On 15 December 2021, KRI hosted a webinar presenting the key findings of the discussion paper “Health and Social Protection: Continuing Universal Health Protection”. This webinar examines the adequacy of the existing healthcare system in addressing health risks as the ongoing pandemic has highlighted that there are several gaps that need to be rectified.
Overall, Malaysia’s health system has performed well in health indicators such as life expectancy, child mortality rates and maternal mortality ratio, however, these indicators are stagnating.
This webinar outlines various policy prescriptions and approaches to sustain universal health coverage for its population. The panel consisted of the authors of the discussion paper, Nazihah Muhamad Noor and Ilyana Syafiqa Mukhriz Mudaris; Dato’ Prof. Dr Adeeba Kamarulzaman, Professor of Medicine and Infectious Diseases, Universiti Malaya; and Tan Sri Nor Mohamed Yakcop, Chairman of KRI.
Health Protection as Social Protection
Every individual faces a potential unexpected loss of health at every stage of their life. In turn, these health risks can translate into significant economic vulnerabilities and even into catastrophic health spending. Catastrophic health spending is where individuals may be forced to choose between spending on healthcare needs and buying other necessary items e.g., food, housing, education.
In 2019, on average, each person in Malaysia lost 2.8 months of the year to ill health with 73% being attributed to non-communicable diseases (NCDs). This effect is compounded when people struck with illness are unable to earn income. This is especially alarming with the number of households living in poverty, estimated at 5.6% or 405,441 households in 2019.
Universal health coverage (UHC) is a policy that would protect all individuals against the financial consequences of paying for health services. The World Health Organisation (WHO) has stated that UHC ‘includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course’.
Challenges to Health Protection in Malaysia
The public healthcare sector in Malaysia has provided UHC since the 1980s but it is under strain due to underinvestment which results in the overcrowding and understaffed conditions in public hospitals. Despite the public sector serving a larger population, expenditures for both private and public are similar. In absolute terms, total health expenditure for both sectors have increased at 13.8% per annum from 1997 to 2019 with its growth being 7.7% per annum.
Whilst the government has stated its intentions in reducing public financing of healthcare due to issues concerning sustainability, a large percentage of individuals are actually still paying out of pocket (OOP), contributingto 35% of total health expenditure in 2019. There are also OOP expenses that are not as well-documented, largely stemming from those that seek alternative, traditional medicine that would also contribute to the total health expenditure.
In Malaysia, most of the health expenditure is spent on curative care instead of preventive care. Increased investments should be made to public health services which are generally more cost-effective as they prevent the need for curative care. Additionally, these services would also benefit a wider segment of the population compared to curative care which is catered to individuals.
Malaysia must aspire to build a healthcare system that is resilient to current and future health challenges
KRI has proposed three policy considerations for Malaysia’s healthcare system, namely:
- Continued commitment to tax-based financing for public health services. Despite the government’s repeated claims that the current level of government spending on healthcare delivery is too high, there is room for increased government spending on health. Tax-based financing should remain the dominant form of health financing to ensure the provision of universal health coverage through the public sector.
- Focused implementation of a comprehensive national electronic health record (EHR) system. The government has already committed to realising an EHR system under the 12th Malaysia Plan; thus we recommend that this EHR system should be leveraged to facilitate person centred continuity of care, promote preventive care services and create a comprehensive database on Malaysia’s public health.
- Integrating a health dimension in all social policies to address social determinants of health. This will allow us to address the causes of the cause of disease in Malaysia. For example, obesity prevention requires approaches that ensure a built environment which facilitates easy uptake of healthier food options and participation in physical activity, and a living and work environment which positively reinforces healthy living and empowers all individuals to make healthy choices.
Lessons from the pandemic: Increasing healthcare investment and strengthening community-based care
In the commentary session, Professor Dr. Adeeba Kamarulzaman described how the public has begun to realise the state of our healthcare system after having collectively experienced a pandemic over the past two years. There is an urgent need to change our approach to healthcare, whether through higher budget allocation, financing or the division between preventive and acute care. Underinvestment within the public health sector has resulted in poorer-than-expected outcomes during the Covid-19 response, in the form of the number of infections and higher death rates, as compared to other countries in the region.
Another lesson learned from the pandemic is the dichotomy between the public and private sector when dealing with acute care. At the height of the pandemic between July to October 2020, this separation was apparent as the public sector struggled to expand its services into the private sector. This caused a considerable delay in treatment as hospitals struggled to cope with the high number of infections. Other than the issue of overcrowding, this pandemic also highlighted that the public healthcare sector is understaffed. Prof. Adeeba highlighted that there was a need for efforts such as advocating for more doctors to be absorbed into the healthcare system to prepare the country for future issues associated with our ageing population and the rise of NCDs.
Lastly, Prof. Adeeba stressed that there should be a continued strengthening of community-based care through financial support, technical skills and accreditation. Especially in the case of elderly care, this approach would be more cost-effective in the long run as it would provide a valid alternative to acute care treatments through preventive management within the community.
Want more stories like these in your inbox?
