Are Cognitive Biases the Hidden Force Shaping Malaysia’s Healthcare System?
DOI:
https://doi.org/10.70895/roe.v1i1.31Keywords:
Cognitive Resilience, Bias-Resistant Healthcare, Ethical Medical Tourism, Systemic Bias Mitigation, Strategic Healthcare EvolutionAbstract
Cognitive biases silently shape Malaysia’s healthcare system, influencing clinical decisions, patient safety, and the nation’s thriving medical tourism industry. While Malaysia excels in affordability and innovation, biases such as confirmation, overconfidence, and anchoring distort diagnoses, amplifying malpractice risks and ethical dilemmas. A 2023 case in Kuala Lumpur exposed life-threatening failures in cosmetic surgery tourism, underscoring systemic blind spots (The Strait Times, 2023). This study integrates macroeconomic analysis, AI-driven diagnostics, and cognitive theory to unravel the hidden forces jeopardizing medical integrity. Findings reveal a paradox: cutting-edge advancements coexist with workforce shortages, defensive medicine, and bias-driven errors. To safeguard Malaysia’s global reputation, this research advocates for AI-enhanced decision-making, cognitive bias training, and strategic workforce expansion. Beyond critique, this work presents a visionary roadmap—one that embeds cognitive resilience into healthcare strategy, ensuring that economic ambition never eclipses ethical imperatives. Malaysia stands at a crossroads: its future as a medical powerhouse depends on its ability to balance innovation, trust, and the sanctity of patient well-being
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References
Agency for Healthcare Research and Quality. (2016). 2015 National Healthcare Quality and Disparities Report and 5th Anniversary Update on the National Quality Strategy. Retrieved from https://nationaldisabilitynavigator.org/wp-content/uploads/news-items/AHRQ_2015-Disparities-report_May-2016.pdf
Ahsani-Estahbanati, E., Sergeevich Gordeev, V., & Doshmangir, L. (2022). Interventions to reduce the incidence of medical error and its financial burden in health care systems: A systematic review of systematic reviews. Frontiers in medicine, 9, 875426.
Alder, S. (2025, January 2). Effects of poor communication in healthcare. HIPAA Journal. Retrieved from https://www.hipaajournal.com/effects-of-poor-communication-in-healthcare/
Alvarez & Marsal. (2024, April 24). Malaysia medical tourism report. Alvarez & Marsal. https://www.alvarezandmarsal.com/sites/default/files/2024-04/Malaysia%20Medical%20Tourism%20report%20-%20revised%20-%20April%2024%2C%202024.pdf
American Medical Association. (2023). Surge in medical liability premiums increases reaches fourth year. Retrieved from https://www.ama-assn.org/press-center/press-releases/surge-medical-liability-premiums-increases-reaches-fourth-year
Annuar, A., & Zailani, Z. (2024, June 4). Malaysia’s advanced healthcare attracts international patients. The Malaysian Reserve. Retrieved from https://themalaysianreserve.com/2024/06/04/malaysias-advanced-healthcare-attracts-international-patients/
ASEAN. (2022). Summary of the ASEAN Post-2015 Health Development Agenda 2021-2025. Retrieved from https://www.asean.org/wp-content/uploads/2022/07/Summary_ASEAN-Post-2015-Health-Development-Agenda-2021-2025_FINAL_adopted-15th-AHMM_May-202239.pdf
Ball, J. E., Murrells, T., Rafferty, A. M., Morrow, E., & Griffiths, P. (2014). ‘Care left undone’during nursing shifts: associations with workload and perceived quality of care. BMJ quality & safety, 23(2), 116-125.
Ball, J. R., Miller, B. T., & Balogh, E. P. (Eds.). (2016). Improving Diagnosis in Health Care. National Academies Press.
Bernama. (2024, May 2). Nursing shortage projected at close to 60% by 2030, says Dr Dzulkefly. The Star. Retrieved from https://www.thestar.com.my/news/nation/2024/05/02/nursing-shortage-projected-at-close-to-60-by-2030-says-dr-dzulkefly
Berner, E. S., & Graber, M. L. (2008). Overconfidence as a cause of diagnostic error in medicine. The American journal of medicine, 121(5), S2-S23.
CARI ASEAN Research and Advocacy. (2017). ASEAN Economic Community (AEC) Blueprint 2025 Analysis: An Analysis of the ASEAN Cooperation in Healthcare (Vol. 1, Paper 23). Retrieved from https://cariasean.org/AEC_Blueprint_2025_Analysis/AEC_Volume1_Paper23.pdf
Columbia Asia Hospital. (2025). Allergy screening package. Retrieved from https://www.columbiaasia.com/malaysia/packages/klang/allergy-screening-package/
Connell, J. (2013). Contemporary medical tourism: Conceptualisation, culture and commodification. Tourism management, 34, 1-13.
