CodeBlue Poll Shows Most Support Social Health Insurance

A CodeBlue survey shows 72% support mandatory social health insurance funded by payroll deductions, 46% back restoring GST to increase the public health care budget, and 88% want the Prime Minister’s Department’s allocation reduced and diverted to MOH.

KUALA LUMPUR, Sept 29 – A survey by CodeBlue on health care financing reform shows clear support for the idea of a mandatory national health insurance scheme with payroll contributions from all employers and employees. 

Despite heavy reservations across the political aisle towards introducing social health insurance to boost Malaysia’s unsustainable health care system, CodeBlue’s survey found that seven in 10 respondents (72.2 per cent) supported it. 

Three quarters of the overall 529 people who participated in the poll are working-age adults. CodeBlue’s survey did not ask respondents for their suggested scale of payroll deductions for a national health insurance programme.

Nearly half (46.3 per cent) of respondents were in favour of restoring the goods and services tax (GST) to raise the public health care budget, although more than half (56.3 per cent) opposed cutting fuel subsidies to increase public health care funding.

The two-week online poll, which ran from September 6 until 21, showed that 92.4 per cent out of 529 total respondents agreed that the annual public health care budget should be doubled to RM70 billion, or five per cent of the country’s gross domestic product (GDP), as mooted by Health Minister Khairy Jamaluddin.

Malaysia’s total public health spending is currently only 2.6 per cent of the GDP.

A vast majority, or 489 respondents – who chose to answer a question about reducing another ministry’s budget to fund an increase in the Ministry of Health’s (MOH) allocation – said that the Prime Minister’s Department budget should be cut for this purpose. Forty out of 529 total respondents opted to skip the question.

The Prime Minister’s Department comprises the personal office of the prime minister, a number of ministerial-ranked advisors, and a slew of agencies, councils, commissions, departments, and units.

They include the Department of Statistics, the National Security Council (MKN), the National Disaster Management Agency (NADMA), the Economic Planning Unit (EPU), the Malaysian Administrative Modernisation and Management Planning Unit (MAMPU), the Department of Islamic Development Malaysia (JAKIM), and councils for various economic corridors.

More than half (51.7 per cent) said budgetary cuts should also come from the National Unity Ministry, the Federal Territories Ministry (47.4 per cent), the Defence Ministry (30.3 per cent), and the Foreign Affairs Ministry (26.4 per cent) to finance a raise of MOH’s allocation.

Under Budget 2022, the Defence Ministry was given an allocation of RM16.1 billion, the fourth highest after the Education Ministry (RM52.6 billion), the Health Ministry (RM32.4 billion), and the Home Affairs Ministry (RM17.1 billion).

The Foreign Affairs Ministry was allocated RM868.5 million, the Federal Territories Ministry  RM670.8 million, and the National Unity Ministry (RM447.9 million).

Only three per cent of respondents said that the government’s RM52.6 billion allocation on education – the largest in Budget 2022 – should be slashed. 

The majority of respondents (56.3 per cent) did not support cutting fuel subsidies to increase the public health care budget. Responses were relatively mixed about removing the RM1 outpatient and RM5 specialist fees at public health care facilities, which was previously proposed by Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib.

About 65.2 per cent of respondents think that Malaysia’s dual health care system is currently unsustainable, while 63.7 per cent support the notion of co-payments, where patients pay a portion for all medications at public health facilities and the government pays the rest.

Nearly 90 per cent support a cap on private hospital fees or greater transparency of private hospital fees. 

Expensive Private Care, Congested Public Health Care Facilities, PWD Can’t Access Medical Insurance

A word cloud for an online CodeBlue survey on health care financing reform conducted from September 6-21, 2022, from answers to the question: “What are the biggest issues you’re currently facing in health care?”. Graphic by CodeBlue.

When asked what the biggest issues in health care that respondents are facing, many cited expensive costs at private health care facilities, as well as long waiting time and poor resources at public health centres.

