Health Issues in Malaysia

Dr Lo Ying-Ru Jacqueline

WHO Representative to Malaysia, Brunei Darussalam and Singapore

Dr Taketo Tanaka, Health Policy

WHO in Malaysia

3 December 2019

WHO Malaysia - Grant to strengthen health systems from EU DG DEVCO

2011

EU With Luxemburg, Ireland, Japan, …

115 countries benefitted Such as Viet Nam, Lao PDR,

Cambodia, Philippines, Mongolia

Phase 4 just started in July 2019 Duration: 3 years

Flexible funding

DCI + EDF funding

Outline

Epidemiological and demographic transition

Health financing and systems issues

Conclusions

Life expectancy at birth (2018) Male 72.7 years Female 77.6 years

Demographics in Malaysia

7%

14%

1950 1975 2000 2025 2050

% Population aged 65 or over

10%

20%

30%

Rapidly ageing populations in WHO Western Pacific, 1950-2050

Data source: UN Population Division

Majority of premature deaths from non-communicable diseases, 2017

Top 5 principal causes of death (2017)

Six building blocks of health systems

7

Source: Everybody’s business: health systems strengthening to improve health outcomes. WHO’s framework for action. Geneva, World Health Organization (2007)

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2

3

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50% of health services in private sector

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29.2

18,429

16,622,744

46,194

154

57,069,523

1,085

28.1

13,684

3,873,935

13,957

200

37,939,354

7,571

0% 20% 40% 60% 80% 100%

Health Expenditure RM Billion (2016)

Doctors(excl. Houseman) (2016)

Bed Days (NHMS 2015)

Hospital Beds (2017)

No. of Hospitals (2017)

Outpatient visits (NHMS 2015)

Health clinics (with doctors) (2017)

Public Private

Source: Health Informatics Centre (HIC), Family Health Development Division, NHMS 2015, MNHA 2017

1

Service delivery – quality, equity & scope

Quality of care No significant difference between public and private providers

Longer waiting time at the point of care at public facilities

In exchange for minimal user charges at public facilities

Equity in service provision Public: widely distributed and equitably utilized

Private: concentrated in the urban and utilized by the rich

Scope of care NCD patients are more likely to seek care at public facilities.

Private providers focus more on episodic and elective care.

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1

Six building blocks of health systems

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Source: Everybody’s business: health systems strengthening to improve health outcomes. WHO’s framework for action. Geneva, World Health Organization (2007)

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Supply of health workforce is increasing but still low compared with OECD countries

Doctors per 1,000 population

Malaysia: 1.8 (2017)

Nurses per 1,000 population

Malaysia: 3.3 (2017)

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https://data.oecd.org/health.htm

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Health workforce – recent issues

Unbalanced labor market for new graduates Number of new medical graduates has been increasing consistently

40% of new graduates are trained abroad

Inadequate slots for post-graduate training

Limited capacity of public facilities to accept new graduates

Inadequate and overburdened clinical preceptors

Unbalanced distribution East Malaysia is underserved

Slow increase of specialists relative to generalists

Leakage from the public to private sector

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2

Six building blocks of health systems

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Source: Everybody’s business: health systems strengthening to improve health outcomes. WHO’s framework for action. Geneva, World Health Organization (2007)

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Health information system

Limited electronic information system in public facilities

Limited information available from the private sector

Lack of linkage between different databases, registries and surveys

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3

Six building blocks of health systems

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Source: Everybody’s business: health systems strengthening to improve health outcomes. WHO’s framework for action. Geneva, World Health Organization (2007)

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Medical products, vaccines and technologies

Public Essentially prescribe generic drugs

Mostly in-house dispensing

Centralized price negotiation, tendering and contracts with pharmaceutical companies through logistics company Pharmaniaga

Public facilities are only allowed to purchase drugs from the contracted companies

Health technology assessment

Private Free to prescribe innovator and generic drugs

Prices are not regulated “yet”.

In contrast, GP consultation fees are specified under the Private Healthcare Facilities and Services.

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4

Recent policy movement to control drug prices

In August 2018, the Government announced its concern for the escalating healthcare cost in Malaysia.

In April 2019, the Cabinet approved to impose price control measures for drugs by applying for the Price Control and Anti-Profiteering Act 2011: Use the external reference pricing (ERP) to benchmark prices.

Set the ceiling price determined by the average of benchmarked prices.

The ceiling price will affect both wholesale and retail prices.

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https://galencentre.org/2019/07/08/drug-price-controls-in-malaysia-implications-and-considerations-no-5-june-2019/

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Use of external reference pricing for medicines 4

Six building blocks of health systems

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Source: Everybody’s business: health systems strengthening to improve health outcomes. WHO’s framework for action. Geneva, World Health Organization (2007)

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Only about 4% of GDP derived from health sector - far lower than in OECD countries

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Source: National Health Expenditure Report 1997-2017, MNHA

Total

4.24% Total

3.04%

5

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

5.00%

-

10,000

20,000

30,000

40,000

50,000

60,000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

shar

e o

f G

DP

RM

mill

ion

(n

om

inal

) Trends of health expenditure, nominal value and % of GDP

Public (nominal) Private (nominal) Public (%GDP) Private (%GDP)

One-third of total health expenditure are out-of-pocket payments (not pooled)

21 Source: National Health Expenditure Report 1997-2017, MNHA

5

Public 51.2%

Private 48.9%

Health financing – financial flow

Sources Citizens, firms, consumers Migrants Employees/employers Individuals

Provision MOH health facilities University/military

hospitals, etc. Private health facilities

Collection

Pooling

Purchasing

Ministry of Health

Oth

er

min

istr

ies

Federal Treasury

SPIK

PA

myS

alam

EPF/

SOC

SO

PH

Co

rp

Private health insurances

22

Taxes Contributions

Ou

t-of-p

ocket p

aymen

ts

Contributions

60-70% of total revenue

5

Six building blocks of health systems

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Source: Everybody’s business: health systems strengthening to improve health outcomes. WHO’s framework for action. Geneva, World Health Organization (2007)

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Leadership and governance - regulators

Public Mostly regulated by the Ministry of Health

University/military hospitals: Ministry of Higher Education, Ministry of Deference

Facilities for specialized care: Ministry of Women

Private Providers: Ministry of Health

Health insurance companies: Bank Negara Malaysia, Ministry of Finance

Third-party administrators: Ministry of Health

Medical products: Ministry of Health, Ministry of Domestic Trade and Consumer Affairs (on-going)

Medical tourism: Malaysia Healthcare Travel Council

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Conclusions

Rapid population aging and high burden of non-communicable diseases will result in increasing cost for government and may have implications on economic growth

Gaps in public sector services filled by rapidly growing private health care sector

38% of out-of-pocket spending may likely increase and may result in catastrophical health expenditures

Health system needs to estimate and project future demand and supply of services and cost

Thank you