A HEALTH watchdog welcomed the inclusion of sustainable healthcare financing as one of the pillars of the Health White Paper tabled in parliament today.

Galen Centre for Health and Social Policy chief executive officer Azrul Mohd Khalib said the white paper shows that the government has what it takes to ensure the future of the healthcare system.

This was coupled with two recent reviews of the healthcare system commissioned by previous administrations, he added in a statement today.

Azrul said ensuring sustainable healthcare for the future has been a consistent feature of these reviews.

“However, this white paper will face the same challenges which have stumped and blocked previous attempts to reform the Malaysian healthcare system,” he warned.

He added that the challenges included gaining sufficient political commitment from the government of the day, ensuring significant resources – for example, funding and manpower – and being able to tackle both the demands and crises of today.

At the same time, he said, the government must keep an eye on the implementation of promised reforms. 

“The challenges are formidable,” Azrul emphasised. 

 Azrul also pointed out that it was unsustainable to keep subsidising healthcare for the public. 

“Healthcare does not cost RM1. It never has and never will,” he said.

“The current system of charges for RM1 (general outpatient) and RM5 (specialist outpatient) per visit were introduced in the mid-1980s and is still used today. 

“Every single patient entering the public system has had more than 95% of their treatment cost subsidised by the public purse. As pointed out in the White Paper, it has long been unsustainable.

“However, increasing these fees is not an option. For example, increasing these fees from RM1 and RM5 to RM10 and RM50 respectively would mean increases of 900%.  

“This may be neither publicly or politically acceptable. It would also be pointless as the amount of funds raised would still be insufficient for cost recovery,” he added.  

Rather than increasing the fee, Azrul was of the view that it must be abolished altogether. 

“These fees are obsolete, inadequate for meaningful cost recovery, and mislead the public regarding the true cost of health care.  

“Even the government frequently describes their services as ‘free’ or ‘cheap’. These charges now act as barriers to reform. Rather than increase the RM1 and RM5 charges, they should be removed altogether. 

“People should not be required to pay anything initially at the point of care,” he said. 

Azrul said a more sustainable and meaningful solution to healthcare financing should be proposed and supported such as the National Health Insurance.

“National Health Insurance involves almost everyone contributing to a common pool of funds, which would then be used to fund healthcare. This has been described in the white paper. 

“Such a scheme would be applicable to all workers and be based on a sliding scale linked to monthly income and age. There would be collective pooling of both funding and risk. 

“It would begin to address the issue by co-sharing the burden and responsibility of financing the health care system. It has the potential to stabilise public subsidisation, allow space for cost-containment, maintain access and quality to essential services, improve access to innovative treatment, and fund equitable access to services in the private health space.

“Will this government succeed where its predecessors have faltered?” he asked. 

Azrul said Malaysia needed strong, fearless leadership in the health sector as well as a belief in working together in partnership between the public and private sectors. 

He said many of these proposed reforms should have been implemented at least 10 years ago. 

Earlier today, Health minister Dr Zaliha Mustafa tabled the health white paper in the Dewan Rakyat.

The document details the challenges faced by the healthcare sector, as well as the policies, strategies and directions for healthcare system reforms to be implemented over the next 15 years. – June 15, 2023.