If you were to compare Malaysia’s healthcare scorecard with that of other countries’, how do you think we’d do? I got answers to that question when I came across a World Health Organisation (WHO) report, World Health Statistics 2017. It lists data on key health-related development goals for all countries.
On many issues, we’re not doing too badly. But one figure caught me by surprise: the amount of money that Malaysia spends on healthcare, as a percentage of total government expenditure. It is a mere 6%.
When I compared that with what our neighbours were spending, I was even more surprised. Thailand allocates more than double the amount, at 13%, and Singapore and Vietnam even more, at 14%. Even many low-income countries, from Afghanistan to Zambia, earmark relatively more funds to healthcare than we do!
Globally, most countries apportion about twice as much as we do to healthcare. This is shocking.
This issue has in fact been raised by politicians and healthcare leaders. Last year, Klang MP Charles Santiago filed an (unsuccessful) parliamentary motion to reallocate RM20bil to the Health Ministry from the Prime Minister’s Department and the Defence Ministry.
He said lower government subsidies in the last few years has resulted in costs being passed onto patients. And more private sector patients are now migrating to public hospitals due to higher medical costs, he added.
He also questioned why defence spending was being raised. “To my knowledge, we are not going to war anytime soon,” he said. “But we are certainly witnessing the predicament of thousands of people struggling with the prices of medicines and the staggering hidden costs of treatment.”
Malaysian Medical Association President Dr Ravi Naidu described current government healthcare expenditure as “too little”. “Almost 50% of spending is from private insurance and out-of-pocket payments,” he pointed out.
(“Out-of-pocket payments” are direct costs made by the patient to healthcare providers – as opposed to, say, insurance coverage – that can make healthcare very inequitable, as the high costs may deter people from seeking care, or exhaust their savings, pushing them into poverty and debt.)
“At the same time,” he added, “non-communicable diseases and obesity are spiralling upwards.” The increase of these diseases has been dramatic in the last decade or so; diabetes, for example, has jumped more than 50% among adults.
“The government needs to work with the profession to come up with a workable solution,” he said.
Prof Datuk Dr Adeeba Kamarulzaman, dean of Universiti Malaya’s School of Medicine, also concurred that current healthcare spending is not enough to prepare us for the challenges of non-communicable diseases and an ageing population; additionally, it cannot overcome the chronic shortage of healthcare workers in the public sector.
“We have not even begun to build the allied health sector – specialist nurses, physios, occupational therapists, medical social workers – all of whom are crucial in dealing with the expansion of chronic diseases and the ageing population,” she said.
“How are we going to be able to access newer, better drugs and technology on that budget when it is not enough to cover basic healthcare?”
She also questioned how the country would achieve universal health coverage. “How is that budget going to cater for those in rural areas?”
Universal health coverage is a global development goal to provide health services to all people, without causing them to suffer financial hardship. Every year, 100 million people are pushed into extreme poverty due to those “out-of-pocket” payments for healthcare.
Malaysia’s healthcare system does provide wide coverage, but there are signs that not everyone is served equitably, particularly the poor and rural folk. One sign is stunting among children – a key survey in 2016 found this affects one in five toddlers.
Another sign is the death of women in childbirth and pregnancy. Let me tell you: in rich countries, women rarely die giving birth. But in poor settings, it can be a fact of life – a fact that reflects inequities.
For decades, Malaysia made excellent progress on maternal mortality, but in recent years, the numbers have stagnated. Countries like Thailand and Sri Lanka have now overtaken us, according to WHO’s report. In Johor, Sabah and Sarawak, maternal mortality actually increased at one point in the previous decade.
This all shows the work the needs to be done in providing basic, essential services to all citizens in all states.
Healthcare has been a national priority and our healthcare system was long considered a model. The rise of the Asian “tiger” nations has even been partly ascribed to investments made in healthcare and education.
The challenges ahead are enormous, including mammoth chronic diseases that are cripplingly costly to treat, but these can be prevented or lessened, with early action. If there was ever a time to invest more in healthcare, this is it. After all, this is an investment in our own people.