Croskerry, P. (2003). The importance of cognitive errors in diagnosis and strategies to minimize them. Academic medicine, 78(8), 775-780.
Crowe Malaysia. (2022). Investing in Malaysia 2022. Retrieved from https://www.crowe.com/my/-/media/crowe/firms/asia-pacific/my/crowemy/insights/investing-in-malaysia-2022.pdf?rev=dc01ec6b24374548917b7f3bf62108eb&hash=267EEB824841E510627CFEDC90B6F8F2
Deloitte, L. (2008). Medical tourism: Consumers in search of value. Retrieved on, 2, 12.
Eftekhari, M. H., Parsapoor, A., Ahmadi, A., Yavari, N., Larijani, B., & Gooshki, E. S. (2023). Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies-a qualitative study. BMC Medical Ethics, 24(1), 82.
Esteva, A., Kuprel, B., Novoa, R. A., Ko, J., Swetter, S. M., Blau, H. M., & Thrun, S. (2017). Dermatologist-level classification of skin cancer with deep neural networks. nature, 542(7639), 115-118.
Gaines, K. (2022, October 10). The nursing shortage in 2022: Study reveals key causes. Nurse.org. https://nurse.org/articles/nursing-shortage-study/
Gopalan, N., Mohamed Noor, S. N., & Salim Mohamed, M. (2021). The pro-medical tourism stance of Malaysia and how it affects stem cell tourism industry. Sage Open, 11(2), 21582440211016837.
Gourevitch, R. A., Cohen, J. L., & Shakley, T. (2025). Changes in patient experiences of hospital care during the COVID-19 pandemic. JAMA Health Forum. Retrieved from https://jamanetwork.com/journals/jama-health-forum/fullarticle/2808746
Grand View Research, Inc. (2020, March 23). Medical tourism market size worth $207.9 billion by 2027: CAGR 21.1%. PR Newswire. https://www.prnewswire.com/news-releases/medical-tourism-market-size-worth-207-9-billion-by-2027--cagr-21-1-grand-view-research-inc-301027994.html
Grant, R. M. (1991). Porter's ‘competitive advantage of nations’: an assessment. Strategic management journal, 12(7), 535-548.
Halal Development Corporation. (2023, August 21). Sustaining Malaysia as the global leader in the halal industry. Retrieved from https://hdcglobal.com/news/2023/08/21/sustaining-malaysia-as-the-global-leader-in-the-halal-industry/
Hana, N. (2024, October 26). Heart surgery cost in Malaysia 2025. Majikan.my. Retrieved from https://majikan.my/heart-surgery-cost-in-malaysia/
Healthcare Asia Magazine. (2023). Malaysia’s healthcare spending to see 7.7% rise in five years: Fitch. Retrieved from https://healthcareasiamagazine.com/healthcare/in-focus/malaysias-healthcare-spending-see-77-rise-in-five-years-fitch
Health-Tourism.com. (2025). A list of JCI accredited hospitals and medical centers. Retrieved from https://www.health-tourism.com/jci-accredited-medical-centers/
Khoo, E. M., Lee, W. K., Sararaks, S., Abdul Samad, A., Liew, S. M., Cheong, A. T., ... & Hamid, M. A. (2012). Medical errors in primary care clinics–a cross sectional study. BMC family practice, 13, 1-6.
Madun, A. (2024, December 9). Addressing rising insurance costs: Insights from global healthcare. Malaysia Gazette. Retrieved from https://malaysiagazette.com/2024/12/09/addressing-rising-insurance-costs-insights-from-global-healthcare/
Malaysia Healthcare Travel Council. (2021). Malaysia Healthcare Travel Industry Blueprint 2021-2025: Maps out sustainable future aspiration. Retrieved from https://www.mhtc.org.my/malaysia-healthcare-travel-industry-blueprint-2021-2025-maps-out-sustainable-future-aspiration/
Malaysia Healthcare Travel Council. (2023). Malaysia Healthcare e-Newsletter: Q4 October-December 2023. Retrieved from https://www.mhtc.org.my/newsletters/malaysia-healthcare-e-newsletter-q4-october-december-2023/
Malaysia Healthcare Travel Council. (2025). Statistics. Retrieved from https://www.mhtc.org.my/statistics/
Malaysia Market Research. (2022, September 7). The development of healthcare technology in Malaysia. Retrieved from https://www.malaysiamarketresearch.com/insight/the-development-of-healthcare-technology-in-malaysia
Malaysia National AI Office. (2025). Applied AI: Healthcare. Retrieved from https://www.ai.gov.my/applied-ai?dest=Healthcare
Malaysian Investment Development Authority. (2021). Medical and healthcare services. Retrieved from https://www.mida.gov.my/wp-content/uploads/2023/11/Booklet-15-Medical-2021.pdf
Malaysian Medical Association. (2022). Berita MMA, March 2022. Retrieved from https://mma.org.my/web/wp-content/uploads/Berita-MMA-03-March-2022.pdf
MalaysiaNow. (2022, September 29). Cost of treatment for heart disease to increase without effective action, health DG warns. MalaysiaNow. https://www.malaysianow.com/news/2022/09/29/cost-of-treatment-for-heart-disease-to-increase-without-effective-action-health-dg-warns
Maspul, K. A., & Ardhin, M. (2025). Network Effects and Trust in Malaysia’s Platform Economy. Journal of Business Management, 2(3), 88-99.
