Based on a WHO report in 2000, Malaysia ranked 49th on overall health system performance. Our neighbours, Singapore, placed 6th whilst Indonesia is at 92nd place[1].
However, Malaysia stands apart from our neighbours for offering healthcare services at an affordable cost – earning a spot as a destination country for medical tourists in the International Medical Travel Journal’s award in 2015 and 2016[2].
The nation received at least 1.2 million medical tourists in 2018[3] – all arriving to receive quality healthcare at an affordable price. These medical tourists are saving between 65-80% costs compared to healthcare costs in the United States[2].
A global perspective on Malaysia’s healthcare services and offerings helps to provide a greater appreciation for it. Have we taken for granted the existing healthcare system in the nation? We explore the healthcare costs Malaysians would have to pay from cradle to grave in comparison to two neighbouring countries – Singapore and Indonesia.
However, please keep in mind that the costs shown are based on secondary research findings ranging from 2016 – 2022. Prices of the treatment may vary slightly from the range based on the specific treatment needed and any complications that arises.
1. How Does The Healthcare System Work In Selected Countries?
Malaysia
The Malaysian healthcare system is funded by tax revenues. The cost of care is heavily subsidised by the government. The public healthcare services can be accessed via Government General Hospitals, Government Health Clinics and Community Clinics[4].
Universal healthcare is provided to both legal residents and Malaysian citizens and does not necessitate the beneficiaries to national insurance programmes. At the same time, there is an option of private healthcare for those who can afford to pay more. Private healthcare services consist of General Practitioner Clinics and Private Hospitals[4].
Singapore
The healthcare system in Singapore is a combination of both public and private facilities. Both citizens and permanent residents can access subsidised healthcare services because of their contribution to Singapore’s health insurance system, the “three M’s” – Medisave, Medishield and Medifund[5].
Medisave is a compulsory savings plan where a working person’s contribution is between 7% to 9.5%. While Medishield is an optional insurance program, The insurance plan serves as backup funding if the funds on Medisave have been fully used. The Medifund is an allocated three-billion dollar government fund specifically to pay medical bills for those in financial need and is subjected to approval[5].
Indonesia
The country runs a mandatory health insurance program called Jaminan Kesehatan Nasional (JKN) intending to widen Indonesia’s access to basic medical care in 2014. Indonesian holding traditional employment is required to pay an insurance premium worth 5% of their salary (1% paid by the employee and 4% by the employer)[6].
Self-employed workers pay a fixed monthly premium as low as $2 a month. Under the JKN programme, Indonesians have the access to visit public and private healthcare providers who are part of it[6].
2. Pre-natal, Post-natal And Maternal Care
| Description | Malaysia | Singapore | Indonesia |
| Cost of vitamins and follow-ups at district clinics/ government hospitals | Free prenatal visits, supplements can be procured at the cost of RM100 – 500[7] | S$500 (RM 1500)[9] | Rp 155 thousand, in B-type facility (RM 45 one visit)[12] |
| Cost of vitamins and follow-ups at private facilities: | Consultation of each visit costs around RM 200 and necessary supplements are variable, depending on the type and the healthcare facility[7]. | Visits to private gynaecologists may cost up to S$2,000 -S$2500 (RM 6000 – RM 7725)[9] | from Rp 250 thousand to 500 thousand (RM 73 – 146.00 per visit) [13] |
| Percentage of women (15-49 years) attended antenatal care 4+ during pregnancy by any provider: | 97%[8] | Not available[10] | 77 [14] |
| Maternal mortality ratio (number of maternal deaths per 100,000 live births: | 29[8] | 8[10] | 177[14] |
| Labour and delivery cost in government hospital: | For natural birth, it is at RM100 – 600[7]. For a c-section, the cost is RM300 to RM1,000[7]. | For natural birth: Depending on the ward chosen by the expectant parents (whether it is a Class C, Class B or Class A ward), the cost of normal delivery ranges from S$1,200 to S$5,016 (RM 3,725 to RM 15,000) [11] For c-section: Depending on the ward chosen by the expectant parents (whether it is a Class C, Class B or Class A ward), the cost of c-section delivery ranges from S$2,200 to S$8,400 (in RM 6,800 to RM 26,000)[11] | For natural birth: Rp 5.000.000 (RM1468.00)[12] For c-section: Rp 4 – 16 million (depending on the type of the government hospital) (RM 1175 – RM 4700)[15], free under JKN but only for type D and C facilities |
| Labour and delivery cost in a private hospital: | For natural birth, it can cost between RM3,000 to RM10,000[7] For c-section, it can cost between RM8,000 to RM20,000 [7] | For natural birth: S$8,500 (RM 26,387)[11] For c-section:S$13,000 (RM 40,000)[11] | For natural birth: could go up to 17 million rupiah (RM 4993.00) [16] For c-section:Rp 32 – 68 million depending on the room type (RM 9401 – RM 19972.00) [15] |
| Infant mortality rate (deaths per 1000 live births): | 7 [8] | 7 [10] | 20 [14] |
3. Childhood immunisation
Malaysia
In Malaysia, mandatory childhood immunisations are free of charge at government facilities and it follows a specified National Immunisation Schedule (as shown below), protecting children against 13 major diseases. However, the jabs are also available at private facilities at a cost [17].
