I have read the recent arguments for a hybrid health financing model with a lot of interest.
It sounds like a sensible middle ground. But I find myself struggling with the same fundamental question: where does the money come from?
Someone Still Has To Pay
A publicly administered insurance scheme would still have to be funded one way or another. Someone ultimately picks up the bill.
We have already established that additional funding is either fiscally difficult or politically difficult.
Guaranteed coverage for pre-existing conditions seems to make this task much harder. I am sure such an insurance product would likely have to charge sufficiently high premiums; otherwise, it may simply collapse under its own weight.
And then comes community rating. This felt almost like the final nail in the coffin, where everyone pays roughly the same amount of premium regardless of their individual risk.
This would mean younger and healthier people would, in effect, have to pay more for insurance than they otherwise might have to, in order to subsidise those who are older and sicker.
What’s In It For Me?
Taking these three ideas together, I find it difficult to see how the system could survive without either making participation compulsory or providing substantial public subsidies.
It might be too idealistic to rely on moral suasion, or to expect younger and healthier individuals to be altruistic and voluntarily participate in an insurance scheme where they are effectively paying for risks that they themselves may not face for decades.
This is clearly not going to happen, and I know this because I am one of them.
Most people are simply making rational decisions around the realities in front of them: this month’s mortgage, utility bills, and groceries. The future has a habit of losing that argument.
But this brings me to something else I noticed recently.
Are We Only Looking At Supply?
When I wrote previously about the queues in government hospitals getting longer, I realised something. There seemed to be more and more younger people in those queues too, people much younger than me.
And that made me wonder whether we have been asking the health care question from only one side of the equation.
We spend a lot of time talking about supply, me included.
In my previous piece, I suggested the need for greater health care spending, as well as making it commercially sensible for private hospitals to serve a much broader group of Malaysians.
All of these are important, and I do not think there is any serious argument against investing more in the capacity of our public health system.
But supply is only half of the equation. The other half is demand.
There is only so much we can do to optimise supply when demand is growing rapidly. And demand is only going to increase as we age as a nation and as more Malaysians live with chronic illnesses.
Knowing Is Not The Same As Doing
This issue has been raised by others many times before, and I have read countless pieces on the importance of preventive care. Yet much of the discussion focuses on prevention in theory.
We should eat better, exercise more and go for screening earlier. All true.
And then, after several hundred or several thousand words explaining why all of this is important, the proposed solution is often the cliché of something along the lines of: we need more education and awareness.
I am not convinced this is enough, and I know this because I am one of them.
Knowing something and doing something are two very different things. We all know we should exercise more. Yet, many of us still spend the evening on the sofa.
Perhaps the problem is not that Malaysians do not have enough information. Perhaps it is that information alone is a weak motivator.
That means public policy has to think more seriously about behaviour. Not in the sense of trying to control every decision people make, but by making healthier choices easier, more convenient and more rewarding.
It has to be easy for people to get a basic health check before something becomes a complicated medical problem.
Many doctors have pointed out that the earlier a problem is identified, the more opportunities there are to manage it before it becomes more serious, complicated, and expensive.
Changing behaviour across an entire population is not something that can be fixed in one Budget or one five-year plan. So perhaps we also need something that can bridge the gap in the meantime.
What Role Can Insurance Play?
This is where I think insurance has a role to play that we do not talk about enough.
Insurance is usually described as protection against the worst thing happening. That is important, but perhaps there’s more that it can do.
It can sit somewhere between a carrot and a stick. It does not have to punish people for living imperfectly. Nor does it have to hand out unlimited benefits regardless of how the system is used.
Instead, the design itself can encourage people to engage with the health system earlier and more regularly.
Imagine an insurance product that is affordable enough for a young working adult to enter without thinking too hard about it.
It does not need to provide the kind of enormous limits associated with premium private medical cards. It could instead be a more basic layer of protection, with a lower limit that keeps it affordable while still providing meaningful coverage.
The important thing is that people enter the system early! When they are still healthy, not only after they have developed multiple conditions.
And once they are in that system, there is much more room to encourage regular check-ups, early detection and healthier behaviour.
The design could reward people for taking care of themselves without pretending that everyone will suddenly become health enthusiasts.
There Should Be A Middle Ground
There is another benefit too. If this creates a new group of Malaysians who can afford basic, routine private care, private hospitals have a reason to develop services for them.
Today, the private health care market is often discussed as though there are only two kinds of patients: those who can comfortably afford it and those who cannot. But there should be a middle.
A person who needs a relatively simple procedure should not necessarily have to choose between paying a large private hospital bill and spending hours in a public hospital queue.
Creating an affordable layer of coverage could help bring some of those patients into private facilities for straightforward care, while allowing the public system to concentrate more of its limited capacity on complex, prolonged and higher-need cases.
Changing The Trajectory
That does not solve everything. It certainly does not remove the need for more public hospital funding, more doctors, more beds and better planning.
But perhaps that is the point. We do not need one grand financing reform that magically fixes Malaysian health care in one go. We need to start changing the trajectory.
On one side, build enough public capacity to cope with the people who genuinely need it most. On the other, create a stronger and more affordable middle layer of private care.
And across the whole system, start thinking about how to reduce avoidable demand by getting people to seek care earlier and take better care of themselves.
None of this is as exciting as announcing a grand national health insurance scheme. It is certainly less dramatic than arguing over which model Malaysia should copy from another country.
But health care is ultimately not just a question of how we finance treatment. It is also a question of how many people need treatment, how early they seek it, where they receive it, and whether the system gives them reasons to make better choices before they become seriously ill.
Perhaps before we ask Malaysians to pay for a much bigger health care system, we should also ask ourselves whether we are doing enough to ensure that the system does not constantly need to become bigger just to keep up.
Because no matter how we choose to finance health care, there is one thing we cannot insure ourselves against forever: a demand for care that keeps growing faster than our ability to provide it.
The author is a CodeBlue reader from Melaka, with decades of firsthand experience navigating Malaysia’s public health care system through his family members.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
