Why universal healthcare needs life support in Malaysia, Thailand, Indonesia – and beyond

Across Southeast Asia, rising costs and funding struggles are threatening the very foundations of public health systems

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Mounting healthcare challenges have raised fears of a creeping privatisation as overstretched and underfunded state facilities seek new revenue streams. Photo: Shutterstock

Hadi Azmi,Aidan Jones,Amy SoodandJean Iau

Published: 12:00pm, 9 Nov 2024

Despite devoting the past decade of her life to working as a nurse at a public hospital in eastern Thailand, Fah* hasn’t had a single pay rise. Yet the number of patients coming through the hospital doors each day has doubled – leaving her and her colleagues stretched to their limits.

“The number of patients has gone up like crazy,” she told This Week in Asia, requesting a pseudonym to safeguard her job and the hospital’s reputation. “So has the cost of living … but my pay hasn’t changed. It’s not a great spot to be in.”

Not helping matters is the revolving door of staff, Fah says, as newly minted nurses leave after only a few short years, lured by better-paying positions in private hospitals.

This is more than just a personal burden; it reflects the broader healthcare crisis facing Southeast Asia. As the region grapples with an ageing population and the lingering fallout from the pandemic, public healthcare systems are buckling under the pressure of delayed treatments and mounting patient needs.

For decades now, universal healthcare has been a cornerstone of Southeast Asia’s social contract, primarily funded through social security contributions.

A nurse checks the blood pressure of a Buddhist monk at a government-run hospital in Bangkok. Photo: AFP

Thailand’s pioneering “30 baht healthcare” scheme, launched in 2002, promised affordable access to medical services, offering the poorest citizens hospital care for less than US$1 per visit – a historic achievement at the time. But as demand surges, the government is under mounting pressure to sustain this initiative long term.