Does Malaysia need a Single Payer Healthcare System?

Malaysia has a 2-tier healthcare system – private and public
The private healthcare system is paid for by consumers “out of pocket” or by private health care insurance (personal or corporate/employers)
The public healthcare system is borne by the Government (i.e. tax payers) via mainly the Ministry of Health and to some extent the Ministry of Education (University Hospitals)

When times are bad, the MOH will see an influx of patients, mainly those previously paying “out of pocket”. The situation is worsened when during bad times, the MOH undertakes budget cuts. All sorts of methods can be used, e.g. trying to limit wastage by not performing “unnecessary” lab tests, but in actual fact there is little wiggle room for the MOH.

There has been a recent call by doctors for a “Single Payer System” and there are good arguments for such a system. In fact we have been blogging for years about a need for health insurance reform.
A single payer system would be in fact a “National Health Insurance Scheme”.

Doctors are proposing a countrywide health insurance system that would allow all Malaysians to visit any hospital, private or public, and eventually remove the distinction between the two.

They contend that the scheme would alleviate the burden at government hospitals which are being swamped now due to their low costs, while making private hospitals — currently shunned due to their prices — more accessible.

The doctors further argue that the proposal could lead to better overall health care services for Malaysians, lower out-of-pocket spending, reduced waiting times and more modern medicines and technology.

Additionally, it would also provide patients with greater rights to demand the level of service that they currently may not enjoy at government hospitals.

The system would entail a single-payer, multiple-provider arrangement where public and private institutions would functionally be the same to the patient.

While this all sounds good, it would mean everyone has to contribute. In a situation where only about 10% of the population pay income tax, who shoulders the burden? There is also a “trust deficit” whenever a single body handles all the finances pertaining to something important as healthcare.

Health policy researcher Dr Lim Teck Onn said Malaysia’s current multiple-payer, multiple-provider system was like the US’, compared to the UK (single-payer, single-provider) or to the single-payer, multiple-provider system in Switzerland, Korea, Japan and Taiwan.

According to him, the advantages of a single dominant-payer system are lowered costs due to competition among health care providers and the ability to demand for better services from both the public and private sector, but the risk of a social health insurance model is an “incompetent, dishonest, unaccountable bureaucracy created to manage the fund.”

“Can we trust a health care ‘EPF’, basically?” Dr Lim asked. “Can we trust them with so much money?”

But the current system is not going to be sustainable in the long run. MOH says it spends a lot of money on health care though the healthcare budget as % of GDP can even be more. As a collector, MOH isn’t perfomring well. There are also conflict of interests involved. As Dr. Milton Lum puts it

He said, however, that one of the problems with a social health insurance is that less than 10 per cent of the Malaysian population pays income tax.

“You cannot ask the fellow who’s paying income tax to carry a lot of the burden for others,” Dr Lum told Malay Mail Online in an interview.

“So MoH has to decide — what are we going to cover? And the MoH is in a very difficult position. On one hand it is a provider, on the other, it is a regulator. There is a lot of conflict of interest there,” he added. “MoH has to take a hard look at itself and decide what they want to be — regulator or provider.”

The former Malaysian Medical Association (MMA) president also said if there were to be any change in the health care financing model, MoH should not be the body collecting funds as they “know how to spend money only; it doesn’t know how to collect.”

MMA President Dr. John Chew says:

Malaysia must spend more on health beyond the overall 4.5 per cent of the GDP.

“Whether public or private, it is for the people to decide. At the moment, the split is 50:50. As private becomes more unaffordable, overcrowding in government hospitals is becoming a big problem,” Dr Chew told Malay Mail Online.

So do we need a Single Payer System and if so, is there the political and public will to create one?
Our take is that this is and has been a very difficult political decision to make. The debate will go one for years and in the meantime the healthcare delivery services are in jeopardy as long as economic times are bad.

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A Single Payer System is needed to finance the Malaysian Healthcare system

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