KUALA LUMPUR, March 9 – Bandar Kuching MP Dr Kelvin Yii has called for funds collected from the proposed excise duties on e-cigarettes or vape liquids containing nicotine to be utilised towards providing health care workers with fair wages.
The DAP lawmaker said that it has been nearly ten years since health care workers received a salary review, and he emphasised the need for fair pay across all health care professions, not just limited to doctors.
“Excess provisions can be used to look after our health care workers who are increasingly burnt out, worried, fearful, and disappointed with our health care system. We know that our health facilities are understaffed.
“Therefore, it is important for us to take care of those who are there.
“For me, one ‘low lying fruit’ is to review the on-call allowance. I know the last adjustment was almost 10 years ago, and now, I feel they should be paid fairly. I’m not talking about doctors, but the entire ecosystem – all health care workers. And this requires the collaboration between the Public Service Department (JPA) and the Ministry of Finance (MOF).
“We often give words of motivation, support, and appreciation to them, especially during the Covid-19 season, but words of affirmation cannot feed the families of our health care workers. It is time we take care of their welfare,” Dr Yii said during his debate on Budget 2023 in the Dewan Rakyat yesterday.
In January, a CodeBlue poll revealed that out of 1,652 government healthcare workers who participated in the survey, 73 per cent (1,205 people) were considering leaving their government health care jobs.
Of the total, 288 individuals provided verbatim responses, highlighting the issues they face, including immense work burdens, understaffing, unfair pay, and insufficient amenities and equipment in public health care facilities.
During a series of interviews with health care workers, a contract doctor shared that they were paid only RM200 for working 28 hours, while their basic pay is just RM2,000, despite having to shoulder the same workload and responsibilities as a full-time doctor. Additionally, a government dentist described their compensation as “peanuts.”
While Dr Yii envisions using the sin tax fund to ensure fair compensation for health care workers, he also believes that the majority of these funds should be channelled towards reinforcing primary care and on initiatives to address issues such as non-communicable diseases (NCDs), which he considers a ticking “time bomb” for the country.
“I hope the government will use the sin tax strategically. I welcome the allocation of 50 per cent of the tax collected for vape products to be allocated to the MOH. This means that Malaysia is among 35 countries that allocate sin tax to public health care,” said Dr. Yii, who serves as a special advisor to Health Minister Dr Zaliha Mustafa.
According to the National Health and Morbidity Survey (NHMS) 2019, approximately 1.7 million adults in Malaysia (8.1 per cent of the population) have all three risk factors for diabetes, hypertension, and high cholesterol, the three main non-communicable diseases. The survey also revealed a significant increase in the prevalence of diabetes in adults, rising from 13.4 per cent in 2015 to 18.3 per cent in 2019.
Additionally, the World Obesity Federation has projected that Malaysia’s obesity rates will skyrocket in the coming years, with an estimated 41 per cent of the country’s adult population becoming obese by 2035. The report warns that this trend could have serious implications for Malaysia’s health care system and economy, as well as for the overall well-being of the population.
While Dr Yii welcomes the higher allocation awarded to the Ministry of Health (MOH), he stresses the importance of stemming the leakage of funds and reducing wasteful spending on health care.
Dr Yii, who was formerly the head of the parliamentary special select committee of health, science, and innovation, believes that proper management and allocation of resources are crucial to improving the health care system in Malaysia.
“We know that greater provisions are one thing, and implementation and execution are another matter. It is more important for us to ensure that all projects under the MOH are sustainable and well-governed, and that good governance is the priority given to all matters.
“Therefore, it is very important for us to reduce the leakage and wastage in health spending.”
To achieve this goal, Dr Yii recommended establishing a task force comprising not only the MOH but also other agencies such as the MOF and Public Works Department (JKR). This task force would identify the priority and necessity of health facilities and closely monitor all development expenses and procurement processes.
Dr Yii has proposed three strategies for the 2023 budget. His first proposal is directed at prioritising prevention, primary care, and preventative care. He believes that the budget should focus on preventative care rather than curative care.
“Firstly, we need to truly focus on prevention and primary care. Preventive care must be made a priority. So, allocation to preventative and primary care must be the focus and prioritised in the budget.
“Although the 2023 Budget increases tax exemption for medication expenses, we see that the focus is still heavily on curative care, not preventative care.
“For example, medication expenses for curative services such as serious diseases have an income tax relief limit of RM8,000, but preventative services such as vaccination are limited to RM1,000 only.
“So, for me, consideration must be made to increase tax relief limits for curative health services. Maybe a periodically scheduled increase of RM1,000 every year for the year 2024 to 2029, for example,” Dr Yii said.
Dr Yii also held that funds should be directed towards structural reforms and not just towards the MOH’s capital and operational expenditures. While he appreciated the RM36.3 billion allocated to the MOH, he said that a greater amount is required for structural reforms that penetrate deep into the health care system.
“Secondly, we should focus on and allocate a larger amount of funds for structural reforms, not just for operating expenses (opex) and capital expenditures (capex). While the allocation of RM36.3 billion for the MOH is a positive step, we still need a larger amount for structural reforms in our health care system, especially given the uncertain state of the economy.
“Therefore, the Health White Paper, which is scheduled to be presented in Parliament in June 2023, is of utmost importance as it provides a roadmap on how to reform our health system and how to efficiently utilise funds,” Dr Yii said.
“In addition, the Health Reform Commission contained in the Health White Paper must receive sufficient funds and support to tackle the three fundamental issues of health financing, human resources, and service delivery organisations.”
To tackle the congestion in hospitals and health care facilities, Dr Yii emphasised the need to address the social determinants of health.
“In a recent debate, I heard an Honourable Member suggest that we should focus solely on hospital issues and not worry about things like smoking. However, Your Honourable, these issues are interconnected. It’s two sides of the same coin.
“To reduce hospital congestion, we also need to address the root cause of why people are going to the hospital.
In support of the government’s efforts to address smoking, Dr Yii welcomed Prime Minister Anwar Ibrahim’s plan to introduce the Control of Tobacco Product and Smoking Bill 2022. He called the bill a “gamechanger” that will not only protect future generations but also save RM4 billion spent on treating smoking-related illnesses.