Governing the Establishment and Licensing of Private Healthcare Facilities in Sarawak: A Multi-Level Regulatory Pathway Analysis

Private healthcare facilities must be built with regulation systems that protect the public, maintain the quality of services provided, and develop in accordance with the nation's growth and zonal land use. In Malaysia, and especially in Sarawak, the building of healthcare facilities is governed by a complicated system of regulations that includes the health, planning, and local governments. This study explores the current regulatory systems used to open private healthcare facilities in Sarawak.
A qualitative analysis of the regulatory process was done by reviewing the existing standards used by health, state planning, and local councils’ authorities during the implementation of specific projects. This analysis concentrates on the various approvals, institutional roles, and mechanisms used to coordinate the process from the registration of a business to the final licensure to operate.
The analysis of the regulatory process used to open private healthcare facilities in Sarawak reveals the process is composed of four distinct steps, each of which is interconnected with the others. The first step is the registration of a business and entity. The second step is the approval of the pre-establishment planning. The third step is the approval for the development and construction of the facility. The final step is the approval of the licensure of the facility. Of the four steps, the second step, approval of pre-establishment planning, contains a double regulatory gate, meaning that the facility must obtain healthcare-related clearance and land use planning approval to proceed with the development of the facility. State-level planning authorities and inter-agency coordination, especially healthcare, environment, and infrastructure, play a central role in integrating and coordinating the various approvals. A risk-benefit approach is taken in the integration of the various approvals, and the final licensure to operate is given only after the facility has been built.
Although the current regulatory framework strengthens public protection and makes regulatory processes more accountable, it increases the complexity and uncertainty of the inter-agency process, especially regarding the timing of approval of private healthcare providers. This is more problematic for those healthcare services that require a significant level of investment, such as dialysis centers, diagnostic services and ambulatory care services. The study suggests that there would be better system governance if there were early health regulatory risk assessments that better coordinated the planning and health assessment criteria and better integrated the regulation. The study provides important policy ideas to improve the governance of healthcare facilities in decentralized regulatory systems.

Regulatory, Law

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