a 2015 paper in the New England Journal of Medicine, which combined and analysed the results from phase III clinical trials in five South-East Asian countries, including Malaysia, and five Latin American countries.

The DCA said although the vaccine offered protection regardless of previous exposure to dengue, major studies reported that it conferred significantly better protection to those vaccinated who were infected before (81.9%), compared with those without previous infection (52.5%).

The agency was also concerned that the vaccine was less effective in reducing dengue incidence caused by DEN1 (58.4%) and DEN2 (47.1%), compared with other strains, DEN3 (73.6%) and DEN4 (83.2%).

According to the ministry, DEN1 and DEN2 are currently the most common dengue virus strains in Malaysia.

The DCA said if the Phase IV study failed to verify the clinical benefit of the vaccine or was not conducted with due diligence during the next two years, the approval for the vaccine could be withdrawn.

Sanofi Pasteur Malaysia said it would collaborate with relevant stakeholders to provide support in giving access to, educating about and monitoring the impact of dengue vaccination in the country.
This includes developing a nationwide immunisation registry and organising education-­cum-awareness programmes for the public and medical professionals. 

The dengue vaccine is currently approved in 14 other countries, including the Philippines, Indonesia, Thailand and Singapore. Mexico was the first country to approve the licensing of the vaccine, followed by the Philippines, both in December 2015.

According to the World Health Organisation, there are currently five other dengue vaccine candidates being researched in clinical trials. Two of these vaccine candidates, from Brazil’s Butantan Institute and Japan’s Takeda Pharmaceutical, are currently beginning phase III trials.
 
/theSTAR 07-04-2017

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