2023 Health Budget Remains Stagnant Against GDP – Dr Musa Mohd Nordin

The Health Ministry’s Budget 2023 comprises 1.98% of Malaysia’s GDP, the same share as in 2022; the Health White Paper targets 5% of the GDP.

There has been much euphoria among Ministry of Health (MOH) politicians and technocrats, the press, health non-governmental organisations (NGOs), and even health think tanks on the 11.5 per cent increase in the health budget from RM32.41 billion in 2022 to RM36.14 billion in 2023.

I would, however, tend to agree with one of my public health colleagues that this 11.5 per cent increase in the MOH budget parallels the whopping 12.1 per cent hike in the total federal budget from RM332.1 billion in 2022 to RM372.3 billion in 2023.

Any changes in the health budget must be rationalised against at least two of the following factors, namely, the MOH share of the federal budget and the health budget as a percentage of the GDP.

On both accounts, there has been no difference in the health budget when contrasted against the government operating and development expenditure (9.7 per cent for both years), or as a percentage of the GDP (1.98 per cent for both years).

If anything, the Ministry of Finance (MOF) did not heed the calls of the Health White Paper (HWP) to increase incrementally the health allocation as a percentage of the GDP, with the 5 per cent mark as the target.

I hope this will offer an alternative perspective to the budget numbers game. We have not even begun to factor in the pressures of inflation and the dwindling value of the ringgit.

Prior to the release of the Federal Budget 2023, I had about six tangible, relatively low budget, but high impact expectations on my budget wish list. All six were missing from my overview of the goodies in the health budget, but I may have missed the fine print or specifics!

The Ministry of Health’s (MOH) annual allocation as share of the federal government’s budget from 1980 to 2023. Graphic by Dr Musa Mohd Nordin.

A savvy and robust Health Information System (HIS)

A HIS that wired up the entire MOH network of General Hospitals, District Hospitals and Health Centres, and the 8,000 GPs (thrown in pro bono by the vendor).

And hopefully with smart negotiations, will eventually wire-up with the Association of Private Hospitals Malaysia (APHM), Ministry of Defence (MOD) and Ministry of Education (MOE) hospitals and other health related institutions.

The HIS will empower every Malaysian and users of the HIS, an Electronic Medical Record (EMR) from cradle to grave, on one’s smartphone. This was amiss!

Instead, a local private hospital is beneficiary of the award-winning, cutting edge, affordable and best HIS.

By the way, this new HIS was unanimously voted tops from among 20 vendors by the MOH-HIS selection committee in 2019. More recently, they won the HIMSS (Healthcare Information and Management Systems Society), best health IT solution award in Bali.

Resilient Public Health Preparedness Tools

Another public health colleague has been in the front-line developing a robust and resilient public health system that can prevent, detect, and respond to infectious disease threats immediately.

It needs to remain contemporary with a central database for disease reporting, genomic sequencing, wastewater sampling, environment sampling, zoonotic diseases, and antibiotic use.

Since the pathogen does not recognise boundaries, Malaysia can take the lead in future public health preparedness by initiating a regional collaborative system, and kickstart with the ASEAN region!

But alas!

The government must urgently address the acute-on-chronic human resource crisis in the MOH by implementing the loud call from experts in the HWP to form the Suruhanjaya Perkhidmatan Kesihatan or similar modus operandi.

107 doctors quit the MOH in 2017, which has escalated to 168, 475, 511 and 768 from 2018 to 2021 respectively.

There has been calls from the health fraternity, including the Academy of Medicine Malaysia (AMM), for an expert committee relook and better analyse the questionnaire and 14,000 pages of verbatim records of the “toxic work culture and bullying” not fully addressed by the Healthcare Work Culture Improvement Task Force (HWCITF) in order to better protect the welfare of house officers and junior medical officers.

Failure to enhance Public-Private-Partnership (PPP)

The MOF and MOH has failed to build on the unprecedented PPP, which was seen in full action during the pandemic.

The APHM has lamented the lack of incentives in the budget to further cement the collaboration between the private and public hospitals and for better utilisation of the “20 per cent of resources in private hospitals which are underutilised, while public hospitals were overburdened”.

No real push in Budget 2023 to mainstream and exemplify preventative health strategies versus the current curative bias mindset.

As far as child health is concerned, the legacy of the Pakatan Harapan (PH) government was the introduction of the Pneumococcal Conjugate vaccine (PCV) within one year of taking office in 2019, despite our crusade for the PCV for 14 years since 2005 through multiple Barisan Nasional (BN) governments.

There is an urgent need to prioritise cost effective (CE) preventative health care, especially since Malaysia has now transitioned into an ageing society.

The percentage of the population aged 65 and over (old age) is 7.3 percent in 2022, and is expected to double to 14.5 per cent in 2040.

If a healthy lifestyle is not maintained, and the plethora of non-communicable diseases (NCDs) is not mitigated, it is estimated that older adults will spend 9.5 years in poor health.

My wish list for budget 2023 was the introduction of either the influenza or pneumococcal vaccine in the National Immunisation Program (NIP) for older persons.

There is like zero vaccine in the adult National Immunisation Programme (NIP). Multiple pharmaco-economic analysis of influenza vaccines in the elder persons have been shown to be Cost-Effective and most first world countries have influenza vaccination programmes for citizens aged above 65 years.

77.2 per cent of laboratory confirmed influenza patients admitted into the ICU or died in Singapore from 2011-2015 were above 65 years and 70 per cent of them had at least 1 chronic medical condition.

Investment in the influenza vaccines has been shown to protect them from getting influenza, but if they are infected, reduces the severity of symptoms, reduces the risk of hospitalisation by 45 per cent, reduces the risk of heart attacks by 36 per cent, reduces by 30 per cent the risk of strokes in diabetics, reduces the risk of death by 42 per cent, and helps to protect the independence of the elder persons.

If RM6 billion was set aside to procure Covid-19 vaccines alone, MOH’s Budget 2023 of RM4.9 billion for “public health spending to procure medicines, reagents, vaccines and disposable items” is pittance.

Is Health Financing (HF) a “dirty word” come General Elections?

Looks like it is business as usual as far as health financing is concerned.

The MOF has not shared any thoughts or insights whatsoever on reorienting the multiple pools of health or investments towards a sustainable trajectory, with a bigger impact on the nation’s productivity and health outcomes.

Didn’t the MOF peep into the much touted HWP which, among others, expressed the importance and urgency of a need to refocus economies and prioritise investments in health to ensure a more sustainable and resilient health system?

There is the need to pool funding sources in order to reclaim market power, to invest in preventative and value-based health care, and to empower strategic purchasing for quality and best prices.

Health financing would be anchored by federal taxation with multiple contributions from employer health coverage, state government health budget, pension healthcare funds, private health insurance, Islamic social funds and others.

Increased pooled health investments in a mechanism like the National Health Fund (NHF) would represent a harmonized approach to Health Financing which avoids fragmentation, duplication, enhances equity (Universal Health Coverage) and efficiency!

It would be the de facto single payer strategic purchasing mechanism to integrate both public and private healthcare providers to deliver high-quality, low-cost and value based health care services, which would achieve “more rumble for the ringgit”.

Dr Musa Mohd Nordin is a consultant paediatrician.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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