ALTHOUGH we are still in the emergency phase of the Covid-19 pandemic, our thoughts should shift to the recovery phase now. On the healthcare front, what can Malaysia do?
We offer three suggestions – greater investment in our health system, more emphasis on preventive health services, and institutionalise a Health Reform Act and committee.
In truth, our healthcare system has been under strain even before the outbreak of Covid-19, as Malaysians are highly dependent on public healthcare. In 2015, more than 75% of Malaysians said they preferred to go to public healthcare facilities when faced with major health problems like cancer and heart disease.
In 2017, Malaysia’s total health spending (both public and private) amounted to only 4.2% of the country’s GDP, of which 52% went to public sector hospitals and clinics.
Given the government’s constrained fiscal capacity, a sharp rise in health spending may not be feasible. However, we urge the government to commit to increasing health spending in fiscally responsible annual increments to achieve a target of 6% to 7% of GDP over the next few years. This would put Malaysia’s health spending on par with peer group countries such as Mexico (5.5% of GDP), Cambodia (5.9%) and South Korea (7.6%).
The additional funding could be used to increase the number of permanent posts for healthcare workers. Improving the terms of service and ensuring adequate numbers of health professionals is not only a sign of gratitude to our Covid-19 frontliners but also a clear signal that the government truly prioritises health.
The function of a public healthcare system is not just to cure diseases; it is also responsible for preventing them. Evidence shows that preventive interventions reduce cardiovascular deaths by about 78%. Preventive health interventions can also reduce rates of diabetes and high blood pressure. When financial resources are limited, preventive services are frequently sidelined for the more immediate need for curative care.
In 2017, Malaysia spent only 7% (about RM4bil) of its total health allocation on preventive services. This money was used for vaccinations, health promotion campaigns, screening programmes and countless other public health programmes nationwide.
Funding for disease surveillance and control programmes, which are crucial in giving early warning of potential outbreaks such as Covid-19, also come from that money.
The case for investing in preventive services has long been evident. It is time we act on this evidence and increase our spending on preventive health services.
Public health is a political choice. Although biology is a significant factor in determining health status, social factors such as housing conditions, income levels and gender roles can also play a substantial role. These social factors are, for better or for worse, significantly affected by politics and the ideologies of those in power.
But health is too important to be unduly subject to politics. In many countries, political changes often present a stumbling block for health reforms and improvements. As such, we propose that Malaysia passes a Health Reform Act creating a permanent and bipartisan vehicle for health reforms, possibly in the form of a parliamentary select committee.
Covid-19 has highlighted the pressures faced by our health system, and we should not waste the political momentum of this crisis.
NAZIHAH MUHAMAD NOOR
Khazanah Research Institute
DR KHOR SWEE KHENG
Physician and health systems specialist
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