HEALTHCARE financing, treating non-communicable diseases and caring for the elderly – these are the three critical areas Putrajaya should look into with the RM41.22 billion allocated to the Health Ministry (MOH), experts said.

The experts said funding for the Health Ministry makes up 10.5% of the RM393.8 billion national spending plan and should be put to good use.

Galen Centre for Health and Social Policy chief executive officer Azrul Mohd Khalib said the government needs to find solutions to bridge funding gaps in healthcare financing.

“This is urgently needed in areas such as staff recruitment and retention, modernisation of medical infrastructure and the treatment of non-communicable diseases.

“The answers to these questions are not known to the public and even policy makers, so we don’t have an understanding of what is needed.

“Health needs more funding but we must also look at where and how it is being spent,” he said.

Azrul said the government must also treat health as a serious investment whose return comes in the form of healthy, productive citizens helping to build the country.

He urged the government to remove the RM1 and RM5 charges for outpatient and specialist care respectively currently being charged to patients in Health Ministry facilities.

“People should not need to pay for anything at the point of registration for treatment at a public healthcare facility.

“These charges also mislead the public into believing that the cost of healthcare in Malaysia is cheaper in government facilities. It is also inadequate for meaningful cost recovery.

“We believe that removing these charges will open the way to meaningful discussion and facilitation of future reforms in healthcare financing, especially social health insurance,” he said.

In tabling Budget 2024 last month, Prime Minister Anwar Ibrahim announced that the MOH will receive the second-biggest allocation – RM41.22 billion or 10.5% of the entire RM393.8 billion federal budget.

This is an increase of RM4.9 billion or 13.5% from RM36.3 billion that was allocated under Budget 2023.

This is the biggest increase of allocations among ministries and is also the biggest percentage of increase for MOH’s budget since 2014.

The prime minister further announced that RM5.5 billion will be channeled to develop medicines and vaccines.

Azrul said another critical issue the MOH should look at is non-communicable diseases (NCDs).

He said Malaysia is in a NCD crisis, of which diabetes is one of the main contributors.

“There are now almost 5.5 million people living with diabetes in this country.

“A recent MOH-World Health Organisation report showed that six years ago, the annual healthcare spending for this disease was RM4.38 billion, and was the highest compared to cardiovascular disease and cancer,” Azrul said.

In other words, he said, for every ringgit spent on the three NCDs, RM0.45 sen goes to diabetes, RM0.41 sen goes to cardiovascular disease and RM0.14 sen to cancer.

Azrul proposed introducing co-payments of up to 30% of actual cost for the treatment of diabetes.

“This will help people increase their adherence to treatment, reduce wastage of highly subsidised medication and reduce the likelihood of developing further complications such as end stage renal or kidney failures,” he said, adding that this move could save lives.

The third area which needs attention is caring for the elderly as special care is needed to deal with the needs of a growing ageing population.

He said politicians often speak of this issue as if it was in a distant future, which should be dealt with by someone else.

Azrul, however, stressed this problem is already upon us.

Long-term care facilities and relevant essential services for the elderly remain limited, mostly confined to urban centres and concentrated to private providers or dependent on already stretched families and households, Azrul said.

“There continues to be a lack of clarity on which ministry should take the lead on care of the elderly, and the care economy.

“There is an unsustainable dependence on informal care. As a result, many older individuals among us are now vulnerable to or suffering from neglect, substandard care, and even abuse.

“The government needs to immediately make improving long term care for the elderly as a priority with the huge allocation in Budget 2024,” he said.

Azrul said there should be a scheme for those above the age of 40 to fund long term care, similar to what is implemented in Japan.

Human resources planning not mentioned

Meanwhile, the Malaysian Medical Association said the health budget did not address human resources planning.

Its president Dr Azizan Abdul Aziz said human resources should be a top priority for the MOH.

“The high attrition rate of doctors and nurses in public healthcare is a concern that should not be viewed lightly.

“We must invest in our human capital with regards to training and improving remuneration and allowances,” she said.

She also called for service expansion, especially in rural areas.

She said Putrajaya should invest in stages and strategically on expanding current hospitals and clinics for better healthcare delivery including rural healthcare services.

Besides this, Azizan also said that some of the ageing assets in public healthcare facilities need replacement.

“Some assets are already very old and do not comply with patient safety standards,” she said.

Addressing the issue of NCDs, Dr Azizan said the government’s “Skim Madani” must be expanded to include NCD management.

“NCD management should be part of efforts to decongest public healthcare facilities.

“MMA is confident of increased participation of private general practitioners (GPs) should the scheme include this service,” she said.

MOH’s operating expenditure for 2024 is set to be in the region of RM35.15 billion, while RM6.07 billion has been set aside for development. – November 12, 2023.