What the budget’s focus on healthcare says

The thrust of the 2020 Budget, tabled on Friday, is obvious with a great focus on the growth and digitalisation of the economy but with an emphasis on human capital and social welfare as well.

The healthcare sector was pretty pleased with the announcement of a larger allocation for healthcare of RM30.6 billion compared to RM28.7 billion last year, an increase of 6.6%. This is a strong indicator of the government’s continued belief in the importance of spending on healthcare. Really, it’s a case of it putting its money where its mouth is on this issue. Kudos.

The other piece of news that really pleased those of us in the healthcare sector was the fact that the budget showed that this government really bothered to listen to the input of the people.

First, the introduction of pneumococcal vaccination for children is a cause that has long been advocated. No previous government bought into it, despite the clear benefit in terms of lives saved and reduction of medical costs.

The fact that this government did shows that it listened to the professionals who have recommended this for a long time and acted on it, also to fulfil one of the items promised in the Pakatan Harapan manifesto.

The second is the excellent decision on strategic purchasing, where the government announced it would centralise and combine the procurement of half-a-billion ringgit worth of medicine purchases across the ministries of health and defence and university hospitals.

Previously, all these institutions had their own procurement systems with separate drug supply prices. The call to “bulk purchase” has been around for years, and it is good that this government has finally made that move.

Hopefully, this marks the entry of innovative financing in public sector healthcare, with a change in the mindset of the powers that be in terms of finding strategies for being more cost-effective and efficient in delivering on health.

The third and fourth reasons why we are happy that this budget reflects the input of the people can be seen in the cases of MySalam and PekaB40. Both are new health-centric social protection schemes only introduced after the last budget. (I reiterate that these are really not health insurance schemes despite many alleging that to the contrary.)

Whether the schemes are being successfully implemented is a different issue. The positive news is that the government is willing to listen to input and to make changes to the schemes and how they are rolled out.

Of course, some might call this a “konar baring” if not a U-turn, but I personally see it as an indicator of the government’s willingness to be flexible and to make necessary changes to an already-implemented programme in order to ensure better delivery and outcomes.

In healthcare at least, this has never happened before given “the government is always right” mentality and the tendency to gloss over failures and bulldoze through any shortcomings.

For MySalam, the social protection programme, we saw in the middle of last year already how the government received input from stakeholders and advocates and made the important change of including university hospitals in the scheme.

In this budget, the programme has been extended to cover nine more diseases and people up to 65 years old (previously it only covered people up to 55 years old).

The age extension, especially, is an important new addition and ensures that a lot of older Malaysians who are identified with catastrophic illnesses only in their early 60s will receive the benefits of the programme. These are issues that we have advocated over the year, and it is genuinely heartening to see that it has borne fruit.

MySalam is also extended to the middle class (M40) now, with coverage extended to those with an annual income of up to RM100,000. Although the total payouts are 50% (RM4,000) compared to that given to those in the B40 group (RM8,000), this is also a step in the right direction as we know that the middle class suffers the brunt of catastrophic health expenditure as much as those from the B40.

The Peka B40 Non-communicable Disease medical screening programme has also been improved in terms of coverage, with the age limit for enrolment set at 40 rather than 50 years old. As has been pointed out in the past, as a screening programme and a gateway to medical aid, the programme would have been highly ineffective when catering only to those who are 50 and above as by then they would already have had a full-blown disease. The government has acted to rectify that by lowering the age for inclusion.

An additional interesting point is how the government has acted to widen the beneficiary population for both the MySalam and PekaB40 schemes by increasing the pool of citizens eligible for Cost of Living Aid to those who are single, above 40 and earning less than RM2,000 a month.

By doing this, the government also provides an additional layer of financial protection in terms of health to these individuals, which promises to be a good thing. This again reflects the input that stakeholders have provided over the year about these programmes.

For advocates of health, this recognition is what we work diligently towards, in terms of influencing genuine, positive change for Malaysian healthcare. However, budgetary allocations, while extremely important, are only the first step.

After all, in Malaysia haven’t we learnt bitter lessons about budgetary allocations in the past which subsequently became “janji kosong” or empty promises? Many of those in government today are people who were previously citizen advocates themselves, and it is really heartening to see that they still have their ears to the ground, at least in terms of health.

The task that we have now is to ensure that the government spends this money effectively and efficiently to improve the health system and delivery of services to Malaysians.

It is critical that we, the rakyat, act as a check and balance to ensure that our government continues to sustainably implement delivery of health to all of us. If not, quis custodiet ipsos custodes – who will guard the guardians? - FMT