MediGence. (2025). Coronary artery bypass grafting (CABG) cost in Malaysia. Retrieved from https://medigence.com/hospitals/cardiac-sciences/cabg/malaysia
Mehta, R., Tsilimigras, D. I., Paredes, A. Z., Dillhoff, M., Cloyd, J. M., Ejaz, A., ... & Pawlik, T. M. (2020). Is patient satisfaction dictated by quality of care among patients undergoing complex surgical procedures for a malignant indication?. Annals of Surgical Oncology, 27, 3126-3135.
Milliman. (2018). Major challenges facing medical professional liability insurers. Retrieved from https://edge.sitecorecloud.io/millimaninc5660-milliman6442-prod27d5-0001/media/Milliman/importedfiles/uploadedFiles/insight/2018/MPL-2018-major-challenges.pdf
Ministry of Health Malaysia. (2017). Cardiac care performance report 2016. Malaysian Healthcare Performance Unit. https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Cardiac_Care_Performance_Report_2016new.pdf
Ministry of Health Malaysia. (2023). Health facts 2023. Ministry of Health Malaysia. https://www.moh.gov.my/moh/resources/Penerbitan/Penerbitan%20Utama/4._Health_Facts_2023-compressed_.pdf
Mirbabaie, M., Stieglitz, S., & Frick, N. R. J. (2021). Artificial intelligence in disease diagnostics: A critical review and classification on the current state of research guiding future direction. Health and Technology, 11, 693–731. https://doi.org/10.1007/s12553-021-00555-5
Moore, D. A., & Healy, P. J. (2008). The trouble with overconfidence. Psychological review, 115(2), 502.
MyMediTravel. (2025). Heart surgery procedures in Malaysia. Retrieved from https://www.mymeditravel.com/heart-surgery-procedures-in-malaysia
Nickerson, R. S. (1998). Confirmation bias: A ubiquitous phenomenon in many guises. Review of general psychology, 2(2), 175-220.
Norman, G. R., Monteiro, S. D., Sherbino, J., Ilgen, J. S., Schmidt, H. G., & Mamede, S. (2017). The causes of errors in clinical reasoning: cognitive biases, knowledge deficits, and dual process thinking. Academic Medicine, 92(1), 23-30.
Petty, R. E., & Cacioppo, J. T. (1986). The elaboration likelihood model of persuasion. Springer New York.
Prince Court Medical Centre. (2025). Heart services. Retrieved from https://princecourt.com/medical-surgical-services/heart
Prodia. (2025). Why do most Indonesians do medical tourism in Penang? Retrieved from https://prodiadigital.com/en/articles/why-do-most-indonesians-do-medical-tourism-in-penang
Rendell, V. R., Siy, A. B., Stafford, L. M. C., Schmocker, R. K., Leverson, G. E., & Winslow, E. R. (2020). Severity of postoperative complications from the perspective of the patient. Journal of patient experience, 7(6), 1568-1576.
Saposnik, G., Redelmeier, D., Ruff, C. C., & Tobler, P. N. (2016). Cognitive biases associated with medical decisions: a systematic review. BMC medical informatics and decision making, 16, 1-14.
Sarwar, A. (2013). Medical tourism in Malaysia: Prospect and challenges. Iranian journal of public health, 42(8), 795.
