Dzulkefly Moots National Health Care Trust Fund

Former health minister Dzulkefly Ahmad proposes a health care financing model with financing sources from insurance companies, individuals, zakat, waqf and endowments.

PUTRAJAYA, Jan 25 – Dzulkefly Ahmad has called for a national health care trust fund with various financing sources to enable access to health care services across the public and private sectors.

The former health minister noted that Malaysia’s current health care financing — in which public health care financing primarily depends on allocations from the federal budget to the Ministry of Health (MOH) — is increasingly unsustainable. 

In 2020, Malaysia’s total health expenditure of about RM67 billion was split between 55 per cent from the public sector and 45 per cent from the private sector.

“It is no longer sustainable for the assemblance of a health care [system] worthy Malaysia to be only dependent predominantly on the consolidated fund or the taxpayers’ money,” Dzulkefly told CodeBlue in an interview in conjunction with the second anniversary of Malaysia’s Covid-19 epidemic.

“Beyond just allocation from the federal budget, you must move on to getting assemblance over health care of a national health trust fund that mobilises all resources from insurance companies, individuals, even zakat, for that matter, even waqf and endowments.”

Dzulkefly did not specify the rate of contributions from workers’ salaries that should go towards the national health trust fund he proposed.

Barisan Nasional tried unsuccessfully in 2011 to move Malaysia towards a social health insurance system called 1Care that was modelled after the United Kingdom’s National Health Service (NHS).

The Twelfth Malaysia Plan (12MP) 2021-2025 has indicated a potential hike in health care charges for “higher-income” patients in the next four years, where patients’ health care charges would be determined based on their income status. However, the reviewed health care charges were not specified in the plan.

In order to diversify funding resources and create an alternative health care funding system, the government has also announced plans to establish a National Health Endowment Fund in another four years. The fund is said to be derived from waqf, a charitable endowment fund made by Muslims in the country.

Dzulkefly laid an emphasis on public-private partnerships that can pave the way for people to access both public and private health care facilities through the proposed national health trust fund.

“That is our vision, that’s my vision, that’s the vision of Pakatan Harapan before. We could strategically purchase this because we have a system called a National Health Trust Fund that pays for it all, finance for it all. And you can only do that if the health care financing of our health care system is addressed.”

Dzulkefly pointed out that current health care financing focusing on a single consolidated fund is unsustainable, as he highlighted the need to explore all other resources in the country.

“More importantly, you see the out-of-pocket expenditure of more than 26 per cent, which is a very wasteful and inefficient spending of the rakyat. Be mobilised and into the assemblance of a health care financing system that will eventually be able to deliver as a health care service, that will be able to access both public and private.”

According to the Health Ministry’s Malaysia National Health Accounts (MNHA), private household out-of-pocket (OOP) expenditure comprised 34.5 per cent of Malaysia’s RM67 billion total health expenditure in 2020. About 43 per cent of the RM23 billion OOP expenditure went to outpatient services.

It is important to note that the Covid-19 epidemic has enabled for effective public-private partnerships (PPPs) by decanting non-Covid patients from the public to private health care facilities amid insufficient budgets. 

In fact, health care service providers in public and private sectors have also been advocating a reformation of the country’s health funding in order to support and build on the many public-private partnership efforts carried out over the course of the pandemic.

According to MNHA, the country’s total health expenditure has been growing each year between 2006 and 2020 — from RM28.98 billion in 2006 to RM67.02 billion in 2020 — a spike of almost 2.3 times in 14 years.

In the same period of time, the country’s spending of its gross domestic product (GDP) on health care increased from 3.7 per cent (RM596.78 million) to 4.7 per cent (RM1.42 billion).

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