One anonymous respondent said government subsidies should be targeted instead of across all fields of public health. “Long waiting time for critical procedures, lack of infrastructures in some government hospitals, and poor hospital and hospital equipment maintenance,” the respondent wrote. 

Another respondent shared the dilemma of middle-income families. 

“Middle-income families like mine have little option. Public health care is free but facilities, equipment, medications are old and too congested. Although facilities, equipment, medications are new in the private [sector], the price is out of reach.

“If public health care can catch up in terms of facilities, equipment, medications, it would give people like my family better peace of mind when it comes to dealing with the uncertainties of adverse health events,” the respondent wrote. 

A number of respondents highlighted the fact that persons with disabilities (PWD) have no access to medical insurance. One respondent, who has a disability, called for a revamp of the current medical insurance system to make it more accessible to PWDs.

“[A] couple of years ago, I was admitted to a private hospital for dengue. I had to fork out my own money. Dengue has nothing to do with my disability. I don’t really know why insurance companies don’t cover PWD for diseases that are non-related to disability. I know it’s difficult for them to cover our disability, but not all diseases are related to disability. 

“I know PWDs can get free treatments at government hospitals, but PWDs should also have freedom of choice just like abled people. If we have medical insurance, we also can go to private hospitals just like normal people would do without worrying about the money,” the respondent wrote. 

A few others wrote about rising out-of-pocket expenses for cancer diagnosis and surgery. One respondent claimed that the cost for even a minor operation has doubled at a private university hospital. Another respondent spoke of month-long waits at government hospitals for check-ups and the lack of oncologists to treat cancer patients in Sarawak.

Survey Participants Mostly Based In Klang Valley

The Covid-19 pandemic has brought into focus the need for health care reforms that promote sustainable access to affordable care. 

Malaysia’s rapidly ageing population and a growing non-communicable diseases (NCDs) burden will put greater strain on a system already stretched thin. In the face of the Delta wave last year, the country’s public health care system had reached breaking point.

Long waits for admission and care at public hospitals often forces patients to seek faster, and usually costlier treatment options at private hospitals. This can be seen in the tripling of out-of-pocket health care spending from RM7.14 billion in 2006 to RM23.15 billion in 2020.

Medical costs in Malaysia have climbed at an average of eight to nine per cent annually from 2013 to 2018, and are expected to further increase in part due to the country’s ageing population, NCD prevalence, advances in medical treatment, and ringgit depreciation.

The Health White Paper, which Health Minister Khairy Jamaluddin intends to table in Parliament by year end, aims to reform the health care system, including its financing.

Out of the CodeBlue survey’s 529 total respondents, 52.9 per cent were male, 43.7 per cent were female, and 0.4 per cent were transgender. The remaining three per cent preferred not to disclose their gender.

About 38.4 per cent were ethnic Chinese, 20.2 per cent Malays, 22 per cent ethnic Indians, 2.8 per cent were Bumiputera Sabah and Sarawak, and 0.2 per cent were foreign nationals. Another 13.4 per cent preferred not to say.

The biggest chunk of respondents (27 per cent) were aged between 50 and 59, followed by those aged 60 years and older (25 per cent), 30 to 39 years (24.6 per cent), 40 to 49 years (18 per cent), 20 to 29 years (4.9 per cent), and less than 20 years old (0.4 per cent).

Nearly 42 per cent of respondents currently live in Selangor, followed by Kuala Lumpur (29 per cent), Sarawak (5 per cent), Penang (4 per cent), Perak (3.7 per cent), and Johor (3.6 per cent).

Most respondents (94 per cent) have a university education, with 6.6 per cent having a secondary education. About 35 per cent currently earn a monthly gross salary of RM10,001 and above, with a further 29.5 per cent earning between RM5,001 and RM10,000 in monthly gross salary. Another 21.6 per cent are retired with or without income.

The majority of respondents (34.6 per cent) live in Selangor, followed by Kuala Lumpur (18.5 per cent), Sarawak (13.2 per cent), Penang (7.6 per cent), and Perak (7 per cent).

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