Tanjong Karang MP Explains Why Health Service Is In ‘Crisis’

Tanjong Karang MP Dr Zulkafperi Hanapi, one of few MPs to openly acknowledge the “crisis” in the public health service, attributes the state of the public health care system to unsustainable financing, calling for copayments and social health insurance.

KUALA LUMPUR, March 23 – Tanjong Karang MP Dr Zulkafperi Hanapi believes that the country’s health care financing system is unsustainable and has contributed to the current state of the public health service.

The Bersatu lawmaker said the public health service under the Ministry of Health (MOH) is in “crisis” due to a multitude of issues, such as old and poorly maintained health care buildings, outdated medical equipment, insufficient health care staff, and overcrowded hospitals and clinics.

Dr Zulkafperi is one of the few MPs to use the word “crisis” to describe the state of the public health service, a word that was previously used by 95 per cent of more than 1,600 government health care workers polled in a January survey by CodeBlue.

“These [are] the signs and symptoms of [an] unsustainable health care financing system that we are having now,” Dr Zulkafperi, a medical doctor who previously served in the military, said in his debate at the committee stage of the MOH’s 2023 budget in the Dewan Rakyat on Tuesday.

The Opposition MP from Perikatan Nasional (PN) attributed these issues to a failure in health care financing. As a consequence, there is a lack of budget for salaries to create new staff positions and insufficient funds to develop clinics, hospitals and to upgrade assets, leaving patients in low-income households to wait long hours for critical procedures, with some being denied treatment.

“A health care financing system funded through taxation is not sustainable at all,” Dr Zulkafperi said. “This is primarily because our tax rate is low – below 30 per cent – while countries in Europe have tax rates of around 40 to 55 per cent.”

“Additionally, our tax system is not effective and many people are avoiding paying taxes. But PMX (10th Prime Minister Anwar Ibrahim) is still not ready to implement the Goods and Services Tax (GST).

“The health care financing system requires reform and political will to implement a co-payment mechanism and shared health risk,” he said. Dr Zulkafperi asked Health Minister Dr Zaliha Mustafa if the MOH is ready to implement a National Health Insurance Scheme as a solution that is more sustainable.

The health minister previously told Parliament that the upcoming Health White Paper, slated to be tabled in Parliament in June, is expected to feature a recommendation for the implementation of a national health insurance programme.

Dr Zaliha, a first-term PKR lawmaker, has admitted that the current level of health care spending is “inadequate” to maintain a sustainable national health care system that can meet the needs of an ageing population with various chronic illnesses and the possibility of future pandemics.

The Galen Centre for Health and Social Policy said last November that introducing a payroll-funded social health insurance scheme could add an estimated RM31.1 billion to fund health care spending.

Tanjong Karang MP Dr Zulkafperi also highlighted Tuesday the issue of staff emoluments in MOH’s Budget 2023, particularly the 1,083 contract medical laboratory technologists (JTMP) who had served as frontline workers during the Covid-19 pandemic.

He expressed concern over the uncertain future of these technicians whose contracts can be terminated at any time, and urged the health minister to consider extending their contracts or absorbing them into the ministry’s permanent workforce.

Additionally, Dr Zulkafperi questioned why there was no budget allocation for the MySalam protection scheme for the bottom 40 per cent (B40) and persons with disabilities who the Tanjong Karang MP said would require RM50 in daily protection for up to 40 days if hospitalised, and a one-off payment of RM8,000 if diagnosed with critical illness. 

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