Is health financing a “dirty word” in general elections?
DR MUSA NORDIN09 Oct 2022 02:36pm
The finance ministry has not shared any thoughts or insights whatsoever on reorienting the multiple pools of health investments towards a sustainable trajectory with a bigger impact on the nation’s productivity and health outcomes.
I would however tend to agree with one of my public health colleagues that this 11.5% increase in the health ministry budget parallels the whopping 12.1% hike in the total federal budget from 332.1 billion in 2022 to 372.3 billion in 2023.
Any changes in the health budget must be rationalised against at least two of the following factors, namely, the health ministry's share of the federal budget and the health budget as a percentage of the GDP.
On both accounts, there has been no difference in the health budget when contrasted against the government operating and development expenditure (9.7% for both years) or as a percentage of the GDP (1.98% for both years).
If anything the finance ministry did not heed the calls of the Health White Paper (HWP) to increase incrementally the health allocation as a percentage of the GDP, with the 5% mark as the target. (see Graphs 1 and 2)
I hope this will offer an alternative perspective to the budget numbers game and we have not even begun to factor in the pressures of inflation and the dwindling value of the ringgit.
Prior to the release of the Federal Budget 2023, I had about 6 tangible, relatively low-budget, but high-impact expectations on my budget wish list. All 7 were missing from my overview of the goodies in the health budget, but I may have missed the fine print or specifics!
1. Savvy and robust Health Information System (HIS).
A HIS that wired up the entire health ministry network to general hospitals, district hospitals and health centres, and the 8,000 GPs (thrown in pro bono by the vendor). And hopefully with smart negotiations, will eventually wire up with educational hospitals and other health related institutions. The HIS will empower every Malaysian and users of the HIS, an Electronic Medical Record (EMR) from cradle to grave, on one’s smartphone. This was amiss!
Instead, a local private hospital is the beneficiary of the award-winning, cutting-edge, affordable and best HIS. By the way, this new HIS was unanimously voted top from among 20 vendors by the MOH-HIS selection committee in 2019. More recently, they won the HIMSS (Healthcare Information and Management Systems Society), the best health IT solution award in Bali.
2. Resilient Public Health Preparedness Tools
Another public health colleague has been in the front-line developing a robust and resilient public health system that can prevent, detect, and respond to infectious disease threats immediately.
It needs to remain contemporary with a central database for disease reporting, genomic sequencing, waste water sampling, environment sampling, zoonotic diseases and antibiotic use.
Since the pathogen does not recognize boundaries, Malaysia can take the lead in future public health preparedness by initiating a regional collaborative system, and kick start with the ASEAN region! But alas!
3. Human resource crisis
The government must urgently address the acute-on-chronic human resource crisis in the health ministry by implementing the loud call from experts in the Health White paper (HWP) to form the Suruhanjaya Perkhidmatan Kesihatan or the similar modus-operandi.
107 doctors quit the MOH in 2017, which has escalated to 168, 475, 511 and 768 from 2018 to 2021 respectively.
There has been calls from the health fraternity including the Academy of Medicine Malaysia (AMM) for an expert committee relook and better analyse the questionnaire and 14,000 pages of verbatim records of the “toxic work culture and bullying” not fully addressed by the HWCITF in order to better protect the welfare of HOs and junior MOs
4. Failure to enhance Public-Private-Partnership (PPP)
The MOF and MOH has failed to build on the unprecedented PPP which was seen in full action during the pandemic.
The Association Of Private Hospitals, Malaysia (APHM) has lamented on the lack of incentives in the budget to further cement the collaboration between the private and public hospitals and for better utilization of the “20 per cent of resources in private hospitals which are underutilised, while public hospitals were overburdened.”
5. No real push
There is no real push in budget 2023 to mainstream and exemplify preventative health strategies versus the current curative bias mindset.
As far as child health is concerned, the legacy of the Pakatan Harapan (PH) government is the introduction of the Pneumococcal Conjugate vaccine (PCV) within one year of taking office in 2019, despite our crusade for the PCV for 14 years since 2005 through multiple Barisan Nasional (BN) governments.
There is an urgent need to prioritise cost effective (CE) preventative healthcare especially since Malaysia has now transitioned into an ageing society.
The percentage of the population aged 65 and over (old age) is 7.3 percent in 2022, and is expected to double to 14.5% in 2040. If a healthy lifestyle is not maintained, and the plethora of NCDs is not mitigated, it is estimated that the older adults will spend 9.5 years in poor health.
My wish list for budget 2023 was the introduction of either influenza or pneumococcal vaccine in the National Immunisation Program (NIP) for the older persons.
There is zero vaccines in the adult National Immunisation Program (NIP). Multiple pharmaco-economic analysis of influenza vaccines in elder persons have been shown to be Cost-Effective and most first world countries have influenza vaccination programs for citizens aged above 65 years.
77.2% of laboratory-confirmed influenza patients admitted into the ICU or died in Singapore from 2011-2015 were above 65 years and 70% of them had at least 1 chronic medical condition.
Investment in the influenza vaccines has been shown to protect them from getting influenza, but if they are infected, reduce the severity of symptoms, reduce the risk of hospitalization by 45%, reduce the risk of heart attacks by 36%, reduce by 30% the risk of strokes in diabetics, reduce the risk of death by 42% and helps to protect the independence of the elder persons.
If RM6 billion was set aside to procure Covid-19 vaccines alone, MOH Budget 2023 of RM4.9 billion for “public health spending to procure medicines, reagents, vaccines and disposable items” is pittance
6. Is Health Financing (HF) a “dirty word” come General Elections?
Looks like it is business as usual as far as health financing is concerned. The finance ministry has not shared any thoughts or insights whatsoever on reorienting the multiple pools of health investments towards a sustainable trajectory with a bigger impact on the nation’s productivity and health outcomes.
Didn’t the MOF peep into the much-touted HWP which among others expressed the importance and urgency of a need to refocus economies and prioritise investments in health to ensure a more sustainable and resilient health system?
There is a need to pool funding sources in order to reclaim market power, to invest in preventative and value-based healthcare and empower strategic purchasing for quality and best prices.
Health financing would be anchored by federal taxation with multiple contributions from employer health coverage, state government health budget, pension healthcare funds, private health insurance, Islamic social funds and others.
Increased pooled health investments in a mechanism like the National Health Fund (NHF) would represent a harmonized approach to Health Financing which avoids fragmentation, duplication, enhances equity (Universal Health Coverage) and efficiency!
It would be the de facto single-payer strategic purchasing mechanism to integrate both public and private healthcare providers to deliver high-quality, low-cost and value-based healthcare services, which would achieve “more rumble for the ringgit”
Dr Musa Nordin is a Paediatrician. The views expressed in this article are the author's own and do not necessarily reflect those of Sinar Daily.
