The document discusses healthcare spending in Malaysia relative to other countries. It notes that while Malaysia spends around 4% of GDP on healthcare, this is split almost evenly between public and private spending. There are pressures to increase healthcare spending due to an aging population and shift to chronic diseases. While additional investment may pay off through economic and health gains, funding needs to be increased through measures like taxes on tobacco or reducing fossil fuel subsidies. The large public-private divide and high out-of-pocket spending also need to be addressed through more strategic purchasing of healthcare services.
WhatsApp đź“ž Call : 9892124323 âś…Call Girls In Chembur ( Mumbai ) secure service
Â
% GDP spending in UK, G5 countries and OECD upper middle income countries. Why it is important to have adequate % spending.
1. #OHEMasterclass
Adrian Towse
Emeritus Director OHE Visiting
Professor LSE
% GDP spending in UK, G5
countries and OECD upper
middle income countries.
Why it is important to have
adequate % spending.
Monash Health Economics Forum 2019
An efficient and sustainable healthcare system
in Malaysia :
The challenges, lessons and future
2. Agenda
â—ŹMalaysian health care spending relative to other countries
â—ŹDrivers for higher health care spending
â—ŹWill investment pay off?
â—ŹFunding additional public expenditure on health care
●Current landscape in Malaysia – the public private divide
â—ŹOptions for moving towards more comprehensive UHC?
â—ŹConcluding thoughts
3.
4.
5.
6. Agenda
â—ŹMalaysian health care spending relative to other countries
â—ŹDrivers for higher health care spending
â—ŹWill investment pay off?
â—ŹFunding additional public expenditure on health care
●Current landscape in Malaysia – the public private divide
â—ŹOptions for moving towards more comprehensive UHC?
11. Pressures for health spending
â—ŹDemand side
â—ŹAgeing of the population
â—ŹChanging epidemiology as shift to chronic non-communicable disease
â—ŹPopulation preferences for health gain as they get better off:
- Income elasticity greater than 1
â—ŹSupply side
●Relative price effects – labour intensive services with a lower underlying productivity growth than
that of the economy
●Technological innovation – moving the health production possibility function outwards (or
improving efficiency – product or process innovation)
●A mix effect – existing technologies are used on an expanded group of patients
12. Agenda
â—ŹMalaysian health care spending relative to other countries
â—ŹDrivers for higher health care spending
â—ŹWill investment pay off?
â—ŹFunding additional public expenditure on health care
●Current landscape in Malaysia – the public private divide
â—ŹOptions for moving towards more comprehensive UHC?
13. New investment in health has a high payback
â—Ź There are two effects:
â—Ź Impact on economic growth
- Human capital
- Labour market flexibility
- Reduce precautionary savings and health debt
- Medical tourism
â—Ź The value people attach to being healthy
â—Ź Between 2000 and 2011, 24% of full income growth in MLICs resulted
from VLYs gained.
â—Ź Progressive universalism would yield high health gains per dollar spent.
Poor people gain the most in health and financial protection
● Use of WHO “best buy” clinical interventions and other evidence based
approaches to priority setting
14. Making the case for investment
â—ŹAn understandable degree of scepticism on the part of
Ministries of Economy and Finance about the returns on
investment in health
â—ŹHealth policy makers need to understand the
perspectives of national economic policy makers, and to
frame evidence and structure arguments in a way that is
likely to resonate with them.
â—ŹEmphasis on the role of evidence e.g.
â—ŹEfficiency of the health care system
â—ŹImpact on productivity of the economy
â—ŹMorbidity and non-market activity
15. Agenda
â—ŹMalaysian health care spending relative to other countries
â—ŹDrivers for higher health care spending
â—ŹWill investment pay off?
â—ŹFunding additional public expenditure on health care
●Current landscape in Malaysia – the public private divide
â—ŹOptions for moving towards more comprehensive UHC?
19. WHO (2018). Public Spending on Health: A Closer Look at Global Trends. WHO/HIS/HFWorking Paper/18.3
20. Increasing revenues
â—ŹLancet Commission: National governments can curb NCDs and
raise significant revenue by
â—Ź heavily taxing tobacco and other harmful substances,
â—Źreducing subsidies on items such as fossil fuels.
â—ŹWorld Bank: increase overall government revenue as a share of
GDP
â—ŹExpand the tax base
â—ŹRemove fossil fuel subsidies
â—ŹRaise taxes on health damaging products
â—ŹEarmarked taxes on non-wage products / activities
22. Agenda
â—ŹMalaysian health care spending relative to other countries
â—ŹDrivers for higher health care spending
â—ŹWill investment pay off?
â—ŹFunding additional public expenditure on health care
●Current landscape in Malaysia – the public private divide
â—ŹOptions for moving towards more comprehensive UHC?
23.
24.
25.
26.
27.
