This article first appeared in The Edge Malaysia Weekly on November 9, 2020 - November 15, 2020

MEDICAL experts found the 2021 healthcare budget bitter sweet, as attempts were made to improve conditions for the sector and frontliners, but not to the degree expected.

Some RM31.9 billion was allocated for the healthcare sector in 2021 compared with RM30.6 billion in 2020. Of the total amount allocated, RM4.7 billion, or 6.8%, was set aside as development expenditure, the balance RM27.2 billion for operating costs.

As the Covid-19 pandemic is expected to persist for a number of years, an additional RM1 billion has been allocated to stem the ongoing third wave of infections going into 2021, including RM475 million for the purchase of reagents, test kits and consuma­bles for the Health Ministry.

Another RM24 million was allocated to address mental health issues, given the severity and mounting cases of emotional stress, anxiety and depression in the community.

In his Budget 2021 speech last Friday, Finance Minister Tengku Datuk Seri Zafrul Tengku Abdul Aziz said tackling the Covid-19 pandemic and protecting public health were a priority, and that specific legislation had been approved to address the pandemic.

Frontliners’ access to a Covid-19 Special Allowance of RM600 a month since March will be continued until the pandemic is successfully addressed, and 100,000 medical staff stand to receive a one-off payment of RM500 as a token of appreciation from the government.

In an immediate reaction, Dr Khor Swee Kheng, a health systems and policies specialist, says the allocations were too small. He says: “The overall allocation to the Health Ministry moves from RM30.6 billion to RM31.9 billion and is only a 4.3% increase year on year. This reduces the Health Ministry’s ability to deliver the needed Covid and non-Covid care, and reduces the ability to achieve universal health coverage and long-term health reforms. There is also no mention of more permanent posts for frontliners, something that nearly all of Malaysia supports.”

Malaysian Medical Association (MMA) president Professor Datuk Dr Subramaniam Muniandy agrees that the lack of permanent positions was a let-down. He says: “Among the disappointments that we have seen is the lack of acknowledgment of the long-standing issues regarding the permanent and contract positions for junior healthcare workers. The announcement of further contract positions for nursing and other healthcare support staff does not bode well for the welfare of the staff, but is needed to ensure that the positions are available quickly, owing to the much-maligned Moratorium on Civil Service expansion.

“Overall, we agree that the budget is focused on rejuvenating the economy but, to the medical profession, it does seem that, despite the applause given to the frontliners, more could still be done to address the needs of our fraternity. It is hoped that the government will be clearer on the employment of new doctors in permanent positions. The general practitioners are also going through a tough time during this period. They should be supported by allowing tax relief of indemnity insurance.”

Khor also says the RM17 billion Covid Fund for wage support and social assistance is “too small to sustain an entire year’s worth of job losses and underemployment, which can impact nutrition, mental health and health outcomes.

“The allocation for vaccines of only RM3 billion may not cover the likely scenario of two vaccine doses of about RM80 a dose for at least 60% of Malaysia’s population, including the logistics of a nation-wide vaccination programme.”

Zafrul had said that, as the Covid-19 vaccine supplies are expected to cost more than RM3 billion to meet the needs of Malaysians, Putrajaya is committed to acquiring Covid-19 vaccine supplies, which will include participation in the Covid-19 Vaccine Global Access (COVAX) programme.

mySalam’s coverage will be broadened to medical devices such as heart stents or prosthesis under Budget 2021, said Zafrul, who noted in his speech that, as at Oct 31, mySalam had paid claims relating to hospitalisation and critical illnesses worth RM64 million to 56,000 thousand patients. Meanwhile, 19,000 individuals have received claims of RM11 million relating to Covid-19 health issues.

Under the Perlindungan Tenang Voucher Programme, all B40 aid recipients will be given a RM50 voucher to purchase life and personal accident insurance.

The stamp-duty exemption period on all Perlindungan Tenang products with an annual premium or contribution value not exceeding RM100 will also be extended until the year of assessment 2025.

“The Budget’s expansion of mySalam benefits, provision of tax breaks for some insurance purchases and introduction of vouchers for the B40 is a positive trend that allows for a more sustainable and diversified funding of healthcare in Malaysia,” Khor says.

To encourage citizens to seek vaccination against diseases, the scope of tax reliefs for medical treatment expenses will now also cover pneumococcal, influenza and Covid-19.

Limited to RM1,000, the tax relief on vaccination expenses is intended for the taxpayer, spouse and child.

The tax relief limit on medical expenses for a taxpayer, spouse and child for serious diseases has also been increased to RM8,000, from RM6,000, and the tax relief limit for expenses on full medical check-up raised to RM1,000, from RM500.

The tax relief on expenses for medical treatment, special needs and parental care expenses is increased to RM8,000, from RM5,000.

“MMA welcomes a number of tax relief initiatives to promote preventive health and we are pleased that the government is giving more attention to mental health in this budget,” Subramaniam says.

About 500,000 Malaysian children are expected to benefit annually from RM90 million set aside for the pneumococcal vaccine programme. The vaccine is typically used for the prevention of pneumonia, meningitis and sepsis.

Some RM25 million was also allocated for the home-based Peritoneal Dialysis treatment programme to enhance the quality of life for kidney patients — as well as reduce their waiting time and overcrowding at hospitals.

More hospitals and clinics will be built, especially in small districts, while outlays will also be provided for the upgrading and maintenance of hospitals and clinics as well as procurement of medical service vehicles and equipment.

To position Malaysia as an investment destination, especially for locally produced vaccines, medicines and medical devices, the Ministry of Health’s Off-Take Agreement Programme will be beefed up to attract investment to this country and potential vaccine production in the future.

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