Taking charge of health

Funding the gap: Low fees for treatment in public health facilities mislead the public about the true cost of healthcare.

FOR the upcoming Budget 2023, the Galen Centre for Health & Social Policy calls upon the government to boost efforts to build the country’s healthcare infrastructure towards sustainability and resiliency.

Commitment and investments must be made in five key areas: healthcare financing; non-communicable diseases; public health emergency preparedness and response; reproductive health; and elderly care.

For too long, conversations concerning healthcare have been dependent on and hampered by issues of affordability rather than centred around meeting the current needs and ongoing challenges of a growing population and an economy transitioning from upper middle income to high income.

Decisions are often based on what we can afford rather than finding out what we need, how much money is available, and finding solutions to bridge those funding gaps.

We need to change the way we look at health.

We recommend that the RM1 and RM5 charge for outpatient and specialist care respectively in public health facilities be scrapped. These charges sustain the perception that healthcare in Malaysia is somehow cheaper in government facilities. They are also inadequate for meaningful cost recovery and misleads the public regarding the true cost of healthcare.

Malaysia is in a non-communicable disease (NCD) crisis. One of these NCDs is diabetes. There are almost four million people living with diabetes in this country.

A recent Health Ministry-World Health Organisation report showed that annual direct healthcare spending for this disease is RM4.38bil, and is the highest compared to cardiovascular disease (CVD) 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 reducing subsidies for diabetic treatments and introducing co-payments of up to 30% of the actual cost.

People must take charge of their own health. It will also help reduce wastage of subsidised medication.

Covid-19 has demonstrated the value and merit of investing in public health systems that are able to respond effectively to emerging diseases and outbreaks.

We need to increase the capacity of the Disease Control Division to prevent, detect and manage future epidemics. That means investing in training more epidemiologists, public health specialists and infectious disease experts and increasing diagnostic laboratory capacity.

Unintended pregnancies are also a national concern. Budget 2023 should have an increased allocation to strengthen essential reproductive health services in the Health Ministry and the National Population and Family Development Board (LPPKN).

Unintended pregnancy is not just a problem of 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 future so that they can finish their education, get better jobs, and not be trapped in a cycle of grinding poverty and deprivation.

Finally, Malaysia is seen as being ill-prepared to deal with the needs of a growing ageing population. Long-term care facilities and essential services for the elderly remain limited, mostly confined to urban centres, and concentrated to private providers.

There is a lack of clarity on which ministry should be responsible, and unsustainable dependence on informal care.

As a result, this issue has suffered tremendous decline, leaving the elderly vulnerable to neglect, substandard care, and even abuse.

It may be necessary to introduce a national insurance scheme for those above the age of 40 specifically to fund long-term care for the elderly.

Ad hoc approaches will not be sufficient or sustainable.

AZRUL MOHD KHALIB

CEO, Galen Centre for Health and Social Policy

Kuala Lumpur