Health Care in Malaysia: The Author Replies.

Abstract

Health Care in Malaysia: The Author Replies Cyprian Thwala and Pricivel Carrera say that researchers have paid little attention to Oman, whose health system is like Malaysia’s—which my coauthors and I discussed (May 2016)— despite good health outcomes in Oman. Lack of familiarity with Omani data prevents me from making specific comments, but I will emphasize one point. Our article drew attention to one scenario where policy combines public spending of less than 3 percent of gross domestic product with a high share of out-of-pocket spending to achieve good outcomes. Other scenariosmay exist—for example, inOman— where similar levels of public spending combined with much less private spending achieve good outcomes. This only reinforces the need for more research to assess good-performing but seldom studied health systems. Wing Loong Cheong claims we argued that the difference in consumer quality that we identified in Malaysia between the public and private sectors had no impact on clinical outcomes. This is a misreading of the article. First, as we noted, the available data were insufficient to assess clinical quality in Malaysia. Indeed, our article ended with a call for further research on this, especially since research on other comparable systems indicates that low public-sector consumer quality does not always translate into worse clinical quality than in the private sector. Second, we did not claim that poor consumer quality is always accompanied by good clinical quality. Our key point was that Malaysia’s public sector constrains consumer quality far more than clinical quality or access by the poor—which is not a claim that clinical quality is unaffected. To the extent that public spending is inadequate to pay for high consumer and clinical quality for all citizens, we think that this is a better trade-off than the alternatives. In an ideal world, countries would provide good quality and access equally, but our article showed what countries can do when spending is insufficient to achieve that goal.