Budget 2024: Madani Government Must Take Health Seriously — Galen Centre for Health And Social Policy

For Budget 2024, the Galen Centre wants investments in health care financing, NCDs, aged care, reproductive health & epidemic preparedness. It recommends a national scheme to fund long-term care for above-40s and scrapping RM1/ RM5 fees in MOH facilities.

The Galen Centre for Health and Social Policy calls upon the Madani unity government to make realistic, serious, and necessary commitments in the upcoming Budget 2024 to boost efforts to build and future-proof the country’s health care infrastructure towards sustainability and resiliency.

The Galen Centre repeats its calls for increases in investments in five critical areas: health care financing, non-communicable diseases, aged care, reproductive health, and epidemic outbreak preparedness and response.

Conversations regarding health care should be centred around meeting the current and future needs and challenges of the Malaysian people. 

Whether we recognise it or not, this country is transiting from a upper middle income to a high income economy and is not dependent on overseas development assistance. 

There is no one to help us if we underinvest in health. We need to help ourselves to ensure that no one is left behind.

We need to find out what we need, how much money is available, and find solutions to bridge those funding gaps, particularly in areas such as staff recruitment and retention, modernisation of medical infrastructure, and treatment of non-communicable diseases.

Yes, health needs more funding, but we must also look at where and how it is being spent. We must also treat health as a serious investment whose return comes in the form of healthy, productive citizens helping to build this country.

We recommend that the government removes the RM1 and RM5 charges for outpatient and specialist care respectively at Ministry of Health (MOH) facilities. People should not need to pay anything at the point of registration for treatment at a public health care facility.

These charges keep alive the fiction that the cost of health care in Malaysia is cheaper in government facilities and mislead the public. They are also inadequate for meaningful cost recovery. We believe that removing these charges will open the way to meaningful discussion and facilitation of future reforms in health care financing.

Malaysia is amidst a crisis of non-communicable disease (NCDs) crisis, of which diabetes is one. There are now almost 5.5 million people living with diabetes in this country.

A recent MOH and World Health Organization (WHO) report showed that six years ago, the annual direct health care spending for this disease was RM 4.38 billion and is the highest compared to cardiovascular disease and cancer. For every ringgit spent on the three NCDs, 45 sen goes to diabetes, 41 sen goes to CVD, and 14 sen to cancer.  

We propose introducing co-payments of up to 30 per cent of actual cost for the treatment of diabetes. This will help people increase their adherence to treatment, reduce wastage of highly subsidised medication, and reduce the likelihood of developing further complications such as end stage renal disease or kidney failure. This move alone could save thousands of lives.

Malaysia has been deemed as being ill-prepared to deal with the needs and consequences of a growing ageing population. Politicians often speak of this issue as if it was in the distant future to be addressed by somebody else.

The reality is that the future is already upon us. Aged and long-term care facilities and relevant essential services remain limited, mostly confined to urban centres, and concentrated on private providers, or dependent on already stretched families and households.

There continues to be a lack of clarity on which ministry should take the lead on aged care, and the care economy. There is an unsustainable dependence on informal care, such as families. As a result, many older individuals are now vulnerable to or suffering from neglect, sub-standard care, and even abuse.

“The government needs to immediately make improving aged and long term care a priority in Budget 2024. We recommend introducing a national scheme for those above the age of 40 to fund aged and long-term care, similar to what is implemented in Japan.

Unintended pregnancy is not just a problem among teenagers, unmarried women, or poor women from disadvantaged backgrounds. Being able to plan or decide one’s pregnancy enables women to take control of their futures, so that they can finish their education, get better jobs, and not be trapped in a cycle of grinding poverty and deprivation. It affects everyone.

Unintended pregnancies are a national concern. This Budget should have an increased allocation to strengthen essential reproductive health services in the MOH and National Population and Family Development Board (LPPKN), which include providing equal access to contraceptives for both married and unmarried individuals.

Finally, the Covid-19 pandemic has demonstrated the value and merit of investing in public health systems which are effectively able to respond to emerging diseases, outbreaks and epidemics. The Disease Control Division of the MOH needs increased investments in capacity and expertise to prevent, detect and manage future epidemics.

That means investing in training more epidemiologists, public health specialists, infectious disease experts, and increasing diagnostic laboratory capacity. Waiting for an outbreak to hit before doing so will be too late and could cost the country billions. Previous budgets seem to not have recognised this urgent need or learnt from the Covid-19 emergency.

The Madani government must take health seriously as Malaysia’s future will continue to be vulnerable if the people are in poor health.

Azrul Mohd Khalib is the chief executive of the Galen Centre for Health and Social Policy.

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