PETALING JAYA: An academic has expressed hope that a national health insurance scheme will be part of the government’s Health White Paper to be tabled in Parliament.
Malaysia Health Economics Association president Syed Mohamed Aljunid Syed Junid said a national health insurance scheme, or NHI, would help increase the availability of funds for healthcare.
He said the annual allocation for public healthcare had been less than 2.5% of the GDP since 1957. The combined healthcare spending by the government and patients (by way of out-of-pocket expenditure) is around 4.5% of the GDP.
This out-of-pocket expenditure can be costly for those with limited funds, he said.
Syed Mohamed said a national health financing scheme would inject money into the country’s underfunded healthcare system, while roping in the private sector to contribute to affordable services.
An NHI scheme requires premium contributions from the government, employers and working adults, and is typically mandatory.
However, the government has not debated or decided on this.
“While individual funds are limited, a NHI pools risks and funds together and strategically purchases and provides better coverage to those who need medical care regardless of one’s pre-existing medical condition or economic status,” Syed Mohamed told FMT.
He said the scheme would allow the use of public and private healthcare facilities to serve the community under a common financing scheme.
The extra funding from NHI would also help cushion the impact of future pandemics, he said, adding that the Covid-19 pandemic almost led to the collapse of the country’s health system, partly due to a breakdown in negotiations between the government and the private sector on the use of private health facilities over costing.
“If we have a NHI, it can be used to fund public and private health facilities,” he said. “All these will be pre-planned prior to any pandemic through strategic purchasing for the best value, and people can seek healthcare in both sectors.”
‘NHI too costly’
However, Dr Lim Chee Han, a senior researcher for the non-profit Third World Network, is opposed to the implementation of a NHI scheme.
Lim said the administrative cost of managing the scheme would be hefty – at least RM3.9 billion.
“This is more than the estimated RM2.4 billion for the health ministry’s management costs under the 2023 Budget.
“If the country switches to a NHI, it will cost RM 1.5 billion more,” he said.
Lim said Malaysia already had a good public healthcare system financed by general taxes and that it would be better to improve the public healthcare services instead.
The government should source revenue from the capital gains tax, goods and services tax, sin tax or a small percentage of income tax earmarked for healthcare, he suggested.
He said cost escalation was a concern under NHI if patients were prescribed unnecessary procedures and medication, especially by private healthcare providers. To control such costs, he said, a mechanism would have to be set up, adding another layer of cost to the healthcare system.
“If healthcare costs fail to be controlled, the NHI authority will have to increase the premiums that people pay,” he said, adding that Taiwan, South Korea and Germany were struggling to control costs and were constantly pressured to increase premiums.
Lim said the current public-funded healthcare system gave “no incentive” to anyone to overtreat a patient and if there was a shortfall, the health ministry could request for additional funds.
He acknowledged that an advantage in a NHI system was that patients would have access to private healthcare facilities besides public ones.
“But patients will have to pay extra if the charges go beyond the limit covered, either by paying it themselves or by private insurance,” he said. - FMT
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