Abstract
One of the challenges to maintain an agenda for universal coverage and equitable health system is to develop effective structuring and management of health financing. Global experiences with different systems of health financing suggests that a strong public role in health financing is essential for health systems to protect the poor and health systems with the strongest state role are likely the more equitable and achieve better aggregate health outcomes. Using Malaysia as a case study, this paper seeks to evaluate the progress and capacity of a middle income country in terms of health financing for universal coverage, and also to highlight some of the key underlying health systems challenges.The WHO Health Financing Strategy for the Asia Pacific Region (2010-2015) was used as the framework to evaluate the Malaysian healthcare financing system in terms of the provision of universal coverage for the population, and the Malaysian National Health Accounts (2008) provided the latest Malaysian data on health spending. Measuring against the four target indicators outlined, Malaysia fared credibly with total health expenditure close to 5% of its GDP (4.75%), out-of-pocket payment below 40% of total health expenditure (30.7%), comprehensive social safety nets for vulnerable populations, and a tax-based financing system that fundamentally poses as a national risk-pooled scheme for the population.Nonetheless, within a holistic systems framework, the financing component interacts synergistically with other health system spheres. In Malaysia, outmigration of public health workers particularly specialist doctors remains an issue and financing strategies critically needs to incorporate a comprehensive workforce compensation strategy to improve the health workforce skill mix. Health expenditure information is systematically collated, but feedback from the private sector remains a challenge. Service delivery-wise, there is a need to enhance financing capacity to expand preventive care, in better managing escalating healthcare costs associated with the increasing trend of non-communicable diseases. In tandem, health financing policies need to infuse the element of cost-effectiveness to better manage the purchasing of new medical supplies and equipment. Ultimately, good governance and leadership are needed to ensure adequate public spending on health and maintain the focus on the attainment of universal coverage, as well as making healthcare financing more accountable to the public, particularly in regards to inefficiencies and better utilisation of public funds and resources.
Highlights
Introduction and backgroundUniversal coverage and access to quality health care requires human capital, infrastructure and material resources [1]
The WHO recommends that for universal coverage to be achieved in Asia Pacific countries, one of the key criteria is to have adequate spending on health; a minimum total health expenditure of 4%-5% of the gross domestic product is set as the benchmark
Higher government spending is widely promoted and regarded as a means to lessen the consumption of private healthcare services that could lead to high out-of-pocket payment (OOP), as it generally relates to the provision of adequate public infrastructure and health service delivery at subsidized cost
Summary
Introduction and backgroundUniversal coverage and access to quality health care requires human capital, infrastructure and material resources [1]. Private sector employers may elect to offer welfare and health benefits and typically negotiates packages with Managed Care Organizations (MCOs) and private insurance companies to provide medical insurance cover for their employees. Public health care services are funded through general taxation, with annual health budgets allocated by Ministry of Finance to the Ministry of Health. The formally employed workforce make monthly contributions to an Employee Provident Fund (EPF), a compulsory savings scheme that provides a measure of security in retirement, and disburses supplementary benefits to members for medical expenses and for capital purchases such as the family home. All private sector formal workers earning less than RM3,000 a month make a minimum contribution to the Social Security Organization (SOCSO), a scheme that provides medical benefits for work related injuries of members. Public sector employees and their families enjoy free access to medical services provided by the public sector, and some of them have private insurance or private medical care benefits
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