Dr Rajeentheran Urology Stone, Urodynamics, Urooncology and Male Health

18/08/2026

The MediAsas Mirage: How Malaysia’s Flagship Health Plan Betrayed Its Promise To The Chronically Ill — Dr Rajeentheran Suntheralingam

The betrayal of the chronically ill is not merely a failure of MediAsas’ product design. It is a failure of political will – voluntary, market-driven insurance cannot deliver universal protection.

A government-designed product should be governed by a government body, not left to the discretion of private insurers. This fund should offer community-rated premiums and guaranteed coverage for pre-existing conditions, regardless of “insurability” assessments.

Need to note the following to understand the current situation of our Healthcare crisis:

1. Medical inflation rate has creeped up above 16% in Malaysia compared to its general inflation rate ranging from 1.5% - 2.5%.

2. The RESET strategy functions as an immediate, near-term operational framework to tackle surging private medical inflation before the broader, 15 year long-term structural reforms of the Health White Paper fully roll out.

3. The Malaysian Healthcare system is based on a dual-tier framework - an overstretched, tax-funded public sector rubbing shoulders with an expensive, profit-driven, fees-for-service private sector - and it is now reaching its breaking point.

4. Urgent intervention is needed for this healthcare crisis, as it will not auto-correct itself.

5. The current health financing model is based on a tax-funded public model.

The income tax revenues from private healthcare services is not ring-fenced to the public healthcare budget. The budget for public healthcare is based on the Federal budget which is based on Parliament approval. This is currently at 2.4% of the GDP amounting to Rm 46.52 billion which is nearly 10% of the total govt spending. This may not be adequate. There are calls for the healthcare budget to be increased to 5% of the GDP.

Subsequently the MOH expects a 10% cut of its 2026 budget, as part of cost-cutting measures to save government funds amid the impact of the Iran war. This cut would be equivalent to RM4.65 billion.

5. The public healthcare sector is heavily tax-funded. Around 2.5 to 2.7 million individual taxpayers currently actively pay income tax in Malaysia, accounting for roughly 15% of the country's total workforce of over 17 million. The remaining workers do not pay income tax because their earnings fall below the minimum taxable threshold, while the remaining workers fall below the minimum taxable income threshold.

6. 2.7 million individual tax payers paying the healthcare for a 33 million Malaysian population will not sustain itself any longer.

7. This is the core structural and financial reason why a National Health Insurance (NHI) scheme is currently unfeasible in Malaysia.

8. Soaring claims ratios - approaching or hitting 100% - pose a severe threat to the traditional pricing models of medical and health insurance and takaful operators (ITOs) making health insurances unsustainable, which leads to private ITOs having no other choice but to implement periodic premium adjustments.

9. For this reason MediAsas should be a government-designed product governed by a government body, and not left to the discretion of private insurers.

10. We should find a middle ground where MediAsas becomes a government-funded public health insurance. Alternatively, the government could partially fund ITO (Insurers and Takaful Operators) schemes to offer affordable MediAsas coverage. This should include people with chronic illnesses and pre-existing conditions. Otherwise, these patients will move to the public health sector and crowd the public hospitals. The government would then spend more money on their care. Investing in MediAsas is a better solution than paying to move public hospital patients (decanting) to private hospitals.

11. Voluntary insurance cannot deliver universal protection. The government must eventually move towards mandatory participation.

If I have time, I will write more on the necessity of whether Malaysia needs to implement a National Health Insurance, Social Health Insurance, or forge a separate middle path effective financial health model.

Dr Rajeen
18 August 2026

The betrayal of the chronically ill is not merely a failure of MediAsas' product design. It is a failure of political will – a refusal to confront the uncomfortable truth that voluntary, market-driven insurance cannot deliver universal protection.

11/08/2026

Prostate Cancer Part 10 – Understanding The Various Eras And Progress In Prostate Cancer Management - Dr Rajeentheran Suntheralingam

Understanding the evolution of prostate cancer treatment from the historic hormonal ablation to modern precision oncology is essential. It prevents repeating past mistakes, reveals how survival rates expanded, and highlights how we shifted from aggressive overtreatment to highly personalized, molecularly guided and patient-centered care.

The history of prostate cancer treatment reveals a consistent trajectory: from anatomical insight to technological refinement, from one-size-fits-all to risk-adapted therapy, from palliation to cure, and from treating the tumor to understanding its molecular vulnerabilities.

