INTERACTIVE: Mixed results for Malaysia's healthcare costs

PETALING JAYA: Malaysia ranked 46th out of 60 countries, with a score of 73 (out of 100), for our access to universal healthcare (UHC) in the country, in the recent The Cost of Healthcare Index report.

The top country, Canada, scored 89, while the bottom country was Nigeria at 42.

Among the Asean countries that were surveyed, Singapore (score of 86), Thailand (80) and Vietnam (75) all outranked Malaysia.

Universiti Malaya (UM) public health physician Prof Dr Ng Chiu Wan noted that the World Health Organization (WHO) considers a UHC coverage index of 60 to 79 as high.

"Malaysia has not done too badly. However, there is room for improvement," said the healthcare financing and health economics expert.

"Of the four categories (of services considered in the index), we scored lowest in coverage of NCD (non-communicable disease) services, indicated by cardiovascular disease prevention, diabetes management and measures to reduce tobacco use.

"This does show that we must do much more to reduce the burden of NCDs."

Universiti Kebangsaan Malaysia (UKM) public health physician Prof Dr Sharifa Ezat Wan Puteh added that: "UHC only covers the population able to access government-subsidised healthcare.

"The public healthcare system is heavily burdened by many areas, specifically communicable diseases and NCDs.

"At the same time, the ageing population and mental health have all but added more pressure to the public system."

Although Malaysia has a healthy private healthcare industry, our out-of-pocket (OOP) healthcare spending was 60.57% below the average (median) for the group of 60 countries, ranking us 45th in the list.

The nation with the highest OOP healthcare expenditure was Switzerland, at 538.38% above the average, with a large gap before the next country, the United States, at 222.45% above the average.

The country with the lowest expenditure was Nigeria at 94.78% below the average.

Within Asean, Thailand (93.21% below average), Laos (92.43% below average), Indonesia (89.30% below average) and Vietnam (79.63% below average) all spent less than Malaysia in this area.

Prof Ng noted: "Scoring below the median only means that we are in the bottom half of the selected countries in the analysis.

"In other words, it very much depends on the countries selected."

She said: "About a third of Malaysia’s health expenditures every year comes from OOP payments and this is mainly payment for private care.

"And this is the worrying issue.

"The problem is that the scope of private insurance packages in Malaysia is mostly limited to hospitalisation care.

"Insurance may not cover care obtained by people who need regular clinic visits, e.g. for management of an NCD, or for care obtained by people who need to consult a specialist, but need not be admitted to the hospital.

"The government is encouraging cost-sharing for healthcare so that health subsidies can be better targeted for the poor.

"However, to do this, we need to review the financing options for those who opt for private care."

On the other hand, the report found that Malaysians pay, on average, 51.41% above the average (median) for medicines within the group of 60 countries, ranking us 16th in the list.

Americans pay, by far, the most for medicines at an average price of 1,309.48% above the average, with the second country, Mexico, far behind at 153.92% above the average.

Turkey has the lowest medicine cost at 70.21% below the average.

For the Asean countries in the survey, only Singaporeans pay above the average for medicines (90.16%), while the others all pay less than the average.

Prof Sharifa opined that Malaysia's deviation from the average medicine price is not too huge though.

"The cost of drugs is now increasing (inflation, novel treatments and global costs play a role), especially in the private sector.

"Even public hospitals have opted into private practice (the full-paying patient system) for well-to-do patients who voluntarily access private healthcare through the private wing of public hospitals.

"More and more patients, even in the public sector, are now purchasing their own treatment with some form of co-payment (e.g. paying for drugs not yet in the Blue Book)," said the health economy expert.

The Blue Book lists the medicines that public hospitals will provide essentially for free.

The survey also looked at total healthcare expenditure per capita, voluntary health insurance as a share of total healthcare expenditure, taxation and compulsory health insurance per capita, average cost per night to treat Covid-19 in the intensive care unit (ICU) and average cost of general outpatient care per capita.

The index was compiled and analysed by US healthcare IT and web development company Medical Web Experts, in partnership with US virtual care and patient engagement company Bridge Patient Portal.