Over the past few months, there has been much spoken about how healthcare has become too expensive for the common man; and how public healthcare which is being provided at highly subsidised rates is not being provided at a quality that most Malaysians are happy with.

This has caused many to resort to obtaining healthcare services from the private sector (and paying for it).

Paying for health is something we should not be doing, some allege, because health is one of the fundamental rights that governments should be providing for their people. Many others also allege that in many high-income countries, health is being provided to the citizenry whereby they do not need to pay for it.

Some even argue that under the concept of universal health coverage or UHC, a country must provide its citizens with free healthcare coverage.

Unfortunately, this premise, along with other beliefs that Malaysians have about free healthcare, is mostly untrue.

Universal health coverage, for example, is a constantly evolving target requiring a country to continue providing accessible, quality healthcare for all without putting them into financial risk.

For many who do not understand, the truth is that Malaysia has had universal health coverage since decades.

However, there are widening gaps within the provision of care under the universal health coverage umbrella; and it is to address these care gaps that people are turning more and more to their own financing mechanisms to address.

In actuality, in most countries (and Malaysia is no exception to this), people are paying for their healthcare in multiple ways.

Today, there is almost no health system in the world where someone spends no money at all. That is a common illusion which will be dispelled, hopefully, in the next few paragraphs.

Even in so-called ‘progressive’ health systems in which most services are provided via the public healthcare system, individuals are required to pay for their health via a specific earmarked health tax, or through social health insurance premiums.

In these systems, access to healthcare is rationed, with specific intervals required before seeing a doctor, for example; or even requirements put in place to follow strict regulated processes such as ‘gatekeeping’ (where you must first see and be treated by a GP before getting to see a specialist).

Additionally, in most social health insurance systems, there are other financial control mechanisms which are used to also ‘ration’ or limit care access such as through the use of deductibles (where you have to pay out-of-pocket up to a certain amount before the health insurance begins to pay for the bills) or co-pay mechanisms (where the user and the health insurance both pay some amounts of the total bill being charged for the healthcare service).

With such ‘rationing’ of care, individuals have to resort to purchasing many health products (or even services) out-of-pocket through accessing over-the-counter medication in pharmacies or paying out-of-pocket for physiotherapy, for example, at a provider.

Quite a few even travel for certain health procedures to other countries where they can get them at more affordable prices- such as flying to get dental or even cosmetic procedures done in certain Southeast Asian neighbours of ours.

Thus, even in countries where the individual is paying health taxes or health premiums through a social health insurance, there is still a lot of purchasing of health which comes from out-of-pocket.

On the other hand, in many other low-and-middle income countries, the public healthcare system is financed through tax (which consists of income tax paid by individuals from their income and other taxes) and in theory, is available for all at either largely subsidised prices or free at point-of-access – meaning you have to pay very little.

Unfortunately, there are significant shortcomings to these public healthcare services and they come in the form of the inability to cope with the huge demand put on them amidst a lack of funding resources.

Countries facing economic turmoil, decreases in tax revenue and a host of other factors often reduce funding to public healthcare- and when this happens, gaps appear in the provision of public health services such as long waiting times for procedures and even unavailability of certain treatments.

People living in such countries then often have to resort to paying and obtaining the health services that they need from parallel, private healthcare systems which develop to cater to this need.

Paying out-of-pocket for accessing private GPs for primary care needs, buying medications over-the-counter from the pharmacy, or even paying premiums to subscribe to a private health insurance scheme are just different ways in which individuals are paying for their healthcare.

In short, irrespective of which country you live in and what kind of health system it has; individuals are ending up paying a significant amount of money both directly and indirectly for their healthcare.

So what’s the problem?

Paying for healthcare currently is based on this premise: You pay when you are sick or when you need a healthcare service.

Unfortunately no one knows when they will fall sick, or worse, how sick they will get. So when you are suddenly faced with a severe illness, few people have the financial capacity to pay for it.

They are then faced with financial distress, inability to pay for treatments, and sometimes… even die from these conditions.

We labour under the illusion that as individuals, we are only paying RM1 or RM5 to access a public healthcare system – and we think that’s all we are spending.

The reality is that even right now, most of us are spending additional amounts up to a couple of hundred ringgit a month on health-while not realising realistically that we are already spending that much.

Worse, this amount of expenditure is often not buying us the quality care that we need.

As individuals, we need to be able to spend better for health, and we need to get quality care for the amount of money that we are already spending for health.

Once we get over the illusion that we are getting healthcare, then we can work towards strengthening and obtaining better quality care for the ringgit you are already spending…. without needing to go into financial impoverishment.

The views expressed are those of the writer and do not necessarily reflect those of FMT.