Understanding the various eras of prostate cancer treatment – from the foundational days of surgical removal and hormone ablation to the modern era of precision medicine – is vital for recognizing how far care has progressed and shaping future treatment paradigms

Understanding the evolution of prostate cancer treatment from the historic hormonal ablation to modern precision oncology is essential. It prevents

04/08/2026

Prostate Cancer Part 9 – Advanced (Metastatic) Prostate Cancer: Terminologies Used And Understanding The Basis Of Clinical Trials In Advanced Prostate Cancer - Dr Rajeentheran Suntheralingam

To be considered a specialist in prostate cancer, the treating specialist must possess comprehensive knowledge that extends beyond simply knowing current treatment modalities. They must have a deep understanding of historical landmark trials, including a critical analysis of those studies and their evolution over time, in order to tailor the best treatment approach for an individual patient at that specific juncture.

Prostate cancer is characterized by profound multi-focal and molecular heterogeneity, resulting in highly variable clinical trajectories and treatment responses. Understanding and participating in clinical trials is essential to map this complexity, identify actionable biomarkers, and transition from generalized therapies to targeted, personalized treatment strategies.

At the core of evidence-based medicine lies a hierarchy. Expert opinion and case series sit at the bottom

Landmark trials are ethical only when there is genuine uncertainty about which treatment arm is superior – a state known as clinical equipoise.

To be considered a specialist in prostate cancer, the treating specialist must possess comprehensive knowledge that extends beyond simply knowing current

25/07/2026

Rethinking Filial Piety: Why Malaysia Needs State-Led Elderly Support In The New Bill — Dr Rajeentheran Suntheralingam

Malaysia has been preparing a Senior Citizens Bill since 2023 to protect older adults from neglect, abuse and exploitation. Now known as the Older Persons Bill, it is being prepared alongside parallel discussions regarding a dedicated Parental Care / Maintenance of Parents Act - that would require adult children to support aging parents, as the country prepares for a sharp rise in its elderly population.

This is due to be tabled at Parliament in the fourth quarter of this year.

While the proposed bills initially seem beneficial for senior citizen care, they raise critical concerns regarding the coercion and penalties imposed on adult children. Furthermore, they spark a fundamental debate over who should ultimately bear responsibility for the welfare of the elderly: their adult children or the state.

Read the final installment of the three-part series exploring who holds the responsibility for senior citizen care.

The debate over filial responsibility has obscured a more fundamental truth: the state has failed to build the infrastructure of care.

As you sow, so shall you reap. It is the state that must now harvest what the senior citizens have sown. Fulfilling the state’s responsibility to its senior citizens is the repayment of a societal debt.

The state must build a system where no senior citizen is left behind, and no family is forced to choose between love and survival.

23/07/2026

The International Playbook: What Malaysia Must Get Right In Its Senior Citizens Bill — Dr Rajeentheran Suntheralingam

This is the 2nd part of a 3 parts article on the proposed Senior Citizens Bill and its accompanying Parental Care Bill, on the effect that this will create, criticisms on legalization of parental laws and filial piety, and their criticism, rethinking filial piety laws, and focuses on abdication of the state from their responsibility.

A house built on sand cannot stand. Malaysia’s Senior Citizens Bill and its accompanying Parental Care Bill must be built on a foundation of state responsibility, not filial coercion.

A society that forces its most vulnerable citizens to depend on family relationships, without providing a robust safety net, is a society that has failed its moral obligations.

A progressive nation cannot legislate filial piety to compensate for an inadequate welfare state. The legislative framework must codify institutional accountability, ensuring that the protection of Malaysia’s senior citizens rests on a foundation of universal public rights, not private domestic obligation.

A society that forces its most vulnerable citizens to depend on the uncertain mercy of family relationships, without providing a robust safety net, is a society that has failed its moral obligations.

The impending demographic shift toward an elderly population, the Silver Tsunami, is poised to hit our shores very soon and will soon place significant demands on our society.

