Both Malaysia and Singapore have been praised for their healthcare systems - Malaysia for the affordability and Singapore for its implementation of a national health insurance plan. However, comparing the two systems is difficult as they are fundamentally different.

Singapore's policy has always been based on individuals being accountable for their own health, emphasising on self-reliance and individual responsibility, resulting in high insurance coverage rates. This makes the system very cost-efficient, reducing the demand on public health and allows Singaporeans to have more healthcare options. However, it means some cannot afford premiums, even with subsidies.

On the other hand, Malaysia makes affordability a non-issue. A minimum fee of RM1 is all that is needed, even for complex treatments such as cancer operations. This provides universal coverage and affordable care as a form of social protection but has also led to the overconsumption of services, deteriorating the standards of care and increasing waiting times in public hospitals.

Malaysia aims to address problems through structural reform

Malaysia is working towards upgrading its existing facilities and construction of more advanced healthcare facilities, predicted to be completed by 2020. Its universal healthcare system is undergoing structural reform to address problems such as long waiting times, over consumption and high price differences between the public and private healthcare sectors.

To reduce overcrowding in public hospitals, the government proposed to cooperate with the private sector of non-governmental organisations (NGOs) to operate non-profit charitable hospitals.

In Malaysia's Budget 2017 RM536 million was set aside for upgrading facilities and RM4.5 billion was allocated to the operation of 340 1 Malaysia Clinics, 11 1 Malaysia Mobile clinics, 959 health clinics and more than 1,800 rural clinics. RM 20 million will fund loans for hospital equipment.

A possible national health insurance scheme

In July 2016, Malaysia's Health Minister Datuk Seri Dr. S. Subramaniam proposed the idea of introducing a voluntary national health insurance scheme to address the high price differences. He emphasised that the scheme will be dynamic and change according to the needs of the population and serve as an alternative to the public health sector - not replace it. The implementation of such a scheme also depended on the support of Malaysians.

Many doctors have seconded this move, urging a single-payer, multiple-provider arrangement that grants patients to demand for better care that the government hospitals are not providing due to cutbacks. Currently, the "full paying patient" scheme is the only way that patients can demand for better care but, this has been met with strong resistance as there is concern that non-FPP patients will be discriminated against.

Singapore focuses on their ageing population

For Singapore, the healthcare policies focus on three general points: seamless care, an urgent review of the Eldershield scheme and a focus on preventable chronic diseases such as diabetes. The Smart Nation masterplan also aims to help patients access or move through different disciplines of care services.

The introduction of the 3Ms policy (Medicare, Medishield and Medifund) makes the government the co-payer in Singapore's healthcare, stressing the accountability of health on Singaporeans themselves. The government has also created a series of social safety nets to help lower or middle-income groups, mitigating the financial impact of falling ill.

A review of the Eldershield scheme also aims to address that and the MOH has placed importance on actively seeking feedback and engaging the population for suggestions and comments on the scheme, in hindsight of the ageing population.

One of the main chronic diseases targeted is diabetes as it is highly preventable and Singapore has the second highest proportion of diabetics. Other associated diseases such as strokes and hypertension are also prevalent, costing the country S$1 billion annually, with a projected rise to S$2.5 billion by 2050.

As such, Health Minister Gan Kim Yong declared a "war on diabetes" and has implemented several education and health promotion programmes to prevent diabetes.

Different holistic approaches needed for both countries

So far, the Singaporean government has prepared for the challenges of rising healthcare costs, only in anticipation. Much more can be done such as the expansion of the list of subsidised drugs and funding home-care services provided by hospitals. Currently, they are mainly covered by the private sector and NGOs with limited subsidies.

The government could help by expanding Medisave to cover home care and increase subsidies accordingly to patients who require it. In turn, it will reduce the systematic cost of managing more hospital beds and deliver more responsive care.

For the Malaysian government, it needs to change the mindset of the public that health is an individual asset. Deregulation of laws to ease the opening of a clinic or private hospital should be considered, as it will create competition in the private health sector and bring healthcare prices down. In the long-term, it will provide an affordable alternative, addressing the problems of overcrowding in public hospitals and clinics. MIMS

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