Abolish, Don’t Raise Public Health Care Fees: Galen

The Galen Centre wants the RM1 and RM5 fees in MOH facilities to be removed altogether, saying it’s pointless to raise them even by 900% to RM10 and RM50 respectively, touting national health insurance instead as a more sustainable financing solution.

KUALA LUMPUR, June 16 – The Galen Centre for Health and Social Policy has called for an abolition of the RM1 and RM5 user fees in public health care facilities.

Galen Centre chief executive Azrul Mohd Khalib pointed out that increasing the RM1 general outpatient fee and RM5 specialist outpatient fee per visit at Ministry of Health (MOH) facilities – which were introduced in the mid-1980s – to RM10 and RM50 respectively translated to increases of 900 per cent.

“This may be neither publicly or politically acceptable. It would also be pointless as the amount of funds raised would still be insufficient for cost recovery,” Azrul said in a statement yesterday.

“These fees are obsolete, inadequate for meaningful cost recovery, and mislead the public regarding the true cost of health care. Even the government frequently describes their services as ‘free’ or ‘cheap’. These charges now act as barriers to reform.

“Rather than increase the RM1 and RM5 charges, they should be removed altogether. People should not be required to pay anything initially at the point of care. A more sustainable and meaningful solution to health care financing should instead be proposed and supported such as national health insurance.”

Health policy analyst Chua Hong Teck previously wrote that the medical fees collected comprised only 1 per cent of the MOH’s expenditure in 2021.

The Health White Paper (HWP), which was passed by a voice vote in the Dewan Rakyat yesterday, proposed a fee review at public health care facilities based on patients’ ability to pay.

After several MPs on both sides of the divide raised concerns about the proposal during their debate on the HWP, Health Minister Dr Zaliha Mustafa defended the planned fee review, claiming that some patients wanted to pay more because of their appreciation for the comprehensive services provided.

She also promised further stakeholder engagements to ensure that the low-income would not be affected.

The Galen Centre said that a national health insurance scheme, as proposed in the HWP, would apply to all workers and be based on a sliding scale linked to income and age.

“There would be collective pooling of both funding and risk. It would begin to address the issue by co-sharing the burden and responsibility of financing the health care system,” Azrul said.

“It has the potential to stabilise public subsidisation, allow space for cost-containment, maintain access and quality to essential services, improve access to innovative treatment, and fund equitable access to services in the private health space.”

Azrul, however, stressed that despite parliamentary passage, the HWP faces the same challenges that blocked previous attempts to reform the health care system, namely the political will to provide significant resources in funding and manpower to both tackle today’s crises and implement promised reforms.

“The challenges are formidable.”

Azrul also told CodeBlue that most of the reforms proposed in the HWP, a document proposing health reforms over 15 years, require supportive legislation.

“Some will only need amendments to existing legislation, others such as the proposal for a national pooled healthcare fund will likely need primary legislation. Even setting up health care facilities to become autonomous will require a substantial amount of funds which are initially needed to invest in new systems, processes and infrastructure. This will require billions in new investments.”

Autonomy For MOH Facilities Likely in Direction of NHS Trust System

The HWP proposed a radical restructuring of the MOH to begin relinquishing both its roles as health care provider and purchaser, so that the MOH would only focus on governance and regulation, setting standards, and drafting health system policies.

These two roles will go to “autonomous” public health care facilities and a Strategic Purchaser entity respectively, as envisaged by the HWP, though the document provided scant details on the restructuring of the MOH.

“Though I don’t believe that the government is proposing the privatisation of public health care services, I wish that the White Paper was clearer regarding its various proposals, especially relieving its role as health care provider and granting autonomy for health care facilities,” Azrul said.

“I see the proposals as moving Malaysia’s health care system in the direction of the United Kingdom’s NHS (National Health Service) Trust system, which decentralises the health care system to geographical regions or zones. If this is the case, this would be a radical shift from the centralised Putrajaya centric decision-making and management that is currently in place today. This would be a positive move.”

Dr Zaliha told the Dewan Rakyat yesterday that public health care facilities given “autonomy” would remain under the ownership of the MOH as not-for-profit organisations, but gave little details besides saying generally that this would provide greater flexibility in operations, enable competition between public and private health service providers, and facilitate integration of health care services.

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