Budget 2023 Shows Higher Reliance On Contract Doctors

The Health Ministry allocated an additional RM600 million for contract staff emoluments for 2023, but maintained the number of permanent positions under its medical programme.

KUALA LUMPUR, Oct 10 – The Health Ministry’s (MOH) 2023 budget indicates the public health care sector’s continued dependence on contract medical officers, instead of increasing the number of specialists.

According to the Finance Ministry’s Estimated Federal Expenditure 2023 document, allocations for contract staff emoluments will be raised to RM2.6 billion, up 30 per cent from RM2 billion in 2022, making it one of the biggest allocation increases in MOH’s record RM36.14 billion budget.

At the same time, the ministry retained the number of permanent positions under its medical programme at 168,077 workers, despite broad increases in emoluments for various services, suggesting higher pay or promotions for existing staff.

By percentage, emoluments for imaging and diagnostic services saw the largest increase at nearly 12 per cent from RM238.5 million in 2022 to RM266.9 million in 2023. However, positions for imaging and diagnostic services were unchanged at 3,725.

The number of positions for pharmacy and supply services, which recorded the biggest increase in emoluments by sum at RM42.4 million (up 8.2 per cent), was also kept at 8,575.

Other therapeutic areas which saw considerable increases in emoluments were paediatric services, which was up by nearly RM20 million (3.3 per cent), psychiatry and mental health (up RM16.9 million or 5.8 per cent), and obstetrics and gynaecology (up RM9.2 million or 1.5 per cent).

Significant percentage increases in emoluments were also noted in urology, which increased by 9.3 per cent to RM32.1 million, otorhinolaryngology or ear, nose, and throat (ENT) services (8.9 per cent), nucleology (8.1 per cent), ophthalmology or eye care services (5.9 per cent), and blood transfusion services (5.6 per cent).

Five clinical specialties saw a cut to their emolument budget, namely, neurology at 9.2 per cent lower, dermatology (-7.5 per cent), plastic surgery (-3.9 per cent), orthopaedic services (2 per cent), and cardiothoracic services (-0.4 per cent).

It is unclear why emoluments for these therapeutic areas were reduced, despite the number of permanent positions being retained for next year.

MOH continued its trend since the 2021 budget of not specifically budgeting drugs and treatments for most medical specialties, with services and supplies only allocated in its 2023 budget for radiotherapy and oncology, dietetics and nutrition, psychiatry and mental health, rehabilitation medicine and traditional and complementary medicine, and blood transfusion medicine.

“We are still unable to see what the allocations for drugs and treatments are under specific disease areas as they continue to be clumped together under broad line items which prevent an understanding and transparency of funding priorities for therapies,” said Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib.

Allocations for specific programmes increased by 15.5 per cent, or RM897.2 million, from RM5.8 billion for this year to RM6.7 billion for 2023.

Under specific programmes, medical supplies for health care facilities received an extra allocation of RM293.1 million to RM3.3 billion for next year, from RM3 billion this year.

Concessions for the privatisation of medical labs and stores, under the financial commitments budget line item, rose by RM200 million from RM1.4 billion this year to RM1.6 billion for 2023.

RM1.7 billion was allocated for 2023 in “additional emoluments” under a new budget line item titled “new policy”. It is unclear what this refers to.

The Academy of Medicine of Malaysia previously wrote in 2020 that Malaysia is currently facing a shortage of medical specialists, with only 3.9 specialists to 10,000 population (as of June 30, 2020) compared to the OECD (Organisation for Economic Cooperation and Development) average of 14.3 specialists to 10,000 population in 2018.

Health Minister Khairy Jamaluddin previously told government doctors not to hold out hope for the abolishment of the contract system in the public health care sector.

He acknowledged manpower issues in MOH health care facilities, but indicated that the controversial contract system introduced in 2016 for doctors, dentists, and pharmacists was here to stay.

The MOH had previously pledged to create more than 8,600 permanent positions for medical, dental, and pharmacy officers from 2022 until 2025. This includes 4,186 permanent positions at the ministry this year.

Khairy said although he managed to get the Public Service Department (JPA) to offer MOH over 4,000 permanent positions this year, including 3,215 for medical officers – the highest number of permanent appointments in the past five years – 9,000 people had applied for the positions.

The health minister has also recognised that Malaysia will need an additional 28,000 specialists by 2030. Calls have been made for more specialists across the board, including in palliative care, geriatrics, and mental health care.

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