Recently, I came across two articles that, at first glance, seemed to have little in common.
The first discussed rising healthcare costs in Malaysia and argued that preventive healthcare is one of the most effective ways to reduce long-term healthcare expenditure.
The second explored perimenopause and menopause, highlighting how many women experience symptoms such as fatigue, anxiety, sleep disruption, brain fog and declining confidence, often without realising that hormonal changes may be contributing to these experiences.
One was about healthcare economics, whereas the other was about women's health.
The Growing Cost of Chronic Disease
For more context, Malaysia is facing a growing burden of non-communicable diseases (NCDs). Diabetes, cardiovascular disease, obesity and cancer continue to place pressure on individuals, families, employers, insurers and healthcare providers.
Traditionally, conversations around healthcare costs have focused on hospital bills, insurance premiums and access to treatment.
Increasingly, however, healthcare experts are pointing towards prevention as a more sustainable solution.
The logic seems straightforward.
If fewer people develop chronic diseases, healthcare utilisation may decrease. If diseases are detected earlier, treatment is often simpler, less invasive and less costly than managing advanced-stage conditions.
From both a health and economic perspective, prevention appears to make perfect sense.
At least on paper.
The Prevention Paradox
The more I think about it, the more I wonder whether there is a gap in how we think about healthcare financing.
Many Malaysians are already investing in their health long before they receive a diagnosis.
We pay out of pocket for health screenings, consultations, supplements, fitness programmes, nutrition advice, menopause-related care and other preventive measures aimed at maintaining our wellbeing.
Yet much of the healthcare financing system remains designed around treatment rather than prevention. Support often becomes available only after a condition has been diagnosed or progressed to a stage that requires medical intervention.
This creates an interesting paradox.
We say prevention is important. We acknowledge that early intervention can improve outcomes and potentially reduce long-term healthcare costs.
We recognise that conditions such as diabetes, cardiovascular disease and even some cancers are influenced by years of accumulated risk factors.
Yet many of the costs associated with prevention continue to be borne primarily by individuals.
The result is a system where staying healthy can sometimes feel like a personal expense, while becoming sick unlocks access to healthcare benefits.
This is not a criticism of insurers, healthcare providers or policymakers. Healthcare financing is complex, and resources are finite.
However, it does raise an important question:
If prevention is truly the goal, how do we better support people during the years before they become patients?
The Missing Middle
This is where I think an important conversation is missing.
We often divide people into two groups: healthy and sick.
But real life is rarely that simple.
Between being healthy and being hospitalised lies a stage that many people will experience at some point in their lives, a period where health may be declining and symptoms may be emerging, yet a diagnosis has not been made.
They may not have a formal diagnosis. They may not require immediate medical intervention. Yet they do not feel 100% well.
They may be experiencing chronic fatigue, poor sleep, anxiety, hormonal changes, weight gain, declining fitness, elevated blood sugar, rising cholesterol or persistent stress.
These individuals occupy what I think of as the "missing middle" of healthcare, a space that receives far less attention than it deserves.
They are not seeking treatment for disease, but neither are they simply pursuing wellness. They are trying to prevent a decline in health before it becomes something more serious.
What Perimenopause Can Teach Us About Prevention
Perimenopause provides a useful example.
Many women in their forties and fifties experience significant physical, emotional and cognitive changes.
Sleep becomes disrupted. Energy levels decline. Concentration becomes more difficult. Anxiety may appear for the first time. Confidence may be affected.
At the very stage of life when women are being encouraged to exercise, manage their weight and reduce long-term health risks, they may be facing barriers that make these goals considerably harder to achieve.
The challenge is not a lack of knowledge. The challenge is that life circumstances and biological changes influence behaviour.
This is why prevention cannot be reduced to simple messages such as "exercise more" or "eat better".
Human beings are more complicated than that.
A Question Worth Exploring
As Malaysia grapples with rising healthcare costs, an ageing population and increasing rates of chronic disease, conversations about prevention will become even more important.
Bank Negara Malaysia's recent efforts to improve the sustainability of Medical and Health Insurance/Takaful plans reflect a broader recognition that healthcare financing cannot continue indefinitely without addressing utilisation and long-term health outcomes.
At the same time, healthcare providers continue to advocate for earlier screening, better health literacy and greater preventive care, while conversations around issues such as perimenopause remind us that many health challenges begin long before a formal diagnosis is made.
Yet an important question remains.
If prevention is truly the goal, how do we support people during the years before they become patients?
The more I think about it, the more I realise that the conversation about preventive healthcare may not simply be a healthcare conversation.
It is also a conversation about value.
Today, healthcare systems are exceptionally good at treating illness. Hospitals, specialists, medications and insurance plans are largely designed to respond once a medical condition has been identified.
But the years before a diagnosis are often less visible.
This is the period when individuals begin noticing subtle changes in their health, whether that is rising cholesterol levels, declining fitness, persistent fatigue, poor sleep, hormonal changes or other early warning signs that something may be shifting.
Many choose to take action during this period. They invest in screenings, exercise, nutritional support, health coaching, mental wellbeing and other preventive measures, often at their own expense.
The question is whether we place enough value on these efforts.
If prevention is truly the future of sustainable healthcare, perhaps the challenge is not only how to treat disease more effectively, but also how to recognise and support the work people do to stay well in the first place.
Which brings me back to the question that started this reflection:
What happens between "healthy" and "hospitalised"?
Because that space may hold some of the most important opportunities for improving health outcomes, reducing long-term healthcare costs and rethinking how we approach prevention altogether.
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