Budget 2020’s Health Allocation Not Enough, Analysts Say

By MP Durgahyeni | 16 October 2019

The health budget failed to focus on primary care and medicines too.

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KUALA LUMPUR, Oct 16 – Despite a small hike in the Ministry of Health’s (MOH) allocation under Budget 2020, analysts were disappointed that government health spending still hasn’t reached 4 per cent of Malaysia’s gross domestic product (GDP).

Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib said although the 6.6 per cent increase to RM31 billion was smaller than last year’s raise, it was important to note that the health budget now comprises 10 per cent of the overall federal government budget of RM297 billion.

“However, we are concerned that the budget may not adequately address the need for a long-term sustainable solution to health care financing, such as development of a national health insurance scheme for all,” Azrul said in a statement.

“We will need this to ensure that Malaysia’s health care system is able to continue to provide quality, affordable and accessible health services in the decades to come and tackle the challenges of preventing and treating NCDs (non-communicable diseases), such as cancer, diabetes, hypertension and obesity, increasingly diverse and complex health needs, and a growing aging population,” he stated.

Another analyst said Pakatan Harapan (PH) has again failed to do good on its election manifesto promises.

“There are other important promises, such as the one that the ruling coalition promised to increase the budget amount equivalent to 4 per cent GDP,” Lim Chee Han, independent health policy researcher, told CodeBlue.

“After this second budget tabled, now I can be convinced that they will be unlikely to fulfill this promise within their first term of governance.”

Lim Chee Han, independent health policy researcher

There are also concerns that the budget has failed to focus on primary care.

“Increase in health care budget seems to be focused in secondary care only; primary health care which has been well-proven to be the most cost-effective approach to prevent diseases seems to be neglected in this budget for 2020,” Monash University Malaysia pharmacy professor Kenneth Lee and pharmacy lecturer June Choon said.

Bigger Allocation Than 2019

MOH was allocated RM30.6 billion under Budget 2020, translating to an RM1.9 billion increase from its RM28.7 billion allocation in the previous federal government budget.

The 6.6 per cent raise in the budget for public health care next year was smaller than the 7.8 per cent increase in Budget 2019.

“The MOH should be applauded for getting higher allocation for the development expenditure; the percentage share of DevEx 2020 (8.7 per cent) is the highest since 2013 (10 per cent),” expounded Lim.

But Lee and Choon sounded disapproval in the lack of funding for the pharmaceutical sector.

“Good but increased funding should be allocated to pharmaceuticals to improve patient access to new and innovative medicines,” they told CodeBlue.

Lim noted that MOH has been given RM500 million in addition for next year.

“Hence you can see the announcement of slightly more allocation for building and upgrading more hospitals, for better maintenance of facilities and improving the rural health services.”

From the RM30.6 billion, the government allocated RM1.6 billion to build new hospitals as well as to upgrade existing ones.

Expansion Of Peka B40 And mySalam

For middle class citizens, mySalam now covers Malaysians with gross annual income of up to RM100,000, who will get RM4,000 cash if diagnosed with a critical illness. The bottom 40 per cent of income earners (B40), or recipients of the Bantuan Sara Hidup cash aid, get RM8,000.

The health protection scheme run by Great Eastern Takaful Bhd under the Finance Ministry’s purview also increased coverage of low-income Malaysians from the ceiling age of 55 to 65 next year, benefiting an additional 1.5 million people; the minimum age of coverage is 18 years.

“The amendments in the mySalam scheme will make a difference. The expansion from 36 to 45 critical illnesses as well as increasing coverage up to the age of 65 years of age, will be a welcome relief for many patients whose families have applied, failed and been left out of the scheme, despite needing the assistance,” said Azrul.

MOH’s Peka B40 health screening programme will also be extended to include the low-income aged 40 and above, from the initial minimum age of 50.

“The Galen Centre is gratified to see that its recommendation to increase the coverage of Peka B40 to include those above the age of 40 years has been taken up by the government,” enthused Azrul.

“This programme is an essential component in closing the gap of early diagnosis by alleviating cost as a significant barrier for people of lower income seeking to get themselves screened for non-communicable diseases such as cancer and diabetes, and get medical devices such as prosthetic limbs.”

Lim, however, is unimpressed with the announcements regarding mySalam and Peka B40.

“There is nothing much exciting about the policies announced, especially the one regarding the two existing programmes such as mySalam and Peka B40.

“The announcement is just an amendment to the existing ones, to expand the beneficiaries, due to low take-up/ claim rate for the current running programmes,” he explained.

Only 13 per cent out of a target 800,000 people from the B40 have been screened under Peka B40 so far, while mySalam only made about RM1.4 million in payouts as of July 30, a fraction of the RM400 million in annual insurance premiums that the government pays Great Eastern. The Singapore-based insurance company is contributing RM2 billion to the mySalam fund for five years.

“mySalam should be extended to beyond five years to facilitate long-term planning of health care organisations,” voiced Lee and Choon.

Pneumococcal Vaccination Promise Kept

Fulfilling its election manifesto, PH earmarked RM60 million to provide all children pneumococcal vaccination.

This is a relief, as previously the government was lambasted for failing to make good on this promise.

But there lingers a question if a proper feasibility study was done for this initiative.

“Though it is for realising one of the Pakatan Harapan Manifesto promises by giving pneumococcal vaccine to all children, I wonder if the MOH has done good study to justify the case for the inclusion of this current optional vaccine in the mandatory immunisation schedule,” opined Lim.

Boost For Medical Tourism

RM25 million was allocated to the Malaysia Healthcare Tourism Council (MHTC) to strengthen Malaysia’s position as the preferred destination for medical tourism in Asean for oncology, cardiology and fertility treatments.

But analysts say these should be expanded in due time to include other conditions.

“Good initiative. Long-term goal should be to extend to cover areas such as metabolic disorder, dialysis and gastrointestinal disorders,” opined Lee and Choon.

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