The Joint Learning Network Global Meeting, initiated by the World Bank saw the Health Ministry of Malaysia (MOH), represented by Health Minister Datuk Seri Dr S. Subramaniam, reportedly considering the introduction of a healthcare insurance scheme, run and supported by the government to address weaknesses in the private healthcare system.

The meeting, themed 'Building Strong Health Systems to Achieve Universal Health Coverage', took place last Wednesday and ended on Saturday, Jul 23. The meeting was a platform for countries to share views, opinions and the problems and challenges faced in delivering a national healthcare system.
Dr. Subramaniam said the government health insurance scheme would be voluntary and an alternative to the private healthcare system currently used by 50 per cent of Malaysians.

"There will be no private player and no profit motive. The government healthcare insurance scheme will evolve according to time.

"It is too early for me to give details such as the structure, the scheme and so on. I am just throwing it as a concept, let the relevant party discuss it," he said.

The move to introduce the government healthcare insurance scheme did not mean the halt of the current public healthcare system.

"The government is still responsible to the public in providing the public healthcare system that everyone is utilising now. The public healthcare delivery will still continue and will not change," Dr. Subramaniam said.

Currently, Malaysia has a two-tier healthcare system that provides access to universal healthcare via the government's network of public hospitals and clinics, along with a complementary private hospital system. The current public healthcare system sees a 55 per cent subsidy on total healthcare since 2011.

The ministry has been studying the government healthcare insurance scheme concept for the past few months and analysing the challenges involved in implementing such a scheme, according to Dr. Subramaniam.

"Once we are confident, we will offer it to the public," he added.

Current issues in the Malaysian Healthcare System

The ministry suggested the idea of introducing the government healthcare insurance scheme as it was aware that one of the challenges for Malaysians was paying for healthcare services.

Although Malaysians are not paying or paying very little for healthcare services, many are required to purchase medicines from private pharmacies, thus forking out a lot of money despite the promise of subsidised medicines by the government.

Statistics published by the Ministry of Health also show an increase in non-communicable diseases, with cases of hypertension up by 43 per cent, diabetes up by 88 per cent and obesity 250 per cent higher in 2012 compared with 2002.

With the evolvement of health patterns, patients require expensive, long-term treatment that public spending is not prepared to match in an era of subsidy reform. If the government decides to cut back aggressively on expenditure and include healthcare in a new austerity drive, consumers could soon find themselves making more out-of-pocket payments, particularly as medical-insurance coverage is sorely lacking.

In the private sector, 79 per cent of treatments received in hospitals and clinics are paid for directly by the consumer, with only 18 per cent of private spending going towards insurance coverage. This discrepancy leaves consumers vulnerable to rising costs, especially as the burden of chronic disease increases.

This affects Malaysians from rural areas as well as senior citizens of Malaysia, having a low source of income or poor economical background.

"Such a situation can get people into financial catastrophe. The government healthcare insurance scheme may just be the answer," Dr. Subramaniam said.

Public feedback needed first

As much as the government healthcare insurance scheme sounds beneficial to the public, a DAP MP urged that the government must obtain industry and stakeholder feedback before proceeding with a proposed national healthcare insurance to avoid the rejection that befell a previous plan.

The Serdang MP said that healthcare and finance are very complicated issues, which made it untenable for the government to make decisions on both matters without consulting those that would be affected by such policies.

“One still remembers the public backlash when the 1Care national healthcare insurance was proposed back in 2011 and the plan eventually had to be scrapped/postponed,” he said in a statement.

“The consequence of this top-down decision making process is that there will be a lot of misinformation and speculation as to the underlying motivation for introducing this healthcare insurance scheme when it is announced. This will make it all but impossible to have a rational and fact-based discussion and debate on this issue."

The 1Care scheme was criticised for adopting a foreign model that did not suit the needs of the Malaysian healthcare system. MIMS