On the eve of the unveiling of the highly anticipated Budget 2019, we spoke to two key players in the healthcare industry: the Malaysian Medical Association and the Ministry of Health. The key question was: What can we expect from the healthcare allocation, and would it be in line with what the people want?

1. Increase in budget

“Going into Putrajaya, we realised that the federal debt is beyond RM1 trillion. Moving forward, particularly in 2019, all that I wish — that there is an incremental increase of allocation to the health ministry — is now put on hold,” said Health Minister Datuk Seri Dr Dzulkefly Ahmad at BFM’s Health & Living Jr 2018 event in October.

However, the Minister went on to say, “I’ve recently told Tun (Dr Mahathir Mohamed) in the cabinet that should we fail to get any increase for 2019 — if I do not get the resources, I will be resourceful in ensuring that there is an increase of budgetary allocation for the ministry.”

For context, the 2018 health budget was RM26.58 billion or 1.87 per cent of GDP. For 2019, the Ministry of Health had requested a budget of RM30 billion for administrative and development costs. Deputy Health Minister Dr Lee Boon Chye had said that this amounted to 2.01 per cent of Malaysia’s GDP, still far below the World Health Organisation's recommendation of 3.5 per cent to 4 per cent GDP.

2. Primary health care

Meanwhile, president of the Malaysian Medical Association, Dr Mohamed Namazie Ibrahim expected more emphasis on primary healthcare.

“Primary healthcare will take the centre stage in all the country’s delivery of healthcare,” he noted. “What we would like the government to do is to engage the 7,000 private general practitioners (GPs) in the country in delivering primary healthcare in a more sustainable manner."

3. Infrastructure upgrades

Datuk Seri Dr Dzulkefly acknowledged that the government had made promises to address infrastructural issues such as ageing equipment and limited parking lots in hospitals, something that we can expect the ministry to fulfil.

4. Pneumococcal vaccination

Speaking of promises, the Pakatan Harapan government's manifesto for the 14th general election included free compulsory pneumococcal vaccination. The Health Minister confirmed that the ministry is still committed to doing that, having put in a request to get the pneumococcal vaccination, which would cost RM180 million for a cohort of 500,000 per year but he added, “As to when we can roll that out, honestly, I have requested that it be done soonest. It wasn't one of those 10 promises within 100 days, but surely within the tenure of the 14th parliamentary session."

5. Social health insurance

The social health insurance (SHI) scheme had garnered quite a bit of controversy. This was another promise made in the government's manifesto, and while it is not a new idea, critics were mainly concerned about its sustainability and whether the government has the financial ability to pull it off. Another point of contention is that the scheme would only benefit the B40 group.

“I think it's about time that we did this because the current system of financing is not really sustainable (but) the government should seriously think of introducing a social health insurance for all and not just for the B40 as planned,” said Dr Namazie.

Datuk Seri Dr Dzulkefly recognised that while the current arrangement is not ideal, and although he has been in consultation with “the best brain, the best mind, the best talent,” there is yet to be a resolution. Regardless, he said he foresees a solution that is hybrid in nature: “With social health insurance in place but along with an increment in public spending that will allow for avoiding the consequences of the downside of SHI such as the escalation of cost, and administrators' layering of cost.”

Listen to the full podcast 'What To Expect For Healthcare':

With these expectations laid out, in the last part of the series, we evaluate whether the actual healthcare allocation will enable the ministry to deliver on its promises.

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