KUALA LUMPUR, Sept 6 – Khairy Jamaluddin aims to double the public health care budget to 5 per cent of Malaysia’s gross domestic product (GDP) within eight years by 2030.
The health minister noted that at currently 2.58 per cent of GDP, Malaysia has among the smallest public health care budgets among middle income countries.
“That’s why I said we need 5 per cent of GDP. That’s non-negotiable,” Khairy told his first town hall session on the Health White Paper yesterday, held at Sarawak General Hospital in Kuching, Sarawak.
“Hopefully, if the White Paper is approved, by 2030, we’ll be at 5 per cent of GDP. More money for us, more money for all of you.”
Despite the Covid-19 pandemic, the Ministry of Health’s (MOH) allocation under Budget 2022 tabled last October increased only by a meagre 1.5 per cent to RM32.4 billion from the 2021 budget.
Khairy also highlighted high out-of-pocket (OOP) spending in Malaysia on private health care.
According to the MOH’s National Health Accounts Steering Committee’s November 3, 2021 presentation, OOP health care spending in Malaysia more than tripled from RM7.14 billion in 2006 to RM23.15 billion in 2020, with 43 per cent of OOP spending last year going to outpatient services.
Private household OOP comprised 76 per cent of Malaysia’s health expenditure in 2020 by private sources of financing, while private insurance made up just 15 per cent.
“A lot of the out-of-pocket is not insurance because a lot of people are not insured, so out-of-pocket is really out of pocket, paid from savings, paid from income for procedures that are really expensive, not because they don’t want to come to public hospital – they love public hospitals – but the wait time is too long,” Khairy said.
The health minister also raised the need for other forms of health care financing in future, besides increasing MOH’s annual allocation from the general taxation revenue pool.
“I don’t even want to start talking about social health insurance. If I start talking about that, it becomes a big issue,” he said.
“But at some point, we have to think about how the financing is sustainable. Now we can ask for 5 per cent of GDP, but after that, are we going to ask for more and more and more? Or are we going to think about how to co-finance this together? So financing is an issue.”
In Malaysia’s dual health care system, public health care is vastly subsidised by the government. Co-financing can come in various forms, either via social health insurance with contributions from workers and employers or by co-payments in the form of patients partially paying for medicines in the public health care system.
During the Q&A session at the town hall, Sarawak Pharmacists Society advisor Wong Sie Sing, who is also a Pharmacy Board Malaysia member, suggested a social health insurance scheme funded by 5 per cent payroll contributions from all employees and employers, in addition to the public health care budget of 5 per cent of Malaysia’s GDP funded from general taxation revenue.
He pointed out that many young people are forced to pay out-of-pocket for their aged parents’ health expenses, prohibiting them from undertaking any business venture.
“So, to improve health care services, a national health care financing scheme is required,” Wong told Khairy at the town hall. “This has been talked about for the past 20 years.”
“It is right that every Malaysian must take responsibility to be healthy and to pay for the upkeeping.”
The Sarawakian senior pharmacist also called for dispensing separation – a proposal to separate the prescribing and dispensing of medicine that has long been opposed to by private general practitioners (GPs).
“Doctors, dentists, nurses, and paramedics should only function in line with formal education and qualification, in line with formal training,” Wong said.
“Doctors diagnose and prescribe, pharmacists clear and dispense prescriptions, and nurses provide tender nursing care.”
Parliament recently passed amendments to the Poisons Act 1952, which regulates medications, but the amendment omitted mandatory prescriptions upon request that were initially proposed in 2019 and had triggered fierce backlash from private medical practitioners.