Kamal Amzan’s book takes aim at Malaysia’s health system, but not evenly
IHH Healthcare Malaysia chief executive officer Dr Kamal Amzan has written a short, pointed book that plainly wants to disturb complacency. The Future We Choose, at 145 pages, argues that Malaysia’s health care problems are not accidental and not confined to any one institution. It presses hard on public-sector weaknesses, poor policy design, and the country’s habit of funding visible outputs while neglecting the slow, unglamorous work of prevention. Yet the book is far less candid when it turns toward the private sector that Dr Kamal himself leads.
The imbalance is difficult to ignore. On price transparency, the expanded sales and service tax on outsourced hospital services, and the government’s Rakan KKM initiative, the book is openly critical of the Madani administration. On the structure, finances, and labor pressures inside private hospitals, it gives broad claims where a chief executive might have offered precise numbers, margins, or operational trade-offs. The result is a book with substance, but also one that asks readers to trust the private hospital industry’s predicament without fully opening its books.
Price transparency and the limits of a charge sheet
Dr Kamal dismisses the Ministry of Health’s price transparency policy as performative and as signaling virtue. He argues that displaying medicine prices does not explain the broader cost base of private hospitals, which includes a 24-hour pharmacy, cross-subsidies for undercompensated services, regulatory compliance, and other overheads hidden from the patient sitting at the counter. In his view, transparency alone cannot carry the weight of reform unless reimbursement models and insurance coverage also change.
There is logic in that argument. A schedule of charges can reveal the retail price of a drug, but it does not capture the cost of keeping a hospital open at all hours, staffing it with trained nurses and doctors, maintaining imaging equipment, or meeting compliance obligations that do not disappear when a patient walks out. Health care does not behave like a simple consumer good. The service is labor-intensive, capital-intensive, and structurally expensive, whether it is delivered in a public ward or a private suite.
Private hospitals are also being squeezed from multiple sides at once. Dr Kamal says regulatory ceilings, insurer demands for deeper discounts, and faster reimbursement cycles all narrow operating room for the sector. He describes the SST on outsourced services — cleaning, linen management, imaging support, laboratory support — as a hidden tax on the sick. Even so, the book does not spell out how much of those costs are absorbed, passed through, or offset elsewhere. On a publicly listed balance sheet, that omission is hard to ignore.
The legal framework matters here. Under the Private Healthcare Facilities and Services Act 1998, only doctors’ consultation and procedure fees are legally capped. Consumables, medicines, and medical and surgical supplies are not regulated in the same way. That distinction helps explain why private hospitals can cross-subsidize some services while itemizing others, and why insurers often object to the structure of charges even when hospitals insist they are merely reflecting real costs.
One sentence in the book lands with particular force: if every patient seeking private care were diverted to government facilities, the public system would be overwhelmed overnight.
A defense of private care that stops short of full disclosure
Dr Kamal’s central defense of private hospitals is familiar but not trivial. Health care, he argues, is expensive because it is always on. Hospitals run 24 hours a day, recruit and retain scarce skilled labor, and absorb costs that most consumers never see. He lists biohazard waste management, servicing of imaging machines, licensing fees, cybersecurity systems, supply-chain inflation, recruitment, and professional compliance among those invisible burdens. He also points to the cost of keeping doctors and nurses through continuous medical education, liability coverage, and overtime pay.
The logic is persuasive up to a point. Skilled labor shortages are not an abstraction in Malaysia. Private hospitals compete for doctors and nurses, and the public sector loses trained staff when compensation remains low relative to the workload and responsibility. If the state paid more competitively, public-sector emoluments would rise sharply. Health financing would look different, but it would not become cheaper.
Still, the book leaves a gap where candor should be. As CEO of one of the country’s largest private hospital groups, Dr Kamal could have made a stronger case by discussing how his company sets prices, how it decides what to absorb, and where profit is reinvested. Instead, the defense stays general. The reader is told that private hospitals are not simply greedy enterprises, yet the inner mechanics of pricing and margin remain mostly out of view. The argument is credible, but incomplete.
The sharper critique lands on public-sector habits
Where the book becomes more confident is in its critique of the public system’s policy culture. Dr Kamal argues that Malaysia repeatedly chases shiny solutions without building the supports needed for scale. His example of a diabetes pilot project is especially revealing: case managers and structured follow-up appeared to improve care during the trial period, but funding ran out, seconded nurses returned to their previous posts, and the software subscription lapsed. The intervention was not defeated by science. It was defeated by discontinuity.
Another example concerns digital diabetes monitoring, where partial uptake came from selected clinics in 2023. General practitioners reportedly faced inadequate training, incompatible software, weak incentives, poor connectivity in some rural areas, and patient reluctance to adopt new devices without help. These are not technical footnotes. They are the ordinary reasons that health reforms fail when implementation is treated as an afterthought.
The book’s deeper point is about prevention. Dr Kamal criticizes a system that rewards hospital launches, new wings, and advanced equipment because those projects generate headlines, while community clinics and preventive services struggle for budgetary survival. He cites the World Bank’s estimate that every RM1 invested in high-quality primary care yields RM3 to RM4 in avoided downstream costs. He also argues for multi-year financing rather than the annual budget cycle that keeps prevention vulnerable to short-term political pressure.
Social determinants, personal choice, and the limits of moralizing
Dr Kamal extends the discussion beyond the Ministry of Health to the social determinants of health: unaffordable healthy food, poor access to green spaces, informal work, and insecure housing. He calls for coordination across education, local government, employers, and civil society. The reasoning is sound. Disease patterns are shaped by systems long before they reach a clinic.
The strongest passages in the book describe how policy makers often overstate individual responsibility while ignoring structural constraints. Illness is not merely the consequence of bad decisions. It is often the predictable outcome of environments that make healthy decisions harder than unhealthy ones. That framing gives the book much of its force.
Yet the same moral intensity is not applied to private health care. Public hospitals are asked to explain their failures. Private hospitals are mostly asked to be understood. For readers looking for full accountability, the asymmetry is the book’s central weakness. It also leaves an unresolved tension: if poor systemic design is the true villain, then both government and business must be examined with equal rigor. Dr Kamal’s book insists on accountability, but only partly practices it.