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Almost everyone with any kind of insight into the healthcare landscape in Malaysia knows what one of the biggest problems in healthcare is: healthcare financing.
Healthcare financing deals with issues of how financing is generated to pay for healthcare (revenue raising); how financial risk is reduced for everyone across the population (risk-pooling), the process of purchasing needed health services (purchasing of services), and types
of services that are available to be used by the consumer (benefit package).
In Malaysia, we generally speak about health financing from a public perspective, since we are largely dependent on the public healthcare system. In the public healthcare system, revenue is raised from tax, and this revenue is used to fund health services in the public sector provided on a same footing for all Malaysians.
However, as a country, we are just not spending enough on healthcare especially within the public healthcare space – these are causing deeper cracks to form in the system which we can see manifested as long waiting times, congested public facilities, the brain drain of healthcare professionals due to compensation issues and others.
Simply put, we need more money into the public healthcare system. The government has made a significant effort to increase the budget allocation for the public healthcare system and as of last year, it hovers around an allocation of around RM42 billion.
This is nowhere near enough. Many, including former health ministers such as Khairy Jamaluddin have touted the need to get to a spending figure of around 5% of the GDP; which comes to around RM80 billion.
There is no way to sugarcoat this in an easy manner to the public. From the viewpoint of health policy professionals there is almost no way we will be able to raise this sum for health spending.
Not in any significant time that matters; unless there are some drastic and overwhelming policy shifts which may increase the overall amount of money available for healthcare from public coffers.
A whole range of consulting teams have, over decades, made the same recommendations to the government of Malaysia and the ministry of health. Find more ways to raise money; and chief among this is the strategy to put in some sort of earmarked mechanism for health financing- be it a special tax or a social health insurance.
Either way, Malaysians have to end up paying more for public healthcare.
However, such a big system fix is also not a practicable solution- despite everyone touting it as something the ‘government should do’.
The reason? Amidst increased expenditure and a sordid economy which is impacted by numerous external factors including another possible large-scale conflict erupting in the Middle East, there is definitely not going to be an easy way to find an additional RM40 billion from existing coffers to finance significant healthcare reform.
The idea of increasing tax to fund healthcare; or a special tax for health; or even putting an additional social health insurance premium onto the public’s shoulders to be borne is also not something that is going to work.
The government, already facing brickbats for last week’s targeted increase of SST, will definitely be quite reluctant to go to the public to ask them to pay more for financing healthcare.
It is a highly unpopular move as moves go. Just to remind everyone, that even at the height of its popularity, the BN government at the time was unable to get approval for a social health insurance scheme under the 1Care initiative.
So what does this leave us with?
While all of us are pessimistically hopeful that such a big healthcare system fix will happen, the more pragmatic view most need to take once they remove their rose-tinted glasses is that individuals (and by default their families) are going to need to self-strengthen their own financial capacity within the healthcare domain so that they are able to pay for healthcare themselves.
Even today, while the debate continues to rage on how we can convince the powers-that-be to finance “large-scale” structural health reform, the reality is that for many Malaysians, they need to spend out-of-pocket (OOP) for a large amount of the healthcare services they need in some form or another.
OOP spending for healthcare is never a good option since it almost always lands people in financial difficulties, and in many cases leaves them unable to pay for treatment they need.
This is worse when individuals are stricken with acute, catastrophic illnesses such as cancer which causes them to have enormous expenses.
So in many cases, Malaysian individuals play a key part in financing their own health. Since we, as individuals, are already playing a large role in paying for our own health, how can we do it better?
Bringing a person-centred perspective to health financing provides a more pragmatic look at how healthcare is being financed by individuals; and how this can be further strengthened and improved across the board- be it through innovative financing products or through better policies supporting self-financing efforts.
Individuals need to be provided with options on how to raise revenue to pay for healthcare especially when faced with catastrophic health conditions; as well as how to better improve their risk-pooling capacity.
Additionally, they need to be able to be equipped on how to better obtain quality health services in a manner that does not financially incapacitate them.
A person-centred perspective to health financing is something all stakeholders should look at as we face the uncertain horizon of awaiting structural health reform. Such perspectives can be used to drive innovative financing strategies which are consumer-focused and able to better build capacity for individuals in the eventuality they will need to tackle a health issue- and with most Malaysians this is a matter of when and not if.
While everyone is expecting a health financing ‘miracle’ where money drops from the sky into the public health financing ‘pot’, the reality is that Malaysia has a dual public-private system which most Malaysians are navigating between- picking and choosing so that they can spend the least OOP to receive the best healthcare they need.
We need to pay for healthcare, and a person-centred perspective is what all stakeholders need to adopt in order to enable innovative health financing solutions that enable us to not “hurt” when we are paying for health.
The views expressed are those of the writer and do not necessarily reflect those of FMT.
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