KUALA LUMPUR, Sept 20 – The Galen Centre for Health and Social Policy today called for the removal of the RM1 and RM5 charges for outpatient and specialist care respectively in Ministry of Health (MOH) facilities in the upcoming Budget 2023.
Galen Centre chief executive Azrul Mohd Khalib said these charges for patient visits at MOH hospitals sustained the “misrepresentation” that health care in Malaysia is somehow cheaper in government facilities.
“They are also inadequate for meaningful cost recovery, and mislead the public regarding the true cost of health care,” Azrul said in a statement today, ahead of the tabling of the federal 2023 budget on October 7.
“We believe that these charges act as a barrier, and should be removed to facilitate future reforms in health care financing.”
Public health care is hugely subsidised in Malaysia. Health Minister Khairy Jamaluddin previously told Parliament last July that the RM1 and RM5 medical fees are unsustainable, pointing out that revenue from these fees account for only one per cent of public health care expenditure.
Azrul pointed out that conversations surrounding health care in Malaysia have long been dependent on and restricted by issues of affordability, rather than being centred around meeting current needs and ongoing challenges of a growing population and Malaysia’s transition from an upper middle income to high-income economy.
“Decisions are often based on what we can afford rather than finding out what we need, how much money is available, and finding solutions to bridge those funding gaps,” he said.
“This is also not just about having more funding, but also how that money is spent. We need to change the way we look at health. Investment not expenditure.”
In his pre-Budget 2023 statement, Azrul also urged the government to reduce government subsidisation of diabetic treatments and to introduce co-payments of up to 30 per cent of the actual cost.
Co-payments refers to payments for health care that are shared between the patient – either out-of-pocket or via health insurance – and the government.
The Galen Centre cited a recent report by MOH and the World Health Organization (WHO) that showed annual direct health care costs from diabetes in Malaysia amount to RM4.38 billion, the highest among three common non-communicable diseases (NCDs) compared to cardiovascular disease (RM3.93 billion) and cancer (RM1.34 billion).
For every ringgit spent on the three chronic illnesses, 45 sen goes to diabetes, 41 sen goes to cardiovascular disease, and 14 sen to cancer. Azrul noted that nearly four million people are living with diabetes in Malaysia.
“People must care and take charge of their own health. It will also help reduce wastage of subsidised medication,” he said.
The Galen Centre suggested introducing a national insurance scheme for those above the age of 40 to specifically fund aged and long-term care, rather than depend on unfunded and unsustainable entitlements.
“Ad-hoc approaches will not be sufficient or sustainable,” Azrul said.
He urged the government to make improving aged and long-term care a priority in Budget 2023, noting that Malaysia is ill-prepared to deal with the needs and consequences of a growing ageing population.
“Aged and long-term care facilities and relevant essential services remain limited, mostly confined to urban centres, and concentrated to private providers,” Azrul said.
“There is a lack of clarity on which ministry should be responsible. There is unsustainable dependence on informal care. As a result, this issue has suffered tremendous decline, resulting in many older individuals vulnerable to neglect, substandard care, and even abuse.”
For Budget 2023, the Galen Centre called for increased commitments and investments in five key areas: health care financing, NCDs, public health emergency preparedness and response, reproductive health, and aged care.
On public health emergencies, Azrul noted that the Covid-19 pandemic has demonstrated the value of investing in public health systems that can effectively respond to emerging infectious diseases and outbreaks.
“We need to increase the capacity of the disease control division of the Ministry of Health to prevent, detect and manage future epidemics. That means investing in training more epidemiologists, public health specialists, infectious disease experts, and increasing diagnostic laboratory capacity.”
On sexual and reproductive health, Azrul described unintended pregnancies as a “national concern”, stressing that unintended pregnancy is not just a problem of teenagers, unmarried women, or poor women from disadvantaged backgrounds.
“Being able to plan or decide one’s pregnancy enables women to take control of their futures, so that they can finish their education, get better jobs, and not be trapped in a cycle of grinding poverty and deprivation. It affects everyone,” he said.
“This Budget should have an increased allocation to strengthen essential reproductive health services in the Ministry of Health and the National Population and Family Development Board (LPPKN), which include providing contraceptives for both married and unmarried individuals.”