Healthcare: On the right track, but financing challenge awaits

This article first appeared in The Edge Malaysia Weekly, on May 6, 2019 - May 12, 2019.

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When the Pakatan Harapan government took over the Ministry of Health (MoH), it was one of the better organised and well-performing ministries, even under the Barisan Nasional administration. Professional, competent and experienced civil servants form the backbone of the health department, steering the ship steadily all along.  Nevertheless, that does not mean the ministry was flawless. In the past, much decision-making and top-level policy actions were seemingly plagued by weak political will to drive through reform. With the change of administration, Health Minister Dr Dzulkefly Ahmad and Deputy Minister Dr Lee Boon Chye now carry the burden of high expectations from the public.

Obviously, health financing is one of the biggest issues and, from the very beginning, Dzulkefly had vowed to keep the Pakatan Manifesto promise to raise the health budget to 4% of the GDP. Unfortunately, that did not materialise in Budget 1019 and only 2.3% was allocated for the MoH budget, or a projected normal increase of RM2 billion.

Dzulkefly proposed that a real estate investment trust be set up to expand the ministry’s revenue, but this was deemed controversial and was finally abandoned in February.

Given the constraints, the ministry probably understands that the rising healthcare demand and disease burdens translate into more financial resources being required in the future. Thus, it has put greater emphasis in two areas: i) strengthening primary healthcare, and ii) addressing severe public health issues, especially non-communicable diseases.

To increase the accessibility of public healthcare services to the rural population, MoH has taken steps to “repurpose” the 1Malaysia clinics into Klinik Desa and reinforce them with medical doctors. It is also introducing the cluster hospital concept, which brings specialists to rural district hospitals to de-congest the waiting crowd in urban areas. Meanwhile, to address public health issues, the government will impose an excise tax on sweetened beverages. Some RM100 million will be provided this year to the PeKa B40 programme for mass health screening for the B40 population aged 50 years and above. Additionally, there is now a ban on smoking within a 3m radius of all eatery premises.

Although MySalam is actually a programme under the Ministry of Finance, it is often perceived as an MoH initiative. It has received its fair share of public criticism regarding the utilisation of the RM2 billion fund managed by Great Eastern Takaful Bhd, which some believe to be driven by the insurer’s self-interest and seen to benefit it. Critics argue that the benefits provided for B40 patients covered by the plan may not be meaningful or substantial enough. Some exclusion criteria would even rule out B40 patients in desperate need of financial support.

The health minister has heard the grievances of housemen who shared their experience of long working hours and responded by reducing the work hours per week from 65 to 75 hours to 60 hours. This shows he will not hesitate to take action to remedy the situation.

The ministry also sees investment value in adopting an electronic medical record (EMR) system, to be extended to all 145 MoH hospitals within three years despite the hefty development cost. This would help in increasing the efficiency of care, as well as improve health management and planning.

All in all, I would rate the performance of MoH as being positive under the PH government, though this has little to do with the Pakatan Harapan Manifesto, which is relatively thin on health matters. The ministry’s current direction is on the right track, but the true test lies in how it will rise to the challenge of designing and implementing a sustainable national health financing policy, as well as tackling the high prevalence of certain non-communicable diseases.

Dr Lim Chee Han is a senior analyst at the Penang Institute in Kuala Lumpur