Of Malaysian healthcare and its financing
LETTER | On May 29, a gathering of 200-plus filled the venue for a public forum on medical inflation and its contributory causes, organised by medical and health sciences students at Universiti Malaya.
An earlier forum in April 2025 had focused on stakeholders' firefighting priorities in the immediate aftermath of steep hikes in health insurance premiums. The recent follow-up forum was an opportunity to address more systemic aspects of Malaysian healthcare and its financing.
The keynote address by Dr Aneil Moorthy, in my interpretation (and rearrangement) of its component parts, was a way of answering the question: Why do we need private health insurance?
The answer I arrived at was chronic underfunding of public sector healthcare, which has obliged many Malaysians to prepare for contingencies if faced with congested public hospitals and long queues and delays when seeking urgently needed inpatient care.
For those without deep pockets, such contingency plans invariably look to commercial hospitals and the requisite insurance coverage for critical care if and when its need arises.
That, sadly, is the backdrop to the recent public uproar over premium hikes for hospitalisation insurance, if one is unfortunate enough to get entangled in a tug-of-war between profit-driven overtreatment ('the vendor tells the buyer what the buyer must buy') and profit-driven insurers' denial of coverage and treatment ('the high-risk cases who are most likely to need healthcare, will be the individuals least likely to get coverage or treatment when they need it').
It's not me, look over there
Association of Private Hospitals of Malaysia's president Dr Kuljit Singh unfortunately declined an invitation as a much-needed panellist, but he was present nonetheless for a watching brief on behalf of APHM's member hospitals.
His occasional protagonist, Life Insurance Association of Malaysia CEO Mark O'Dell, deftly explained why insurers were not the sole culprits deserving of brickbats and deflected blame from irate policyholders (and hospitals), for the steep hikes (40 percent-70 percent) in health insurance premiums for 2025.
Despite five and a half hours of animated exchanges (yes, audience engagement was that sustained), time did not allow for me to ask O'Dell a second question from the floor: Should profit-driven risk-rated healthcare insurers have any role in healthcare financing?
Should Bank Negara Malaysia, as the insurance regulator, allow only uniform, community-rated health insurance which was non-discriminatory of risk sub-groups? (In effect, mandate cross-subsidies as an unavoidable feature of risk pooling and sustainable risk management in health insurance)
A primary care detour
Malaysian Medical Association president-elect Dr Thirunavukarasu Rajoo rightly emphasised the key role of primary care in a comprehensive national response to our ongoing epidemics of noncommunicable diseases (NCDs).
With the added involvement of other health-related personnel and civil society organisations, it could contribute importantly towards cost control by pre-emptively reducing the need for expensive referrals for higher levels of care and inpatient services.
Notably, he did not dwell at length on GPs' discontent over medicines price labelling and its underlying complications of stagnant GP consultation fees, (compensating) increased & opaque mark-ups on dispensed medicines, patients upset with prescribing fee on top of consultation fee, pharmacists wanting dispensing fee too, etc (sympathies for Health Minister Dzulkefly Ahmad. I wonder if a meaningful solution for these problems is possible without considering [flexible] separation of prescribing and dispensing).
Healthcare cost ≠ medical bills
Just as the primary care response to NCDs entails promotive, preventive (and in the near future, predictive?) care as well (i.e. much more than just prescriptions and medications), academic Nirmala Bhoo Pathy made an important point, from a patient perspective, that health-seeking costs do not equate to medical bills.
She eloquently pointed out that a more meaningful listing would include 'health-related costs beyond medical bills: transport, lost income, special diets, caregiving… real cost protection requires cross-sector solutions across social welfare, transport, labour, local governments, and NGOs'.
Sourcing for increased Health Ministry allocations
Did special guest Khairy Jamaluddin signal that 'KJ akan kembali, selepas Keluar Sekejap?' (KJ will be back after Keluar Sekejap?)
Khairy was the first health minister who publicly acknowledged, during his short tenure, that the Health Ministry was chronically underfunded and that he would seek a doubling of federal allocations to five percent of GDP within five years.
In his closing remarks at the Health Policy Summit 2022: Future of Our Healthcare - Health White Paper Development, he candidly remarked that he had pointedly avoided the 'i' word (insurance) in the preceding two days because he didn't want to get embroiled in a discussion on Social Health Insurance.
Unfortunately, he left the forum early, and I missed a chance to ask if he still favoured SHI labour taxes as a principal source for doubling the ministry's allocations, despite extensive, consistent evidence (Yazbeck et al, 2020; Wagstaff, 2009) that tax-funded healthcare systems outperformed SHI-funded healthcare systems.
During his articulate presentation, Khairy did concede, as did former deputy health minister Dr Lee Boon Chye, that the most urgent task was to upgrade, reinforce, and reform an adequately funded public healthcare delivery system before asking the public to consider supplementary taxes for further system improvements, or increased patient co-payments at point of service.
Lee further remarked that RakanKKM was, in his opinion, a band-aid stopgap that was unlikely to significantly improve affordable access, perhaps could even degrade the quality of care for regular patients.
By way of concluding, kudos are due for the excellent organising abilities and attention to detail of the UM students who convened this event.
It is indeed encouraging that medical and biomedical undergraduates are going beyond their usual preoccupations with clinical and laboratory skills to engage with urgent health system and health policy priorities on the national agenda.
CHAN CHEE KHOON is the coordinator of Citizens' Health Initiative.
The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.
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