A government-funded health insurance scheme can lead to better overall healthcare at lower costs
HEALTH is wealth, so goes a traditional saying. A healthy society is central to national wellbeing and productivity.
Accordingly, our healthcare system, largely pioneered by the Health Ministry (MoH) has sought to ensure that Malaysians are healthy and lead a healthy life. And, so, it is gratifying to note that recently, the International Living magazine voted Malaysia’s healthcare system the best in the world. It sure should be. Who will dispute that Malaysians have almost-free access to high quality healthcare? At four per cent of the gross domestic product, only three per cent of the cost of public healthcare is recoverable by government.
Rome was not built in a day. Malaysia’s journey to excellence started with the traditional medicine-man of days gone by. His inevitable eclipse came with the Portuguese conquest of Malacca and the subsequent pervading influence of British rule in then Malaya, Sabah and Sarawak. Notwithstanding the inexorable march of modern medicine, traditional and complementary medicine continue to play a role in safeguarding the nation’s health.
After independence, the stewardship for healthcare fell on the MoH. Under its watch, the MoH has effected one paradigm shift after another. The focus has shifted from the “business of medicine” to the “business of health”. The shifts have gone on in other areas as well, from curative to preventive; traditional medicine-men to health professionals; charlatan tooth-pullers to dental surgeons; manual to advanced information-technology diagnostics and treatment; mere access to equitable access; commoditisation to personalised healthcare; and, mere practice of medicine to extending its frontiers through advanced research and development.
These shifts have been as much due to a response to the ever-increasing challenges confronting the nation’s health as it progresses to become a developed nation, as it has been due to the MoH’s foresight in spotting an emerging health issue and springing with alacrity to action. All these have not only enhanced the nation’s health, they have also caused diseases, such as leprosy, to be eliminated.
In the course of its journey, MoH has partnered with the private sector and non-governmental organisations. The synergy that this partnership has created has enhanced the people’s health further. But, more importantly, the MoH has roped in the individual and community. The MoH has so empowered them that they have increasingly taken charge of their health as no one can better do so than the individual himself.
The international recognition suggests that MoH is on the right track in its healthcare delivery. However, success comes at a great cost. Healthcare costs have multiplied over the past decade. With a perennial budget deficit overhanging the national coffers, the healthcare budget, consuming roughly one-tenth of total public expenditure, or RM25 billion, will come under increasing scrutiny to ensure its viability.
Malaysia has become a victim of its success in healthcare. The increasing longevity of between 73 (for men) and 77 (for women), and the consequent ageing of its population — 15 per cent of the population will be over 60 years old by 2030 — portend ill for healthcare costs. As Malaysia races to be become developed and rich, the resultant modern lifestyle has resulted in a significant rise of non-communicable diseases such as hypertension, obesity and diabetes. These account needlessly for three-quarters of deaths. These conditions will demand costlier healthcare.
Malaysia, therefore, is at the crossroads — quality healthcare or cost? With the government’s uncompromising stance of ensuring that Malaysians continue to enjoy high-quality healthcare, the pain of cost escalation has to be alleviated. There are two options to do so.
FIRST, the public will have to increasingly bear the cost of services, albeit, not necessarily the full cost. User-charging for public-health provision has to be equitable. The low-income population should continue to enjoy free services; and,
SECOND, compulsory health insurance has to be introduced. Singapore, for example, implements medical savings and insurance coverage through its Central Provident Fund. Such coverage takes care of critical illnesses, with additional premiums for specialist and routine treatment. A similar system, made compulsory for wage earners, could be dovetailed into our Employees Provident Fund system. The government’s contribution to such a scheme can be to offer generous tax rebates for those participating in this scheme, or subsidise premiums for such cover. The government could also operate a health-insurance scheme that is owned by it.
Both options have been floated by the government. Sadly, these initiatives have been resisted; there is some justification to the grumble that healthcare is an inalienable right of every human being and that the government should get its priority right.
As with the developed nations of the United States, the United Kingdom and Australia, ours is a state-of-the-art provision. It is only fair that the public should shoulder a chunk of its costs or suffer the inevitable compromise to its quality. Or, take greater responsibility for its health and stay healthy.
However inadequate it may be, Obamacare, a US law that ensures Americans can get health insurance, offers a modicum of guarantee of health provision for US citizens. A majority of Americans want President Donald Trump to make it work rather than undo it.
A government-funded health-insurance coverage is one way to go if we want our healthcare to be sustainable in the long run. Health insurance can accommodate healthcare pricing at fair value. It will lead to better overall healthcare at lower costs to government. Health insurance is an unhappy necessity. Free services, like honeymoons, don’t last forever.
The writer, Datuk Dr John Antony Xavier is the head of the Strategic Centre for Public Policy at the Graduate School of Business, Universiti Kebangsaan Malaysia. He can be reached via john@ukm.edu.my.