Malaysian healthcare takes pride in its universal access to all its citizens. The Health Ministry’s annual reports indicate year on year improvements in ensuring that every Malaysian is able to receive primary healthcare – from improved accessibility to increased outreach to rural areas.
However, data shows that only 65% of Malaysian citizens are being served by the public healthcare sector and the lower-income bracket being in much poorer physical and mental health[1]. This beg the question: How effective is our healthcare system in aiding those who are financially marginalised?
Whilst we have heard of economic inequalities, there is much to learn about inequalities in healthcare. Similarly to economic disparities, healthcare services are heavily convoluted with income inequality. In order to analyse the gaps in our system, we need to visit places where its standing is most vulnerable.
Pockets Of Limited Healthcare
A good place to start would be to go through the healthcare services specified in rural areas. Understandably, government healthcare can only employ a certain amount of medical professionals a year. With this limited workforce – doctors, nurses, and dentists that are deployed by the Ministry of Health are distributed throughout the nation including healthcare facilities in rural areas such as clinics, district hospitals, and tertiary hospitals. This distribution of medical professionals is be divided based on the size and available manpower in the district or state. However, places located in remote locations or situated within high mountains or deep forests, unfortunately, are often left out geographically[1]. The fact of the matter is these places are much harder to access by both medical professionals and medical supplies compared to healthcare facilities in the city.
Too Many Doctors Going Private
Unfortunately, another reason why our public healthcare system is slightly limited is because of medical specialists being concentrated in privatised healthcare. Specialists prefer to work in the private sector. The Neurosurgery department in the public department, for instance, is severely understaffed, to an extent that government hospitals have needed to purchase services of private neurosurgeons in order to cater to their patients. This reigns more truth especially during emergencies wherein Kota Kinabalu Sabah, cardiology, and cardiac surgical services are bought with weekly rotations of specialists from IJN (Institut Jantung Negara) at hefty prices[1].
Pay More, Say Less Policies
It is also worth noting that there is a system of full-paying patients(FPP), where a portion of these fees is utilised for physicians’ reimbursement, channelled into their salaries. The Ministry of Health’s FPP programme is offered by selected government hospitals to patients who can afford to pay. Patients are given the option and opportunity to be treated by an eligible specialist of their choice and would be charged fully without subsidies from the government for their medical treatment and services[1].
While the FPP allows those who can afford a fast-tracked service, it inevitably promotes a culture of queue jumping and further widens the disparity gap between the haves and have nots. This same system automatically punishes the poor for being less financially capable to receive the same standard of care, at the same pace.
Healthcare Inequality Is Not An Issue Unique To Malaysia
The Philippines, Vietnam, and Indonesia, for example, have a decentralised approach to healthcare systems with top to bottom devolution approach but the current system of decentralisation and liberalisation, issues of equity, and lack of infrastructure continue to be a crisis in the development of the healthcare sector.
Thailand’s Government introduced the 30-Baht and universal coverage scheme amongst the urban poor with an objective to ensure equitable access to healthcare which includes the poorest citizens. For flat users, a fee of only 30 baht is allowed or a free consultation for those who are in the exemption. A whopping 86% of overall satisfaction on the improvement of healthcare coverage for the poor ever since the scheme was premiered. Though there is the overall positive feedback of the program from beneficiaries, there is still a glaring issue on the system as there it fails to properly distinguish between the poor and the poorest as it also favours those with an income above the national poverty line instead of those below[2], all in all, who gets to decide who is poor and who is not?
Vietnam’s healthcare fund for the poor (HCFP) utilises the government revenues to aid financially in healthcare for the impoverished, ethnic minorities, and those who are geographically disadvantaged. The HCFP is efficiently targeting Vietnam’s poor with 20% of the population being recipients from 50% of the HCFP beneficiaries, the program avoids paying healthcare out of pocket blasphemy spending on healthcare. Though with its benefits, the HCFP acknowledges that there is no impact on average out-of-pocket spending and even with the coverage, poor households are expected to spend a lump sum from their income on out-of-pocket health expenses at considerable risk of emergency spending[3]
Malaysia’s Attempts to Bridge the Healthcare Gap
According to healthcare expert Dr Lum (2019), most Malaysians heavily rely on their income to cover healthcare fees as of 2019, 91.6% of Malaysians have paid employment as their main source of income[4]. We currently have two schemes in place to mediate the current stand of healthcare inequality. These include PeKa B40 and MySalam.
PeKa B40 is an initiative by our Ministry of Health which aims to provide healthcare needs of groups with low incomes by narrowing down on non-communicable diseases (NCD), the scheme is effective for those who are at the bottom 40% of the household income range (B40), benefits of PeKa B40 includes Health Screening, Medical Equipment Assistance, Incentives for completing cancer treatment and treatment cost initiative[4].
MySalam is also another initiative with a similar objective to help those who are financially disadvantaged to have sufficient healthcare coverage, MySalam provides B40s free takaful health protection for 36 listed critical illnesses diagnosed after or on 1st January 2019[4].
Though we do have two main schemes in mending the gap in healthcare inequality, there were complaints on practicality on the usage of the two initiatives such as MySalam’s complicated application procedures which include exclusions from coverage due to marital status or pre-existing medical conditions. Some voiced their dissatisfaction about PeKa B40 as it includes a lengthy screening and most are unaware of the process.
…ideally, policymakers should review and tailor their strategies to complement a sincere partnership with implementers. A “take it or leave it” attitude will not do. In short, policymakers have to change their approach. – Dr. Milton Lum, President of the Federation of Private Medical Practitioners Associations Malaysia
Explore Our Sources
- D. Quek. (2014). The Malaysian Health Care System: A Review. Link.
- S. C. Cronberg, W. Laohasiriwong, C. A. Gericke. (2007). Health care utilisation under the 30-Baht Scheme among the urban poor in Mitrapap slum, Khon Kaen, Thailand: a cross-sectional study. Link.
- A. Wagstaff. (2013). Health Insurance For The Poor: Initial Impacts Of Vietnam’s Health Care Fund For The Poor. Link.
- M. Lim. (2019). Health Policy Implementation Gap — mySalam And Peka B40. Code Blue. Link.
Written by Khadijah Al-Khared and edited by Wiki Impact team.
