WHILE the private sector is expected to enjoy encouraging growth, there is a growing call for public healthcare structures to remain relevant and economical as a sizeable portion of the ageing populace is also expected to be cash-strapped. 

The one thing both government and privately collated data agree on is that ageing poses significant challenges to developing countries such as Malaysia, which puts a lot of stock into its youth. Locally, there is not much exposure on this side of the coin although the global phenomenon dubbed the “Silver Tsunami” — where a rapidly ageing population will come to represent a disproportionate number in terms of the total population across the region — is predicted to place greater demand on public healthcare.

Malaysian Medical Association (MMA) president Dr H Krishna Kumar points out that an ageing population is caused by two factors — declining fertility rates and increasing longevity. People are living longer due to socio-economic developments and improving medical technology.

“A larger group of people are living longer and the number of people above the age of 60 is increasing. At the same time, the younger population is not increasing at the same rate … the base is becoming smaller and the peak, bigger,” he says.

Krishna, who is a maternal and foetal medicine specialist, adds that the burden is on the government to ensure that the existing primary healthcare system, which up to 2011 was 55% subsidised, continues to stay at rock-bottom prices.

It is necessary to keep costs low as this group could be headed for a retirement crisis with tens of thousands leaving the workforce in their golden years with less savings than are required to keep them out of poverty.

Many are retiring without sufficient funds to sustain them in their golden years, disclosed the Employees Provident Fund (EPF). About 70,000 active contributors aged 54 only had an average savings of RM167,000 in 2013, or 15% below the recommended minimum savings level of RM196,800.

More alarming is the fact that 69% of all EPF contributors of that age have less than RM50,000 in their accounts. As the average Malaysian is expected to live until 75, retiring at 60 with RM167,000 means surviving on only RM700 a month for the rest of their lives, which is below the poverty line of RM830 a month in Peninsular Malaysia.

“We don’t have facilities just for older people, but we do have one of the best healthcare systems, which was voted third best in the world recently … and it is very cheap compared to most Western countries as long as you stick to public healthcare,” says Krishna. 

“So, we have to ensure that the public healthcare system remains free and nothing changes,” he adds, citing InternationalLiving.com’s Global Retirement Index 2014.

Malaysia’s ranking dropped a notch on the index this year, while Ecuador, Panama and Mexico took the top three spots. However, the American publication still found that Malaysia provides top-notch healthcare at the cheapest rate in the world.

The country’s healthcare system is economical and commended by the UN Development Programme as an exemplary structure for other developing countries, as the co-existence of heavily subsidised primary healthcare and a private sector catering for those who can afford specialty services have contributed to the increase in the average life expectancy.

Malaysians, however, have more to be concerned about than just out-of-pocket expenses. According to the Economist Intelligence Unit (EIU), citing statistics from the Ministry of Health, non-communicable diseases have reached worrying levels as hypertension has gone up 43%, while diabetes has shot up 88% and obesity is 250% higher in 2012 compared with 2002. 

These patterns will require costly and long-term treatment, and public spending is not sufficient, says industry consultant Y S Chua, who has spent two decades in the pharmaceutical industry. He also served as an adviser to the Prime Minister’s Department’s Performance Management and Delivery Unit (Pemandu) for two years.

He says these diseases place the most burden on the healthcare ecosystem. “The cost of one person with diabetes is RM20,000 a year … This is the scary bit — there are close to 2.5 million people in Malaysia suffering from diabetes.” 

Under Budget 2015, the Ministry of Health was allocated RM23 billion, or about 8.4% of the country’s total expenditure of RM273.9 billion.

The shift in paradigm with regards to preventive healthcare and holistic wellness is progressing, albeit statistically too low, Chua says. 

Seeing the affinity of individuals towards preventive healthcare, various government institutions as well as private stakeholders are taking proactive measures.

“The solution is clear … what needs to be done is to promote a better lifestyle. And the Malaysian government, on its part, is already are spending millions on creating awareness,” he says.

The EIU, in a report on the sustainability of Malaysia’s healthcare mechanism last year, points out that policymakers have recognised the sector as a driver of economic growth, having identified it as one of the 12 National Key Economic Areas (NKEA), particularly in transforming Malaysia into a leading destination for medical tourism, as tourism is the country's sixth largest industry.

The Ministry of Health has undertaken a public-private collaborative effort and created the Malaysia Healthcare Travel Council to advocate and promote local medical services abroad and to ensure that participating hospitals meet the stringent international quality requirements. 

The government has also introduced various activities, including under the umbrella of FitMalaysia, to get more Malaysians to change their sedentary lifestyle for better health and social well-being.

Programmes such as running and cycling are conducted nationwide.

As far the private initiatives go, some renowned fitness activities, including the Penang Bridge International Marathon and Standard Chartered KL Marathon, have registered a record number of participants over the years. In 2013, 47,000 runners took part in annual event in Penang, while more than 35,000 registered for the Standard Chartered event last year.

Despite such national level initiatives, one’s commitment to preventive healthcare is a personal choice, says Chua. “Prevention is most cost-effective, but it is also the most difficult task.”

This article first appeared in Personal Wealth, The Edge Malaysia Weekly, on April 20 - 26, 2015.

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