28. Making sense of Malaysian public private divide
â—ŹAround 4% of GDP split almost 50:50 public and private
â—ŹTwo separate systems, very little overlap
â—ŹPrivate system is predominantly OOP, no community rated insurance
â—ŹPublic services more important in the rural areas and amongst poorer families
â—ŹOne potential way forward is for the government to buy services both from public and private
providers – a revamped mySalam B40 insurance scheme?
â—ŹStrategic purchasing of this kind allows a shift to debate investment in additional services and
priority setting
â—ŹChanges in funding flows and payment mechanisms can incentivise provision of priority services
29. mySalam B40 insurance scheme and related initiatives
â—ŹTwo new health protection schemes came into effect from 1 March for B40 patients:
â—ŹPeKa B40 addressed at B40 patients aged 50 and above, to reduce the burden of NCD by providing free health
screenings, medical equipment aid, transport aid and incentives to complete cancer treatment
â—ŹmySalam provides lump sum payments for B40 patients 18-55 for 36 critical diseases
â—ŹThe Selangor state introduced Skim Peduli Sihat, in 2017, which funds provision of basic care for B40 families at private
clinics. Providers reimbursed to an annual value of M$700 per family.
â—ŹRecipients of mySalam receive one-off payments up to RM8,000, and daily payments as (income replacement in the
event of hospitalisation) for up to 14 days at RM50 per day or RM700 per year.
â—ŹInsurance and tawakal penetration rate of 30.2 per cent among low-income earners, with the 50.4 per cent rate of
Malaysians in higher income categories in 2017
â—ŹThis will involve de facto allowing public money to be used to buy services in the private sector
â—ŹHowever, this is (limited) financial protection
â—ŹThe government has no influence on the services that are provided
30. Agenda
â—ŹMalaysian health care spending relative to other countries
â—ŹDrivers for higher health care spending
â—ŹWill investment pay off?
â—ŹFunding additional public expenditure on health care
●Current landscape in Malaysia – the public private divide
â—ŹOptions for moving towards more comprehensive UHC?
31. Making sense of this: Moving to expanded UHC
â—ŹSouth Korea has a single payer UHC scheme with high OOP spending
â—ŹThailand has a multi-payer UHC scheme with low OOP spending
â—ŹEmployer based social insurance
â—ŹCivil service scheme
●Universal coverage (ex “30 Baht”) scheme for everyone else
â—ŹIndia is finally moving towards a federally supported publicly funded UHC scheme
â—ŹThe challenges in Malaysia are:
â—ŹTotal separation of public and private provision and use
â—ŹNo significant pooled private insurance e.g. employer-based
â—ŹNeed to raise taxes to fund an expansion of publicly funded health care
32. Concluding thoughts
â—ŹPressure to spend on health care will increase
â—ŹAnd it can be a productive investment with a high economic pay off
â—ŹReal terms Government health expenditure needs to rise at a higher rate
â—ŹMalaysia is lagging behind other upper MICs in public spending on health
●Raising additional revenues – “sin” taxes are not earmarked taxes for health
● The public – private divide, high dependence on OOP spending needs to change
â—ŹThe public sector should buy from the private sector
â—ŹMoves to national health financing need to be incremental and progressive
â—ŹBut financial protection should lead to strategic purchasing of services
â—ŹNeed for an overall strategic vision for national health financing implementation
33. References
â—ŹCylus et al. (2018). Making the economic case for investing in health systems. What is the evidence that health systems
advance economic and fiscal objectives? WHO Observatory
â—ŹMalaysia National Health Accounts (MNHA) 2018
â—ŹReport of the WISH Investing in Health Forum (2016). Investing In Health The Economic Case
â—ŹSmith (2019) Can a Strong Economic Case Be Made for Investing in the NHS? Office of Health Economics
https://www.ohe.org/publications/can-strong-economic-case-be-made-investing-nhs
â—ŹSolidiance (2018) The ~USD 320 billion. healthcare challenge in ASEAN
●The Lancet Commission (2013). Global health 2035: a world converging within a generation. Lancet 2013; 382: 1898–
955
â—ŹWorld Bank Group (2019). High-Performance Health Financing for Universal Health Coverage
â—ŹWHO (2018). Public Spending on Health: A Closer Look at Global Trends. WHO/HIS/HFWorking Paper/18.3
34. To keep up with the latest news and research, subscribe to our blog.
OHE’s publications may be downloaded free of charge from our website.
ohe.or
g
OHE
Southside
105 Victoria Street
London SW1E 6QT
United Kingdom
Telephone
+44 (0)20 77478850
FOLLOW US
Toenquire about additional information and analyses,
please contact:
Adrian Towse
atowse@ohe.org
Editor's Notes
The government is concerned with high OOP and risk of catastrophic financial stress hence the need for social health insurance scheme. However, the 1Care program proposed in 2012 received a lot of negative backlash and was shelved. It would take a lot of political willpower to implement such a scheme.