Covid-19 has been Malaysia’s worst public health disaster, with the health system on the brink of collapse on several occasions, exposing its shortcomings.
Chronic underfunding, and therefore underinvestment, in the public health sector has drawn and continues to draw heavy costs from health insurance. Rakyat.
Moreover, a series of fatal errors contributed significantly to the number of cases and deaths, with Malaysia having the highest per capita mortality rate in ASEAN.
A key lesson from Covid-19 is the enormous impact of inequity and structural disadvantage on its course and outcomes.
But have policy makers learned and implemented changes to future-proof the healthcare system?
Chronic underinvestment in the public health sector, health inequities, resilience of health professionals, mental health, non-communicable diseases, building ventilation, and social determinants of health.
Health: the core issue of GE15
The government has made international commitments to Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs).
The government has ratified the Paris Agreement, a legally binding treaty on climate change, with the goal of keeping global warming below 2 degrees Celsius, preferably 1.5 degrees Celsius.
UHC involves access to quality essential services, sustainable financing and financial protection, improved access to essential medicines and health products, training of health professionals, healthy labor policies, and national health policies for civil society. Participation in and monitoring, data and information.
SDG3 should address the social determinants of health, promote cross-sectoral approaches to health, and prioritize health in all policies and healthy environments.
The Paris Agreement calls for economic and social change based on the best available science to reduce greenhouse gas (GHG) emissions. Malaysia has committed to reduce her GHG by 45% by 2030.
There has been much discussion and debate among medical and other health care professionals and civil society about the expectations of government responsibility for health and health care. Some salient issues in these discussions are discussed below.
Prioritize health in all policies
The main focus of the incoming government will be to prioritize health in all policies.
Health and healthcare spending should be viewed as an investment in the future, not an item of expenditure.
Increase public sector budget allocations
Malaysia’s public investment in health care is chronically inadequate, with around 2% of gross domestic product (GDP) being spent on health care compared to 5-8% in similarly developed countries is.
High levels of inefficient and regressive out-of-pocket health care costs (approximately 35% of total health care costs (THE), with many families experiencing devastating health care costs and 47.6% of private spending) are financially insolvent due to THE.
It is too simplistic to praise the 11.5% increase in the Ministry of Health (MOH) budget, which is comparable to the 12.1% increase in the total budget for 2023 announced on 7 October 2022.
As such, the current health budget allocation to the public sector should be phased up to 5% over five years.
Additional budget allocations are needed to compensate for longstanding chronic underfunding and underinvestment (repairs, replacements, renovations, etc.).
However, increased health care financing and allocation must be accompanied by cost inflation control, efficiency improvement, and waste reduction.
medical finance reform
Governments should create new statutory non-profit institutions accountable to Congress to control all public funding for health care.
This agency is responsible for funding and purchasing health care in a strategic and equitable manner from both public and private institutions.
Its strategic, efficient and transparent functions should ensure a more coordinated and efficient use of providers to meet public needs. Better integration across all levels of care. Shift spending from hospital care to primary care, community care and public health.
Various funding options include general taxation, payroll tax, sales tax, donations, and cost recovery from employers.
trust and transparency Prerequisite To secure and maintain public support for reform.
Separation of Ministry of Health and Welfare regulator and provider functions
The Ministry of Health’s current dual role is a fundamental cause of policy implementation, which contributes to an unfair public-private sector divide and even the perception of double standards. It’s time to end the current schizophrenic and myopic approach.
Separating the MOH’s regulator and provider functions will enable the MOH to exercise strategic and policy leadership. Strengthen and expand current public health and research capabilities. Promote the cross-sectoral coordination necessary for health promotion and protection by monitoring the performance, quality, safety, and population-based health improvement goals of all public and private health care facilities and services.
The functions of current MOH providers must be taken over by incorporated public non-profits with decentralized decision-making down to the local facility level.
Consistent human resource development and management
Health Care Professionals (HCPs) are the lifeblood of any healthcare system. The current production, employment, placement and rewards are not only inefficient and ineffective, but also ruin the lives of many young Malaysians.
It must be replaced with a coherent system where decisions are based on strategic planning based on regular and timely data.
Like police commissions and other similar commissions, the establishment of health care commissions goes a long way toward synchronizing the production, deployment, staff resilience, and management of public sector human resources.
Reorienting healthcare delivery
Transitions from hospital care to primary care, community care, and public health may be necessary.
Total healthcare expenditure in the hospital sector has increased from 48.3% in 1997 to 55.3% in 2019, far exceeding primary care. About 15% of hospital admissions are for conditions manageable in primary care.
Poor coordination between primary and hospital care. between the public and private sectors, as well as
The driving force is shifting spending from hospital care to primary care, community care and public health.
fit-for-purpose health
The MOH website lists about 30 health laws. Some of these laws overlap with others.
For example, some sections of the Poisons (Amendment) Act 2022 are inconsistent with the Dangerous Drugs, Medical, Dental, Private Health Facilities and Services, and Personal Data Protection Act.
All health legislation needs to be amended so that it is fit for purpose, avoids misunderstanding and is consistent with the fundamental rights guaranteed by the Federal Constitution, UHC and SDG3.
Patient safety and quality care
Adverse events from unsafe care are a leading cause of disability and death. In high-income countries, it is estimated that 1 in 10 of her patients is affected while she is being treated in hospital, and nearly 50% of them are preventable.
Globally, 4 in 10 patients are affected in primary and outpatient care, and up to 80% are preventable. In OECD countries, approximately 15% of total hospital activity and expenditure is directly caused by adverse events.
In Malaysia, reports of 53% administrative errors in public primary care clinics and 15.3% adverse events and 49.7% near misses in public hospitals are disconcerting.
The 2016 Sultanah Aminah Hospital fire is an example of a fatal patient safety issue.
Patient safety and quality care must be emphasized. Investments in reducing patient harm can lead to significant savings and, more importantly, improved patient outcomes. Even the simple act of involving a patient, if done well, can reduce his burden of harm by 15%.
Improving health literacy
Malaysian health literacy in healthcare, disease prevention and health promotion was reported at 49.1%, 44.2% and 47.5%.
Health literacy is limited among older adults (68%), those with lower levels of education (64.8%) and those with lower household incomes (49.5%).
To improve health for all, steps must be taken to improve health literacy among the public, especially vulnerable populations.
climate change
Greenhouse gas emissions (GHG) from fossil fuels are a major contributor to both climates. Change and air pollution. Many policies and individual actions, such as transport, food and energy choices, can reduce GHGs and generate significant health benefits.
The impact of climate change on human health, especially air pollution, has been addressed before.
By phasing out polluting energy systems and promoting public transport and active mobility, we can reduce GHGs and reduce the burden of air pollution.
In summary, the foregoing indicates that the five objectives of the Institute for Healthcare Improvement are to improve the health of the population; is successfully encapsulated by enhancing health equity and improving health equity.
do you have the political will
Health is a public good with a large social return on investment. The role of government is basic.
Covid-19 underscores the importance of continued public investment in health.
Are political parties and politicians tasked with addressing the grave problems currently facing a decidedly unsustainable health system, or are they paving the way for the next government?
Their responses will help many in deciding who to vote for.
Dr. Milton Lam is the former President of the Federation of Malaysian Private Medical Associations and the Malaysian Medical Association. This article is not intended to replace, prescribe, or define an evaluation by a licensed physician. The views expressed do not represent those of the organization with which the author is associated.
- This is the personal opinion of the author or publication and does not necessarily represent that view code blue.
