THE theme of World Health Day 2019 was Universal Health Coverage (UHC), which referred to a combination of legal assurance of healthcare, covering more than 90 per cent of health insurance and professionally assisted childbirth.
More than 100 United Nations member states have made a commitment to work towards establishing UHC by 2030 to promote wellbeing for all at all ages.
The goal of UHC is to ensure that all people who require health services (prevention, promotion, treatment, rehabilitation,
and palliative), irrespective of their living standard, should receive the services.
Among Asean countries, Brunei, Malaysia, Singapore and Thailand have achieved almost universal coverage.
Malaysia has an extensive near-free comprehensive healthcare that is funded by general tax.
The government strived to “improve wellbeing for all” through various efforts, including enhancing the capability of both facilities’ and healthcare personnel as well as extending coverage to underserved locations.
The government introduced the National Immunisation Programme vaccinations, covering 12 major childhood diseases and provided free at all government clinics throughout the country.
In March, the government tabled a proposal to amend the law to make two of these 12 vaccines, namely MMR (mumps, measles and rubella) and diphtheria, mandatory.
HEALTH SERVICES, LIFE
EXPECTANCY AND PRODUCTIVITY
Health services cover reproductive, maternal, newborn and child health, infectious diseases, non-communicable diseases and service capacity access.
Malaysia scores a service coverage index of 70 out of 100, which is considered high compared with Asean countries, and globally at 55th and 64th respectively.
UHC reduces risk factors and through effective health policy has increased life expectancy in high-income countries.
UHC has shown to have a significant impact on life expectancy at birth (LEAB) and healthy life expectancy (HALE).
HALE estimates how many years that an individual might live in a healthy state. Evidence has shown a lower HALE in low-income countries; 53 years compared with about 17 years more in high-income countries.
HEALTHCARE AND ECONOMIC GROWTH ARE HIGHLY
CORRELATED
A good healthcare system is critical to productivity growth. Recent evidence published by the Journal of Global Health Reports 2019 shows a positive relationship between LEAB and gross domestic product growth in 56 developing countries, including Malaysia. A US$8.11 increase in income per capita of these nations on average results in 3.27 years’ rise in LEAB.
In Malaysia, LEAB had increased by nine years (68-75) after the achievement of UHC in the 1980s in contrast to only three years (66-69) in the previous decade.
This points to the fact that economic growth may be a proxy gain of UHC.
Nonetheless, there are countries, such as China, Brazil, and the US which are without UHC and yet they perform very well economically.
In these countries, however, life expectancy has not improved as much as in countries that achieved UHC.
There are many issues and challenges in achieving UHC in Malaysia.
Firstly, the demographic transition into an ageing population that will impact on healthcare utilisation and the requirement to cater to the needs of increasingly older people.
Over the past decade, there has been a transition of patterns from communicable diseases to non-communicable diseases (NCD), such as diabetes, obesity, hypertension and mental health issues due to the adoption of unhealthy lifestyles where the death rate is almost four times higher than for communicable diseases.
Despite the existence of UHC, out-of-pocket (OOP) expenditure for health in Malaysia is higher (37.8 per cent in 2016) than the recommended cut-off by the World Health Organisation of 20 per cent.
The increase in OOP payments is mainly due to a rise in the purchase of private care, which is frequently utilised by the urban population.
This is due to the expansion of private healthcare and long waiting lists in government hospitals.
PUBLIC-PRIVATE (PP) MIX
There is an urgent need to integrate private and public provision of primary care. This is essential for ensuring sustainability of UHC in order to address the demands of the rising burden of NCDs, population ageing and improving overall quality of care.
The involvement of the private sector in achieving optimal health outcomes through UHC needs an effective regulatory framework.
The government should establish broader accessibility to an affordable and quality health system to cater to the larger population.
Private health providers could deliver the services for a publicly financed, universally available, basic health system. A total of 1,892 public and private clinics throughout Malaysia have registered to participate.
Therefore, more public private mix strategies should be extended to provide other essential health services.
The PP Mix will ensure the fiscal sustainability of our Universal Health Care.
The writer is president of the Malaysian Economic Association.