1.0 Introduction
Malaysia health services provision and delivery comprise of the public health services and medical services. The main goal of public health is aim to reduce the burden of chronic disease in population. Most of the chronic disease in early stages, their medical cost involved is relatively inexpensive, but in late phase the medical cost involved could be much more expensive and most likely to over the affordability of most Malaysian family. As reported in new research by Mercer Marsh Benefits, in Asia the medical costs are expected to increase by 11.5% against an inflation rate of 2.1% in Asia. (2) With better understanding of disease trajectories in chronic disease, it is recognized that public health is one of the greatest things in which a government can invest.
Malaysia government had made great effort in improving the life expectancy for its people; for women from 65.6 to 76.4 years and for men from 61.6 to 71.6 years in between 1970 -2008(1). As we can notice Malaysia is undergoing an epidemiological transition in which the mortality causes of the population is gradually shifting from communicable diseases to non-communicable diseases. Since independence, Malaysia government has not fully decentralized its public health care system, with this the Ministry of Health have the authority in formulated, funded and administered the policies and programmes (3).
2.0 1 Care for 1 Malaysia
“1Care for 1Malaysia” is one of the Country Health Plan: 10th Malaysia Plan 2011-2015 (4) proposed by the Ministry of Health in 2009. The main focus of this plan is to restructure the country health care system with which integrate both the public and private health sectors into optimizing the growth and resources (5). 1Care is a national health system initiated to provide better health care choice for the public, based on the foundation and understanding of previous and current public health needs and the challenges faced, and with the consideration of government’s ability to finance it and value for money.
2.1 Pros
“1Care for 1Malaysia” aims to create effective, efficient, fair and high-tech health care system accessible to all at various appropriate levels of healthcare. It is proposed to reform and restructure Malaysia existing tax-based funded system with a mandatory social health insurance scheme. The proposed 1Care will have 3 major reformations in the sector such as governance reform, delivery systems reform and healthcare financing reform (6). The government revamp all these into making the public believe 1Care will make health care cheaper and better.
2.2 Cons
Unfortunately the plan didn’t succeed as it intended to be. Indeed the whole idea is very noble but scrutinizing into details and implementation, undoubtedly do have several flaws. According to the structure in this system every employees need to pay a mandatory amount of premium at community rated and calculated on sliding scale as percentage of income, which is roughly 10% from their monthly gross salary to contribute to National Health Care Financing Authority (NHFA). The problem is those unemployed people or others such as the poor, disabled and the elderly, are they eligible under this program? Even though they are supported by government’s contribution, will it be really adequate? If everyone in the nation enjoys this medical benefits it means that those employed need to cover those unemployed. This project would fail can somehow be related and explained with why Communism or socialism failed. In communist community, every resources is shared equally, and it work fine until the human greed started to grow. Communism failed to provide incentives or reward for those who work harder and more productive and punish those who is lazy and inefficient, without all these people sooner or later will lost the initiative to make an effort and this is the reason for the poor performance and failed of this ideal (7).
Besides that as employee we cannot opt out otherwise the respective employer will face legal action. Because it is under the one plan, basically you cannot choose the doctor to seek for treatment. Under this insurance plan, NHFA will subsidise certain amount of the medical consultation fee and injection if it is needed, other than that the patients will be charge based on current private healthcare rates instead of public healthcare rates.
3.0 Voluntary Health Insurance Scheme
In July 2016, our health minister Datuk Seri S. Subramaniam announced that the Health Ministry is planning an alternative non-profit health financing scheme to assist those who in need of medical financing (8). This whole health insurance scheme is a non-profit scheme and is on individual voluntary basis and do not involves private sector such as private insurance company.
3.1 Pros
The scheme introduced is mostly targeted those who are not insurance covered or rejected by private insurance company. According to statistic from World Bank, in year 2014, 55.2% out of total health expenditure in Malaysia is public health expenditure, while out-of-pocket expenditure took up to 35.3%.
The charges of RM1 for outpatient treatment and RM5 for specialist outpatient treatment has been remain unchanged for over 30 years according to what has been set in the Fees (Medical) Order 1982 (9). Throughout the years even though medical prices and costs keep on increasing, but still are heavily subsidised by the government. As the population need of medical support keep on increasing, the government need to look for alternative solutions funding the healthcare, instead of just solely depend on general taxation. The introduction of this voluntary health insurance scheme in certain way will benefit the population especially those ageing population and patient with multiple chronic diseases in long run if the fund is being managed properly. Still it is too early to conclude its benefit as not much details of this scheme been released out yet.
3.2 Cons
This voluntary health scheme is similar with other private health scheme will somehow attract unqualified or unhealthy people from enrolling. As most insurance scheme is like a pool of fund with all the different policy holders from different health background inside this pooled fund. With this pooling basis, those who are healthier and stronger will often unconsciously subsidise the insurance cost of those that not so healthy such as the elderly and those chronic diseases patients. This possess greater risk as if most of the person insured are old and sick, these pooling benefits might loss its benefits (10).
4.0 Conclusion
Government’s responsibility is to protect the interests of the society such as delivery of high-quality health care and improve the quality of life of the public. Undeniable private section took a large portion of responsibility in making sure the population is well insured, but private financing alone cannot ensure all the public access equally to quality health care, hence the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness.
The ultimate goal of achieving high quality of care accessible to all require strong corporation between the federal, state governments, private sector and the public . The effort of government in planning and implementing various schemes and plans to increase the possibility of equity in obtaining medical support is very encouraging. Still if the government wants to expand health insurance to more and more people, transparency and trust by the public is vital important.