Malaysia must provide a robust safety net, and this must be based on a foundation of state responsibility, not filial coercion.

https://codeblue.galencentre.org/2026/07/the-international-playbook-what-malaysia-must-get-right-in-its-senior-citizens-bill-dr-rajeentheran-suntheralingam/

22/07/2026

The State Must Care, Not Coerce: A Critique Of Malaysia’s Senior Citizens Bill — Dr Rajeentheran Suntheralingam

This is the 1st part of a 3 parts article on the proposed Senior Citizens Bill and its accompanying Parental Care Bill, on the effect that this will create, criticisms on legalization of parental laws and filial piety with their criticism, rethinking filial piety laws, and focuses on abdication of the state from their responsibility.

Meaningful action requires courage, commitment, and the humility to admit that you cannot legislate what only love can provide.

A society is judged by how it treats its oldest members. By that measure, Malaysia is failing. The proposed Senior Citizens Bill, in its current form, represents a dangerous abdication of state responsibility.

State, not filial piety, should bear the primary responsibility for elder care.

Meaningful action requires courage, commitment, and the humility to admit that you cannot legislate what only love can provide.

16/07/2026

Facing The Silver Tsunami: Why Malaysia Must Overhaul Its Aged Care Infrastructure — Dr Rajeentheran Suntheralingam

Malaysia is confronting an unprecedented demographic shift, transitioning into an aged nation at a rate 1.5 times faster than Japan

As the demographic shift known as the Silver Tsunami approaches, it is critical to recognize that time and tide wait for no man.

By 2030, one in six Malaysians will be elderly. By 2040, one in five. The question is not whether we can afford to act. The question is whether we can afford not to.

By 2030, one in six Malaysians will be elderly. By 2040, one in five. The question is not whether we can afford to act. The question is whether we can afford not to.

10/07/2026

The Great Medical Inflation Puzzle: Who Is Really Responsible? — Dr Rajeentheran Suntheralingam

Every time we choose a hospital because of its marble lobby rather than its clinical outcomes, we are voting with our feet and our wallets for a system that prioritises hospitality over health care.

Private hospitals blame insurance companies for demanding crippling discounts. Insurers blame hospitals for creative itemisation and opaque billing. And while these two giants wage their war of words, the patient quietly bears the cost.

The current model, competing on luxury, blaming insurers, and passing costs to patients, is unsustainable. It is time to focus on affordable, value-based health care for Malaysians, not just luxury amenities for medical tourists.

Every time we choose a hospital because of its marble lobby rather than its clinical outcomes, we are voting with our feet and our wallets for a system that prioritises hospitality over health care.

07/07/2026

First, Do No Harm: Why Doctors’ Professional Fees Must Be Excluded From Malaysia’s DRG Implementation — Dr Rajeentheran Suntheralingam

Malaysia’s health care financing structure stands on the precipice of a monumental shift. Yet as Malaysia prepares to roll out its Diagnosis-Related Group (DRG) payment system – a fixed-fee, diagnosis-based hospital billing model scheduled for phased implementation beginning January 2027 – the government risks inflicting a profound and entirely avoidable harm upon the very profession that sustains the nation’s health care system.

Keeping professional clinical fees separate from the DRG ensures that medical practitioners retain the autonomy needed to prioritize patient welfare over corporate financial targets

Health care is not a commodity. It is a sacred trust between doctor and patient. And that trust cannot be sustained if the very doctors who uphold it are systematically undervalued, underpaid, and ultimately driven away.

Designing a system that respects the distinct roles of institutional facilities and clinical experts will allow the country to protect public affordability without compromising patient safety or clinical excellence.

05/07/2026

PART 2 Who's Protecting the Patient? The PAC's Damning Indictment of Malaysia's Healthcare Industry - PART 2

29 June, 2026

Dr Rajeentheran Suntheralingam

"Every man for himself" is a proverb that has no place in the practice of medicine - yet the Public Accounts Committee's recent findings have forced us to confront just how far we have strayed from that fundamental truth.

For those of us who have dedicated our lives to healing, this is not merely a policy failure - it is a moral crisis. We entered this profession to protect the vulnerable, to comfort the sick, to place the welfare of the patient above all else. Yet what we have witnessed is a system that has forgotten that primary duty, reducing patients to profit centres and treating illness as a revenue stream.

The PAC report has done its part by exposing the truth. Now it falls to us - concerned healthcare professionals, policymakers, and citizens - to ensure that the welfare of patients is restored to its rightful place at the very centre of every decision, every regulation, and every consultation. Because if we do not protect the patient, who will?

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