Noting the decades of under-funding in public health and the relative lack of social protection in the country, Mohamed Aslam Haneef of International Islamic University Malaysia (IIUM) said the Covid-19 pandemic has exposed vulnerabilities in both systems.
“We are not putting enough into the public health system,” he said.
“Hence, even before the Covid-19 pandemic, despite having dedicated doctors and nurses in public hospitals, we could see the queues and long waits in our public health system.”
Aslam said Malaysia’s health expenditure as a percentage of gross domestic product (GDP) has varied from between 3% and 4.2% for roughly the last 25 years, and expenditure on public healthcare accounts for roughly 2%.
“This figure is small compared to how much we spend on education. Many experts have recommended doubling the figure to at least 4%,” he said.
“Looking at the importance of the public health system going forward, I think this is a good start and it would be important to give health expenditure priority in Budget 2022.”
Apart from the need for physical buildings – general hospitals, district hospitals and health clinics to be built – Aslam said the infrastructure has to be complemented with sufficient facilities and equipment.
He said human personnel is another major component in which increased spending is required, and the scheme of service for medical talent needs to be re-examined to avoid a brain drain to private hospitals or overseas, where the pay and work environment are perceived to be better.
He opined that Malaysia needs social market economy reforms, in which solidarity, or “taking care of everyone”, is a key principle – with public health a central part of social spending
He also said the country has spent “very little” on any kind of social insurance scheme, pointing to a 2019 health ministry report which stated that 38% of health expenditure on treatment and other items comes from out of pocket (OOP) expenditure.
“Only 1% (of Malaysians’ healthcare expenditure) is covered by our social insurance scheme, whereas in countries like Germany that promote the social market economy, they can have a social insurance scheme that takes care of 80% to 90% of peoples’ medical bills,” he said.
“In Malaysia, we have an inequitable health system – those who can afford it can get expensive private healthcare, while the huge number of those in the B40 (or maybe now B60) can’t afford to get sick.”
Noting that increased social insurance coverage might mean higher monthly deductions for workers, Aslam said the “fear” of less monthly income can be addressed by considering the various methods to fund social insurance.
He said there are at least three sources of funds to create an effective social insurance scheme, and apart from being self-funded, the scheme can be subsidised by the government or financed by endowments, wakaf (Muslim endowment) or other agencies that are able to pay for these expenses, especially for those who are less well-off.
“This last category is something that should be given much more attention,” he said.
“Besides looking at how other successful countries like Germany have funded their social insurance schemes, we could get lessons from history to see how endowments and wakaf were able to fund health very effectively.”