Singapore
The National Childhood Immunisation Schedule covers 12 diseases and the mandatory vaccinations are against measles and diphtheria. It is free of charge, and fully subsidised at facilities participating under the Community Health Assist Scheme (CHAS) [18].
Indonesia
The Indonesian government provides free inoculation against mandatory preventable diseases jabs at the government facilities. However, there are recommended immunisations for children that require parents to visit specialists and pay a higher cost [19].
| Description | Malaysia | Singapore | Indonesia |
| Percentage of children inoculated for measles: | 84% [9] | 84% [10] | 49%[11] |
| Percentage of children inoculated for diphtheria : | 98% [9] | 96% [10] | 77%[11] |
4. General medical care
| Description | Malaysia | Singapore | Indonesia |
| Outpatient fee for all government facilities: | RM1[20] | S$24 (RM 74) [22] | Not available |
| Outpatient fee in private hospitals: | RM30 – 250[20] | S$20 to more than S$120 (RM 62 – RM 373) [23] | Not available |
| X-ray: | Government: RM 10[[20] Private: RM 35++[20] | Blood test and X-Ray: Government: S$50-S$80 (RM 155 – RM 248)[22] Private: S$75 -S$125 (RM 233 – RM388)[23] | Government:Rp30 ribu to Rp300 ribu (RM 8 – RM 88) [25] Private:Rp 800ribu to Rp 900.000 (RM235 – RM 264) [26] |
| Blood test: | Government: RM 1[20] Private: RM 50++[20] | Not available | Government: free Private: Rp80 ribu to 200 ribu (RM 23 – RM 58)[27] |
| Dental care in government hospital: | Filling for each tooth: Up to RM 20[21] Tooth extraction: RM 15-35[21] | S$16 to S$29 (RM 49 – RM 90) [24] | Filling : Rp50.000 (RM 14) [28] |
| Dental care in private hospital: | Filling for each tooth: RM 150 – 1200 (case-by-case basis) Tooth extraction: RM 70 – 120 [21] | S$40 and S$150 (RM 124 – RM 466) [24] Filling: $50 – $500 (RM 155 – RM1555) [24] | Rp25.000 to Rp250,000 (RM 7 – RM 73) [28] |
5. Cancer treatment
| Description | Malaysia[29,30] | Singapore [31] | Indonesia |
| Consultation (government): | Free on first consultation, and RM 30 for subsequent visits | Not available | Not available |
| Consultation (private) : | RM 80 – 235 | Not available | Consultation (private) : Rp 250.000 – 450.000 ( RM 73.51 – RM 132) [32] |
| Surgery | MOH Guideline: surgeries shouldn’t exceed RM 10,335 (RM 7030 for surgeon and another 3305 for anaesthesiologist) | the cost can reach up to S$10,324 (RM 32,000) | Rp 44 million (RM 12940.00) [33] |
| Radiotherapy | MOH Guideline: RM5720 | S$56,119 (RM 174, 536.00) | Not available |
| Radiotherapy (government): | Up to RM 500 | Not available | Not available |
| Radiotherapy (private): | RM1,400 to RM4,800 | Not available | Not available |
| Chemotherapy per cycle (government): | RM 50 to 200 | the cost depends on the ward, ranges from S$463 to S$1,978 (RM 1439 – RM 6151) | Rp 2 juta (RM 588)[33] |
| Chemotherapy per cycle (private): | RM170 – 1030 | S$3,338 (RM 10381.00) | Rp 1,5 juta to Rp 3 juta (RM 441 – RM 882) [32] |
6. Healthcare Safety Nets In Each Country
Malaysia
The government rolled out two schemes in Budget 2019 to widen the social safety net.
