THE health white paper, the initiative of former health minister Khairy Jamaluddin, was finally published and tabled in parliament on June 13.

The 57-page document, currently only available in Bahasa Malaysia, is a landmark publication by the Health Ministry. It is probably the boldest step for systemic and structural reform since the ministry proposed 1Care more than 10 years ago.

This document also shows that the Health Ministry can acknowledge what the health challenges and issues are in this country without the government having to spend precious taxpayers’ money on a particular international consultancy firm to carry out a study or “‘advise”.

The Health Ministry has learnt from the lessons of 1Care. It listened to the stakeholders while drafting the white paper, and it is now determined to build cross-party support in parliament for the 15-year plan.

The paper makes many big calls: separation of the ministry’s roles as service provider and purchaser; autonomy for hospitals and primary healthcare (PHC) teams; creation of a dedicated public account for the health fund; creation of a new strategic purchaser entity; greater collaboration and integration between the public and private sectors and NGOs in service delivery; a paradigm shift from “sick care” to promotive and preventive health care through the establishment of community-based PHC teams; adoption of the use of electronic medical records.

Given the limitations and challenges of the existing health system and larger government operations, as well as the social demographic and health trends outlined in the first chapter of the document, it is clear to the Health Ministry that it is unsustainable to maintain the status quo.

The proposals it calls for are not without challenges: to increase public investment in health to 5% of GDP, the paper suggests not relying on one source (federal budget allocation) but diversifying and pooling the resources of government-linked companies, individual contributions, wakaf, foundations, and donations.

The mechanism for the so-called National Health Contribution Scheme (“Skim Caruman Kesihatan Negara”) is not mentioned; it could be controversial, as the paper already calls for the adjustment of the fee structure under the Fee Act.

The scheme reminds some of the 1Care proposal, which was met with many objections.

In principle, I agree that there should be cross-subsidisation of health expenditure, that higher income households that can afford to pay for healthcare should not be subsidised as much as lower-income households.

But it might not be easy to get selected income groups to start contributing to a health fund.

I imagine the more populist politicians would seize the chance to portray the move as an unfair loss for the affected households.

But it is uncertain if the scheme would have the compulsory health insurance feature of the 1Care proposal. I would not vouch for it, given the high administrative costs of running an insurance system. Some members could easily be left out.

It will be interesting to see how the so-called “health benefit package” mentioned in the health white paper actually works out; whether it is similar to the current PeKaB40 packages that do not require people to pay for the health screening services that they provide.

The paper holds many promises of reform to planning and management based on evidence, value and need. There is much emphasis on better integration, resource sharing and collaboration between the public and private sectors.

My concern is that should the private sector put its own interests ahead of public interest, would the public-private partnership deals really benefit the people? What are the potential risks and costs? Will the private sector fully trust the government? How much does the government have to give in to the demands of the private sector?

As to separating the Health Ministry’s roles as provider and purchaser, I would be interested to see how this could be done without adding layers of bureaucracy that would affect the efficiency of health service delivery. I understand the risk of so-called “conflict of interest in the narrow sense of resource demarcation of federal budget items, although both roles should still largely work for the public interest and demand. I am concerned that the role of separation can lead to gatekeeping where the “purchaser” can limit or deny more genuine demand for services.

Nevertheless, I welcome the paper as a serious and sincere effort by the Health Ministry to reform and transform our health system for better sustainability and to deliver better health outcomes for the population.

This should be the beginning of a substantive discussion on what the health reform should look like. – June 19, 2023.

* Lim Chee Han is a founding member of Agora Society and a policy researcher. He holds a PhD in infection biology from Hannover Medical School, Germany, and an MSc in immunology and BSc in biotechnology from Imperial College London. Health and socioeconomic policies are his concerns. He believes a nation can advance significantly if policymaking and research are taken seriously.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.