Health Care Financing Missing From Budget 2023: Galen

Azrul Mohd Khalib tells the government to invest in a new and sustainable approach to funding health care, amid challenges with NCDs, mental health, and an ageing population.

KUALA LUMPUR, Oct 8 – The Galen Centre for Health and Social Policy has expressed disappointment that the federal government’s 2023 budget did not provide long-term and sustainable health care financing solutions.

Galen Centre chief executive Azrul Mohd Khalib told the government to summon the political will and commitment to invest now in a new and sustainable approach to funding health care, so that Malaysia’s health care system can continue providing quality, affordable, and accessible health services to all in the decades to come.

Azrul also cited challenges of preventing and treating non-communicable diseases (NCDs), mental health, and an ageing population.

“More than ever before, we need to invest in future-proofing and increasing the resilience and sustainability of the public health care system. We cannot take it for granted,” Azrul said in his comments on Budget 2023 tabled yesterday.

Previously, Azrul called for the removal of the RM1 and RM5 charges for outpatient and specialist care respectively in Ministry of Health (MOH) facilities. These fees, he said, were inadequate for cost recovery and should be replaced instead with co-payments for certain treatments like diabetes and with social health insurance.

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.

In a recent interview with Astro Awani, Azrul explained that a social health insurance scheme in Malaysia could model after the United Kingdom, Taiwan, Singapore, Indonesia, South Korea, Australia, or New Zealand, where employees and employers would make payroll contributions – like the Employees Provident Fund (EPF) or Social Security Organisation (Socso) – into a certain fund earmarked for health care costs, such as for treatment or infrastructure.

“When we have more people contributing into this pool, we would be able to collect this pool of money to invest into developing health care. This would not replace existing allocation that the government already provides under the federal budget; it would complement.”

MOH’s 2023 budget increased by a whopping 11.5 per cent, or RM3.7 billion, to RM36.1 billion from RM32.4 billion in this year’s budget. The increment is the largest both in terms of percentage of increase and absolute figures in the past five years.

“When the budget 2023 document is reviewed, the breakdown for that allocation gives a mixed impression of being part of a responsive budget and being business as usual,” Azrul said, commenting on MOH’s allocation.

The Galen Centre also criticised budget cuts to health education and the Peka B40 health screening programme, pointing out that one in five Malaysian adults live with diabetes, three in 10 with hypertension, and that half of the adult population are either overweight or obese.

“Despite the Finance Minister recognising that Malaysia is still in pole position among countries in this region with a high population who are obese or living with non-communicable diseases, there seems to be little to address this situation.”

Azrul further criticised the government for its unwillingness to fund a nutritious food programme in schools for all children to address child malnutrition, despite allocating RM150 cash assistance in the 2023 budget for all children, regardless of household income, under the Bantuan Awal Persekolahan (BAP) programme.

“Stunting and obesity are both affecting a significant proportion of Malaysia’s children, regardless of economic backgrounds. When are we going to invest in addressing the problem of childhood malnutrition?”

CodeBlue reported that based on the Finance Ministry’s Estimated Federal Expenditure 2023 document, the government made a 14.7 per cent budget cut to health education under MOH’s public health programme for next year, amounting to a decrease of nearly RM9 million.

The Peka B40 health screening programme, which provides fully subsidised health screenings for the bottom 40 per cent (B40) of income earners, lost RM5 million in funding for 2023, or a cut of about 6 per cent.

Although Azrul welcomed the RM34 million allocation to establish a National Centre of Excellence for Mental Health, he said the money would be better spent on increasing the number of psychiatrists, psychologists, and other mental health professionals.

“We need to increase availability and coverage of mental health services, which currently are inadequate. We need more service providers, or at least means for people to access both public and private mental health services. This will require long term investment and commitment.”

According to the Estimated Federal Expenditure 2023 document, MOH made a 2 per cent cut (RM580,000) to services and supplies for psychiatry and mental health under the medical programme.

Azrul criticised the lack of transparency in MOH’s budget, noting that allocations for drugs and treatments under specific disease areas are unclear as they continue to be lumped together under broad-line items, “which prevent an understanding and transparency of funding priorities for therapies”.

The Galen Centre, however, welcomed the allocation of RM1.8 billion for building new hospitals, clinics, and health care facilities, besides an RM420 million allocation towards the repair, maintenance, and upgrading of existing facilities.

“This is an important point as over the past five years, there have been several fires at aging facilities, including one at the Sultanah Aminah Hospital in Johor, which saw six fatalities due to a fire in 2016. Out of Malaysia’s 156 public hospitals, 45 are over 100 years old,” Azrul pointed out.

“The government also wants to address the contract doctor issue by increasing the line item for contract recruitments, but seems to not have increased permanent positions despite large increases in emoluments across the board. This is obviously intended to fund the promotion of existing staff and increase salaries to support retention of skilled healthcare workers,” he added.

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