Much like Singapore, Malaysia will face an ageing population in less than 20 years. While Singapore is preparing to accommodate their senior citizens by improving geriatric care and even drawing up dedicated national health insurance schemes for them, Malaysia seems to be one step behind.

Despite the praise for many positive changes over the last decade for the Malaysian healthcare system, the elderly still worry about their healthcare. Indeed, the Ministry of Health subsidises 95% of patient costs so that primary health care at government hospitals are extremely affordable, with patients paying only RM1 for outpatient treatment and RM5 for specialist care. For senior citizens, it is even better, as healthcare is free for them.

However long waiting times and the requirement of patients to buy certain medicines from private pharmacies are an issue. Millions of ringgit have been set aside to subsidise medicine, yet patients often have to fork money out from their own pockets. The poor and the senior citizens especially, would not have to spend almost a full day to get treatment and consultation at government hospitals if they could afford the pricey medicines.

To make matters worse, in January, Prime Minister Datuk Seri Najib Razak announced a budget cut of 10% for the Health Ministry forcing the healthcare industry to make drastic cuts and improve their administrative efficiency.

EPF not enough for basic needs during retirement, let alone healthcare

92% of the population worry about their retirement funds and with valid reason, as reports have stated that in reality, only 22% of the 6.7 million Employees Provident Fund (EPF) active contributors who are aged 54 years have sufficient savings of at least RM196,800 to sustain themselves during retirement.

Balgais Yusoff, the head of EPF's strategy management department said that the other 78% did not have the basic amount for their retirement years and have to worry about what to do in the future. Furthermore, 65% of EPF active contributors had less than RM50,000 in their savings. Balgais blames this on the low salary structure in the country, as 89% are earning less than RM5,000 a month, falling into the lower bracket of the saving rates for the EPF.

Basic savings constitute of an expenditure of at least RM820 per month in their retirement years and for the 65% with RM50,000 in their EPF, they would only be able to sustain for five years. Realistically speaking, RM820 is only enough for necessities such as grocery shopping, petrol and utility bills. At the age of retirement, many are prone to being struck with non-communicable diseases that can lead to chronic diseases such as cancer, arthritis, and cardiovascular diseases.

Therefore, with the current price of medicines on the market, it is impossible to live with just RM820 a month.

10% medical inflation per year hikes up cost drastically in 20 years

As such, many have to start planning in their mid-20s to 30s. Currently, the disease that commonly affects senior citizens at retirement is heart attacks, which is the highest ranking cause of death by disease in Malaysia, followed by stroke, cancer, cataract, hip and knee replacement, and kidney failure.

Today, medical treatments for those diseases range from a few thousand ringgit to RM200,000 but in 20 years, taking into account a 10% healthcare inflation per annum, the cost can range from RM25,000 to a whopping RM1.1 million.

Even with the government subsidising 95% of the costs, there will be a point when higher co-payments are needed to stop the bleeding of healthcare system, which the government has attempted in implementing the '1Care' system in 2012.

Various healthcare costs from government and private hospitals in Malaysia. Source:
Various healthcare costs from government and private hospitals in Malaysia. Source:

Apart from medical treatments, looking further ahead, medical long-term assisted care in a nursing home would be increasingly needed. Geriatric care includes basic home care, day care, integrated residential care centres (IRCCs) and dementia care. Costs range from RM1,000 to RM5,000 per month.

Statistics have also shown that 10% of those who stay at a nursing home would continue to do so for at least five years and have to take into account a 10% medical inflation per annum.

One can argue that medical insurance policies can be bought during their younger healthier years, however the insurance companies play a part in contributing to the rise in medical costs as claims are usually made in private hospitals which are known to slap exorbitant charges onto their patients - such as a RM20,000 fee for an appendicitis surgery. Besides, for those with a salary below RM5,000 and a family to care for, can they still afford premium medical insurance?

Government solutions to address the problem

Only 40% of the Malaysian population are medically insured, which leaves 18.5 million people uninsured, turning to the government in times of need, especially when costs at private healthcare centres are extremely steep. However there is only so much the public hospitals can cope with and this has led to long waiting times - an average visit can take up to five to seven hours.

Moreover, the wait for surgeries can range from a few days to months. It has also led to a huge disparity between public and private healthcare services in Malaysia. The public sector loses many of the trained medical professionals to the urban-based and more lucrative private sector.

Additionally, it has to cater to the ever growing number of patients, especially elderly patients, due to affordability issues. So the brain drain coupled with the higher volume of patients have resulted in an increase in workload for the public healthcare system.

The government has taken steps to address this by implementing the LEAN healthcare system to free up beds quickly. The Health Ministry has also urged public hospitals to utilise day care services and for insurance companies to cover claims including day care services and not only inpatient claims.

Recently, the MOH has announced that talks were underway to introduce a national health insurance scheme, however current debate circles around whether the public is up for it or against it and it seems like a matter that would be delayed once again.

The MOH has also announced the proposal of a new Act to standardise regulations applicable to care centres for senior citizens, according to Dr. Safurah Jaafar, the director of Family Health Development Division.

“There is already the Care Centres Act (CCA) 1993 and Private Healthcare Facilities and Services Act 1998, however certain areas had not been addressed when it came to long-term care, and as such all the various stakeholders have been engaged but the Act has yet to be tabled,” she said while pointing out that the scope of services for the elderly needs better governance.

Healthcare as a right rather than a business

Governance aside, a 62-year-old businessman stated that due to the lack of financial support from the government, healthcare services for the elderly are not enough. There is actually no provision in the annual budget for elderly care and according to him, healthcare in Malaysia has become "a business rather than a right."

The man, who wishes to remain anonymous, was denied immediate surgery - even though doctors were aware of the multiple blockages he had - as his insurance clearance was delayed.

“It has become a question of ‘Can you afford medical treatment?’ and if you have money, most certainly they can afford for ‘the best medical treatment Malaysia has to offer’ but what about those who are not financially fortunate?” he asked, and concluded by emphasising that healthcare has become a business commodity and somewhat a status symbol, especially in providing better healthcare services for the elderly in Malaysia. MIMS


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