LETTERS: There were high hopes for the 2024 Budget, with the Health White Paper promising a focus on prevention, health promotion, and equity.
Overall, the budget increased by 1.4 per cent in the face of an inflation rate below two per cent and an estimated 4-5 per cent GDP growth.
Indeed, the 15 per cent increase in the budget allocation for health is widely praised, and we sincerely hope that this increase will continue year after year, leading to healthcare spending reaching five per cent of GDP by 2027 Budget, as indicated in a recent statement released by the Malaysian Health Coalition.
However, when it comes to overall spending on older adults, the 2024 Budget appears "underwhelming."
While there is an increase in the health budget, there is no specific ring-fenced funding dedicated to the development of health services for older persons or the treatment of dementia.
Malaysia, like any other country worldwide, is committed to the United Nations Decade of Healthy Aging (2021-2030) and the Global Action Plan for Dementia (2017-2025), which is scheduled to last until 2025.
Yet, the budget for 2024 remains silent regarding dementia funding. The long-awaited National Dementia Action Plan has yet to materialise, despite initial promises made in 2019 and public announcements in 2021 that a former prime minister has dementia.
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Without specific allocations for services for older adults, it is likely that their funding will be drawn from allocations to general medicine, which has been offered a 1.7 per cent increase in funding, mental health (1.9 per cent increase), family health development (3.8 per cent), and disease control (1.9 per cent).
Funding for geriatric medicine will be drawn from general medicine, while funding for dementia services could be obtained from general medicine, mental health, family health development, and disease control. Funding for disease prevention and community-based care for older adults will also be obtained from family health development, with the Older Persons Sector in the Health Ministry falling within the Family Health Division.
However, other areas with larger increases, including dental (2.5 per cent), pharmacy (3.9 per cent), and food safety allocations, may also indirectly benefit older adults, who are major users of the first two services, in particular.
Furthermore, there is a 52 per cent increase in federal pensioners' medical treatment, which is great news for federal pensioners who have faced difficulties in obtaining funding for more expensive treatments.
Additionally, the new allocation of RM1.65 billion toward new policies is much welcomed, and we sincerely hope that the new policies will accurately reflect the needs of our population, including some directly involving new policies for older adults and dementia.
Nevertheless, apart from government pensioners' medical treatment, the 15 per cent increase in funding does not seem to be reflected in allocations that are likely to directly impact older adults' community care and support services.
Dedicated funding for older adults does exist in the budget and can be found in the allocation for the Women, Family, and Community Development Ministry, which receives a total allocation of RM 3.5 billion, less than 1/10th of the RM41.2 billion allocated to the Health Ministry.
The Welfare Department is nested within this ministry and appears to be allocated RM923 million for social care funding for older adults, of which RM905 million is allocated toward socioeconomic support for older persons.
Of the remaining funds, specific allocations have been made for senior citizens' activity centres, which have increased by two per cent, transport services (no change), and home help services, which have seen a 13 per cent funding cut.
Rumah Seri Kenangan, our government-funded residential care facilities and day care services, will, on the other hand, see welcome funding increases of 38 per cent and 75 per cent, respectively. In total, however, older persons' allocation has increased by one per cent from RM91.3 billion last year, which, in real terms, represents a funding cut considering two per cent inflation and the actual increase in individuals aged 60 years and over, which will exceed four million by 2024, up from 3.8 million in 2023.
This also does not reflect the overall budget increase, let alone the 15 per cent increase in health funding. Instead, funds appear to have been shifted from the emphasis on home-based and community care provision to day care and residential care, though the injection of funds into both these areas is very much needed.
The figures may be difficult to digest, but the major concerns include the lack of recognition of the gap between health and social care, as well as the fact that older persons' needs tend to exceed those of social care and pension funding.
Integrated approaches supported by policies that merge both health and social care will ensure that resource allocation supports the development of balanced service systems and is not directed solely toward acute healthcare at the expense of prevention, primary, and community services.
Without this approach, imbalances in allocation between health and social care will persist, leading to inappropriate use of hospital facilities for care provision and avoidable admissions, resulting in the inefficient use of resources and negatively affecting the quality of life of older adults and those who care for them.
The rise in non-communicable diseases and obesity in our population will give rise to an older generation at high risk for dementia. Strategies for prevention and treatment are major public health concerns.
Unfortunately, the budget does not reflect the government's commitment to dementia care, which is needed by the World Health Organisation by 2025, as well as the UN Decade for Healthy Aging, for which three years have passed without a clear indication of government policies in this direction.
The apparent lack of focus on older adults may reflect the need for structural reforms to meet the needs of an aging population. Malaysia is acclaimed as the best affordable retirement destination internationally.
With good weather and excellent healthcare, Malaysia has every opportunity to capitalise on the Silver Economy, not only to ensure it's a great place to grow old but also as a source of foreign revenue in health tourism and retirement living.
Eleven months may not be sufficient to effect structural change, but with the promises of the Health White Paper and the Ageing National Blueprint, we certainly hope that this budget will at least fund the processes that will lead to much-needed structural reform to effectively deliver the population aging agenda and ensure Malaysia can capitalise effectively on population aging.
Jointly written by:
Professor Tan Maw Pin
President, Malaysian Society of Geriatric Medicine
Professor Shahrul Bahyah Kamaruzzaman
President, Malaysian Healthy Ageing Society
Cheah Tuck Weng
President, Third Age Media Association
The views expressed in this article are the author's own and do not necessarily reflect those of the New Straits Times