Seraj, Z. (2025, February 17). Premium care at ‘fraction of the cost’: Why medical tourists are flocking to Malaysia for their nips and cuts. Yahoo News Malaysia. Retrieved from https://malaysia.news.yahoo.com/premium-care-fraction-cost-why-230000904.html
Shekhar, D. (2023, August 7). Heart bypass surgery in Malaysia: Hospitals, cost, risks. HMS Desk. Retrieved from https://hmsdesk.com/medical/malaysia/heart-bypass-surgery-malaysia
Singh, H., Meyer, A. N., & Thomas, E. J. (2014). The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ quality & safety, 23(9), 727-731.
Singh, H., Schiff, G. D., Graber, M. L., Onakpoya, I., & Thompson, M. J. (2017). The global burden of diagnostic errors in primary care. BMJ quality & safety, 26(6), 484-494.
Singh, J. (2024, November 13). The role of AI in predictive healthcare: Improving diagnostics and treatment outcomes. FPGA Insights. Retrieved from https://fpgainsights.com/artificial-intelligence/role-of-ai-in-predictive-healthcare
Sok May, C., Sivanandy, P., Ingle, P. V., & Manirajan, P. (2024). Assessment of patient safety culture among healthcare providers in tertiary hospitals in Malaysia—A cross‐sectional study. Health Science Reports, 7(10), e70035.
Stanovich, K. E. (2009). Distinguishing the reflective, algorithmic, and autonomous minds: Is it time for a tri-process theory. In two minds: Dual processes and beyond, 55-88.
Statista. (2025). Total population of the ASEAN countries from 2019 to 2029. Retrieved from https://www.statista.com/statistics/796222/total-population-of-the-asean-countries/
Subramaniam, D. (2023). Addressing the shortage of nurses in Malaysia. Sunway University. Retrieved from https://sunwayuniversity.edu.my/explore/thinkpieces/addressing-shortage-of-nurses-malaysia
Syah, A. M., Deemod, K., Li, L. Y., & Rosman, A. (2022). The growth of medical tourism and the impacts on local wellbeing equality: a case of Thailand. Geo Journal of Tourism and Geosites, 40(1), 200-209.
Tahir, N. U. A., Rashid, U., Hadi, H. J., Ahmad, N., Cao, Y., Alshara, M. A., & Javed, Y. (2024). Blockchain-Based Healthcare Records Management Framework: Enhancing Security, Privacy, and Interoperability. Technologies, 12(9), 168.
Tamata, A. T., & Mohammadnezhad, M. (2023). A systematic review study on the factors affecting shortage of nursing workforce in the hospitals. Nursing open, 10(3), 1247-1257.
Tatum, M. (2022, July 6). How South East Asia is rebooting medical tourism in a pandemic world. Medical Tourism Magazine. https://www.magazine.medicaltourism.com/article/southeast-asia-rebuilding-medical-tourism-amid-the-pandemic
Taxand. (2022). Malaysia. Retrieved from https://www.taxand.com/wp-content/uploads/2022/07/Malaysia.pdf
Taylor, R. A., Sangal, R. B., Smith, M. E., Haimovich, A. D., Rodman, A., Iscoe, M. S., ... & Declan, A. (2024). Leveraging artificial intelligence to reduce diagnostic errors in emergency medicine: Challenges, opportunities, and future directions. Academic Emergency Medicine.
The Star. (2023, January 2). A stronger, more positive comeback for Malaysia's medical tourism. The Star. Retrieved from https://www.thestar.com.my/lifestyle/travel/2023/01/02/a-stronger-more-positive-comeback-for-malaysia039s-medical-tourism
The Straits Times. (2023, March 22). Over 300 complaints filed over unregistered beauty premises since 2023, says M'sian Health Ministry. The Straits Times. https://www.straitstimes.com/asia/se-asia/over-300-complaints-filed-over-unregistered-beauty-premises-since-2023-says-msian-health-ministry
Turner, L. (2012). Beyond" medical tourism": Canadian companies marketing medical travel. Globalization and Health, 8, 1-11.
Tversky, A., & Kahneman, D. (1974). Judgment under Uncertainty: Heuristics and Biases: Biases in judgments reveal some heuristics of thinking under uncertainty. science, 185(4157), 1124-1131.
World Health Organization. (2020, April 7). WHO and partners call for urgent investment in nurses. World Health Organization. https://www.who.int/news/item/07-04-2020-who-and-partners-call-for-urgent-investment-in-nurses
Yau, C. W. H., Leigh, B., Liberati, E., Punch, D., Dixon-Woods, M., & Draycott, T. (2020). Clinical negligence costs: taking action to safeguard NHS sustainability. Bmj, 368.
Yong, S. P., Goh, Y. N., Ting, M. S., & Lunyai, J. (2021). Revisit intention for medical services: an investigation on Penang as a medical tourism hub. Malays J Consum Fam Econ, 26, 127-157.
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