The People’s Health Forum (PHF) launched its blueprint on health reform recently at Cafe Liberal Latte, Kuala Lumpur.
The blueprint draws on input and recommendations made by various stakeholders, including medical and allied health professionals, academics, civil society organisations, representatives from the Ministry of Health (MoH), patient groups, and trade unions in six roundtables organised by PHF from 2019 to 2021 which deliberated on the way forward for Malaysia’s health system.
As the MoH’s health white paper on health reform is being developed, the PHF’s blueprint calls for public attention to critical health policies and issues, emphasising the importance of the sustainability of Malaysia’s health system to meet the current and future health needs of the people and underscoring the need for equity in healthcare financing that does not burden any segment of the population.
Covid has highlighted the acute need for a strong health system and appropriate health policies as an imperative for protecting health, reviving the economy, and holding society together.
PHF’s blueprint offers an analysis of the chronic and critical issues affecting the efficiency, quality, and coverage of care in Malaysia and makes policy recommendations for better health outcomes and healthcare financing.
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Health services constitute a major component of social protection provided by the federal government and are fundamental to access to care and wellbeing of the people. They also foster social solidarity, which is vital for reducing social inequalities and promoting social protection and empowerment.
Thus, decisions on health reform need to ensure that access to care and good health align with equity, sustainability and the active participation of the people in health policy development and delivery of services.
Many of the pressing and chronic problems of Malaysia’s health system arise from an underfunded health system, fragmentation and lack of coordination between public and private health sectors in health services delivery, and disrupted linkages of care between primary, secondary and tertiary healthcare.
There is also increasing segmentation of care between income groups, which compromises risk pooling and cross-subsidisation between the rich and the poor, and the healthy and the ill.
It is also high time for a new governance mechanism for MoH personnel to be able to meet the country’s current and future health needs.
It is to the credit of the MoH that Malaysia continues to enjoy high-quality care in the public healthcare sector at a low cost, which especially ensures that lower-income groups continue to obtain affordable care.
PHF welcomes the health white paper initiated by the MoH. We are reassured by the white paper’s commitment to equity, sustainability and resilience goals and support the need to future-proof the reforms by embedding them within processes and public institutions such as Parliament.
We hope that our blueprint will contribute to the white paper and deliberations which promote access to healthcare for all, based not on the ability to pay but on need.
Some of the highlights of the blueprint include:
- Increase in the total expenditure on health as a proportion of gross domestic product (GDP) from the current 3.8% to the world average of 6.6%, including an increase in public expenditure on health. The increased expenditure should be invested in expanding public healthcare infrastructure, expanding primary care and prevention, training and retaining specialists in the public healthcare sector, and reducing co-payments for implants and equipment currently paid for by the people
- Toward this end, the PHF favours incremental changes and improvements to the current system over massive restructuring, keeping to the global budget/capitation approach to allocating the health budget, and reliance on progressive taxation, not extra contributions from ordinary (lower-income) citizens to fund healthcare
- In this regard, the PHF has serious reservations about the introduction of a social health insurance system and reimbursement of healthcare providers based on the treatment given. This will require the creation of new bureaucracies and will incur a significant increase in administrative costs and workforce resources. These additional costs will drive up the cost of healthcare unnecessarily. The PHF is also worried that the fee-for-service payment model will make hospitals and clinics focus more on treatment and disincentivise physicians from providing health promotion and preventive care
- Strengthen primary care and prevention via a GP capitation-based system where programmes like the PeKaB40 are expanded to include the middle 40% of households, and families are covered by a family doctor system that provides periodic health screening, health consultation and health promotion
- Link the expansion of primary care to the development of community-based care, which will include the delivery of services in the community and the growth of posts for community nurses and other allied healthcare professionals to visit patients with special needs in their homes, and provide basic nursing care, physiotherapy, as well as health and nutritional education at the community level
- Set up a public health services commission to address the longstanding problems of human resources for health – such as the attrition of specialists from the public health sector and systemic problems faced by medical officers – by establishing more transparent processes for recruitment and promotion, providing incentives for specialists to remain in public service, and addressing issues of tenure and professional development of the current contract medical officers. A moratorium on the expansion of private healthcare is required to stem the brain drain of specialists from the public health sector. Tangentially, there is also a need to review medical student intakes in medical schools to address the imbalances in human resources for health
- Ensure affordable medicine and treatment by making the patent system more stringent, imposing a medicine price regulation mechanism and promoting the local pharmaceutical industry for the production of generic medicines, vaccines and medical devices
- For health information, set up data hubs for public visualisation, usage and downloading of health data; update and publish national registries more frequently; and publish disaggregated health information for migrant populations
- Recognising the contributions of migrants to the country, provide universal access to healthcare for migrant workers and non-citizens as was done in the case of Covid treatment and vaccination, repeal the directive to arrest undocumented migrants in public healthcare, and integrate NGO clinics providing primary care to refugees and asylum seekers into the wider system
- Strengthen pandemic control capacity by taking a health-in-all policies and whole-of-society approach that addresses social inequalities laid bare by Covid, especially in the case of the poor, and migrant and indigenous populations. Pandemic preparedness should also include better integration between the public and private healthcare sectors to address the imbalances in the distribution of care between the public and private sectors as seen during the Covid pandemic, reduced dependency on foreign vaccine suppliers, and the setting up of co-ordinated responses on multiple fronts – health, economic, financial, essential goods and services, public order and security, and social support
- Ensure that leadership and governance on health are guided by a evidence-based and value-based healthcare policy that provides equal opportunity to access healthcare and enjoy good health. Towards this end, the voices of stakeholders, including patient groups, consumer associations, civil society organisations and community leaders, need to be heard and integrated into health policy development and the delivery of services
We sincerely hope that the PHF blueprint will spark public discussions and expand the imagination of health reform in Malaysia.
The time has come for the nation’s leaders to demonstrate political will to improve the health of the people, not to politicise the health and health system.
We call on all parliamentarians and political parties to rise above partisan politics, engage in the ongoing discussion on health reform with a listening ear and respect for the people, and make decisions that will enable the people to live the healthier and happier lives they deserve. – PHF
Download the blueprint on health reform in Malaysia