2019 Budget Wishlist: Malaysia’s Healthcare Problems and Concerns

It goes without saying that healthcare is one of the most crucial components in a country. A country full of healthy people can contribute to a thriving workforce that in turn yields a prosperous economy.

Renowned American writer, historian Will Durant once famously said that “the health of nations is more important than the wealth of nations”.

It’s impossible to stay in the pink of health at all times, which is why it’s important for people to have easy access to healthcare.

Is spending a lot on healthcare the ultimate solution?

In a word: no. Healthcare systems and services vary from one country to another and are influenced by factors like healthcare policies and population sizes.

It is also important to note that just because a country spends a lot on healthcare, it doesn’t necessarily mean that the healthcare plan in that particular country is any good. It could simply mean higher prices for drugs and medical supplies. The United States, for example, has the highest allocation for healthcare, but it also has the lowest life expectancy and highest infant mortality rates.

According to the World Health Organization (WHO), it’s really hard to come up with a definite amount that a country should spend on healthcare. A country with a malnourished population or an epidemic will require a different kind of budget than a country where mental health is the main concern. However, the general consensus on the recommended budget for healthcare seems to be around 7% of GDP.

How much is Malaysia spending on healthcare?

In 2018, former health minister Datuk Seri S. Subramaniam said that the ministry’s allocation for healthcare is RM26.58 billion, which is a 9.5% increase compared to what it received in 2017. While that displays the government’s commitment towards improving healthcare in the country but is that enough?

Last year, Klang MP Charles Santiago called for the Government to allocate an additional RM20.7 billion for healthcare so that the total allocation can amount to the recommended 7% of GDP. He proposed that the government move some money from the Prime Minister’s department and Defence ministry to achieve this.

“This further injection of RM20.7bil to the Health Ministry’s existing budget allocation (will be) consistent with the 7% (of GDP) recommendation by the World Health Organisation,” he said.

He also said that this will help to make medicine more affordable for Malaysians.

“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.”

Our healthcare expenditure is ‘too little’

In an article by The Star, Malaysian Medical Association President Dr Ravi Naidu said that the government’s current healthcare expenditure is “too little”. He noted that almost 50% of healthcare spending comes from private insurance or out-of-pocket payments.

He added that he also wants to see an increase in healthcare expenditure in Malaysia, while also expressing concern about the growing number of patients and the insufficient number of hospitals in the country.

“The number of doctors graduating is 5,000 a year. The number of hospitals has only gone up from 36 to 42 while the number of patients has doubled,” said Dr Ravi Naidu.

“The health ministry needs more hospitals to reduce overcrowding and decentralise care. We would like to see a much greater expenditure on healthcare, with a significant increase in the development budget,” he added.

Not enough beds, not enough nurses

Insufficient health expenditure does not only affect patient’s ability to access healthcare, it also takes a toll of nurses and their well-being, says Shannon, a nurse who prefers to remain anonymous.

“First of all, it’s absolutely true that we do not have enough hospitals to cater to the increasing number of patients. We don’t even have enough beds in the hospitals to cater to everyone who needs to be admitted,”

“The general nurse to patient ratio is about 1:5 or 1:8. When one nurse has to take care of too many patients, the quality of the nursing care given decreases. This can result in missed nursing care, which can lead to patients not receiving adequate treatment.”

“I also understand it’s difficult for the hospital to hire more nurses when they don’t have enough funding. Which is why I hope the government will give additional priority to healthcare this time around. We really need more resources, not only in terms of the number of beds or more hospitals but also access to all the latest technology and drugs to improve our general healthcare,” she added.

Medical/healthcare beds, peripherals and accessories provider LKL International Bhd also agrees that Malaysia has a serious problem when it comes to hospital bed-to-population ratio in the country. Managing director Lim Kon Lian hopes that the Budget 2019 will provide adequate resources to resolve this matter.

Lim added that this issue would be an even greater problem in the future, with 20% of the Malaysian population reaching over 60 years old by 2050.

Aside from hospital paraphernalia, UMMC doctor Kejal Udani’s concern leans heavily towards providing for the elderly and patients will disabilities.

“In the upcoming 2019 budget, I’d really like to see special allocations for older persons. The cost of looking after an older people is not cheap, especially so if they have debilitating diseases (a condition that prevents someone from doing their daily activities). For that, yes we have the OKU card- which means free admissions and blood in hospitals. But other stuff like tubes, extra medications, diapers, milk and all need money,” she said.

“Also, medications that were previously covered by JPA now have to be paid. For example, if one has osteoporosis, fosamax is the usual medications – and that’s free. But if we see that the patients are not responding, we would usually change agents – these can cost up to RM1,400 to RM1,500 per year or even more – and this is no longer covered by JPA for pensioners. I really hope the government can look into that,”

“In addition to that, hospitals should create a more ‘older-friendly’ environment. Fix the potholes, have more grab bars at the sides, railings, good lighting, and probably continued inspection to ensure the older patients are in a safe environment,”

“I also think we should use technology to improve documentation and possibly build apps that will help caretakers in taking care of their patients and loved ones. It’s important to have an integrated medical record system so no matter where or which hospital the patient is in, the attending doctors can have immediate access to notes and the latest medications,” she added.

What does healthcare look like in the 2019 Budget so far?

Although we are all braced for a ‘belt-tightening’ budget, we know that healthcare is something that cannot be compromised. So far, the Ministry of Health has said that it will incorporate a national healthcare financing scheme for the B40 income group (bottom 40% of household who are making less than RM3,900).

“This will be a federal B40 health protection scheme. It will be focused on the health protection of the B40 group, with allocation provided, so they won’t have to pay,” said Health Minister Datuk Seri Dr Dzulkefly Ahmad.

The health minister also reiterated that Prime Minister Tun Mahathir is committed to strengthening the healthcare delivery system and establish a national health policy that will benefit all Malaysians.

 

Editor’s note: Most healthcare professionals we interviewed declined to personally comment on the state of healthcare in Malaysia. Due to this, we have had to break from the regular format of our wishlist and present you with a different take on the subject matter.