- MySalam (Social Protection Fund)
Malaysians who receive Bantuan Sara Hidup (BSH) and those with an annual income of or below RM100,000 within the age of 18 to 65 years old. The benefits include a one-off payment of up to RM8,000 to beneficiaries of BSH (RM4,000 for those with an annual income of up to RM100,000 a year) for the listed 45 critical illnesses. The fund also includes a hospital allowance of RM50 for 14 days or a maximum of RM700 per year[4].
- Peka B40
The recipients of BSH aged 40 years old and above are eligible to receive the funding. The benefits include health screening and assistance in procuring unsubsidised medical devices. Cancer patients in particular are provided incentives and travel allowances provided that they were screened through the Peka B40 scheme[4].
Singapore
In addition to public insurances such as MediShield Life [34], the Singaporean government has launched two schemes catered to the older population in the country and one that is focused on improving the lives of the disabled community.
- The Pioneer Generation package [34] is offered to older residents who have contributed to Singapore’s nation-building. As it is likely that there won’t be sufficient money in their MediSave accounts to support retirement health needs, the programme was introduced late in their working lives, the residents receive additional outpatient care services also annual MediSave top-ups (up to S$800) and MediShield Life premium subsidies.
- The Merdeka Generation package [34] recognises the efforts of Singaporeans behind an independent Singapore. The benefits include MediSave top-ups of S$200 per year for five years from 2018 onwards. The senior citizens also receive additional subsidies for outpatient care at selected clinics along with an additional subsidy of 5% for their annual MediShield Life premiums that increases to 10% at age 75.
- CareShield Life [34]that includes a higher cash payout starting at S$600 (RM 1865) and would increase over time. The payment is made for the policyholders as long as they remain severely disabled. A withdrawal up to S$2,400 (RM 7461) yearly orS$200 (RM 621) monthly can be made to meet their long-term care needs.
Indonesia
Indonesia is currently gearing toward universal health care protection for its citizens through the Jaminan Kesehatan Nasional scheme. The government aimed to ensure all citizens were fully covered by 2019, however, the progress has been slow [6].
7. Ageing population
| Description | Malaysia[35] | Singapore | Indonesia |
| Average annual check-up: | Private: RM1,500 | Government: S$226.83 (RM 702)[36] Private: S$2,092 (RM 6506)[36] | Government : Rp50 thousand – Rp150 thousand (RM14 – RM44)[38] Private : Rp 757,00 (RM 222)[39] |
| Assisted living at a residential care (monthly): | RM2,500 | $700 to $4,000 a month, however it is subjected to whether the citizen is eligible to subsidies (RM 2177 – 12440.00) [37] | From 2 million rupiah to 20 million rupiah (RM588 – RM 5884)[40] |
| Treatment for heart attack: | RM10,000 and RM30,000. Predicted to be around In 30 RM174,494 to RM523,482 in 30 years | With no complications: S$1,293 (RM 3990) [36] | Not available |
| Coronary bypass | Government: RM 4,000 Private: RM25,000 to RM80,000 | S$36,978 (RM 115,005)[36] | Government:Covered under the national insurance programme[41] Private: Rp 150-300 million (RM44,000 – RM88,265)[42] |
| Treatment for stroke : | RM35,000 to RM75,000. In 30 years, the amount will likely increase from RM610,729 to RM1,308,705 | With no complication (government): S$1787 (RM 5557)[36] With no complication (private): S$9,836 (RM 30591)[36] | With no complication (government): Covered under the national insurance programme [42] With no complication (private): Rp794 miliar (RM233,609)[43] |
What Do Malaysians Think About The Affordability of Our Healthcare Services?
We have made great progress over the years and COVID-19 has only pushed the Ministry of Health gearing to a more universal healthcare coverage similar to Indonesia.
Malaysia is committed to providing the best health services that are not only of high quality and value, but also keeping the cost of treatment affordable. – Tan Sri Dr Noor Hisham Abdullah, Malaysia’s Health Ministry Director-General [44]
Over the years, our national healthcare has been kept affordable to ensure it is accessible to lower-income households. For example, an expectant mother paid only RM 30 for a normal delivery and a night at the hospital.
It was a smooth delivery process even when I was already overdue. And yes, it was a public hospital. – Nur Zaini, a mother who gave birth at a Malaysia’s public facility [45]
At the same time, the private facilities in Malaysia were made to abide by a set ceiling price to ensure the cost of major surgeries will not be exorbitant.
Malaysia is… easily a quarter of what is being charged in Singapore, and almost half when you compare to Thailand — and we are talking about world class hospitals. – Sherene Azli, CEO of Malaysia Healthcare Travel Council [46]
There are caveats, however, that could improve the existing healthcare system; such as the accessibility to healthcare among marginalised communities, the long waiting time and improving the patient-doctor ratio.
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