Budget 2023 must reflect govt’s strong commitment for healthcare reforms

MMA hopes to see an increase in the national healthcare budget to 5% of the country’s GDP to improve the public healthcare system and infrastructure 


IN BUDGET 2022, the government have allocated RM32.4 billion to the Health Ministry (MoH) and the current health crisis pushes the need to reform the healthcare system even more. 

For the upcoming Budget 2023, which will be tabled on Oct 7, healthcare players expect substantial amount is allocated citing that the sector has been delivering high-quality healthcare for many years despite miniscule amount is available at hand. 

The Malaysian Medical Association (MMA) specifically hope to see an increase in the national health- care budget to 5% of the country’s GDP to reflect the government’s strong commitment to reforms in the healthcare system. 

It is also their hope that the upcoming budget addresses the shortages in manpower in public healthcare facilities. 

“We still have a long way to go in addressing the issue of contract doctors. We hope the current 1,500 permanent positions for next year could be doubled,” MMA president Dr Muruga Raj Rajathurai said. 

Shortages in Specialists 

Malaysia is also in acute shortages of specialists; hence, it is hoped that the allocations could be increased to support specialisation programmes to cope with the demand for specialisations that will be high when the country reaches ageing nation status. It is expected that Malaysia will reach the ageing nation status in 2030 where 15% of the population will be 60 years old or older. 

Besides that, MMA also proposes that more funds can be given to maintain and upgrade outdated public healthcare facilities, with a proper assessment done prior to identifying facilities that need to be given priority. 

This also includes new facilities in rural communities to ensure equal distribution of healthcare services. 

“The deep interiors of Sabah and Sarawak are where these efforts are needed the most. There is a need also for a respiratory centre in Kedah,” Dr Muruga said. 

White Elephants 

Additionally, MMA wishes more funds will also be injected into the setting up of specialised centres in the north and south of Peninsula Malaysia as there are still patients travelling to Kuala Lumpur and Selangor for certain specialist treatments. 

However, to avoid “white elephants” in the form of underutilised infrastructure due to a shortage of labour, the development of manpower must be done in line with the building of the infrastructure. 

“If there are new facilities being built, we will also need roads and other conveniences for access,” he said. 

He added that this supporting infrastructure can be budgeted under relevant ministries such as the Housing and Local Government Ministry and not necessarily under healthcare. 

R&D Allocation 

Dr Muruga hopes for a budget allocation on R&D to reduce the dependency on foreign pharmaceuticals

Dr Muruga is also hoping that the Finance Ministry (MoF) could allocate a budget for research and development (R&D) to reduce the dependency on foreign pharmaceuticals. 

“The current prolonged disruption of medicinal supply is evident that it is important to address the medicine security,” he said. 

Meanwhile, in line with the ministry’s plan to give workers an additional day of leave to undergo health screening, the government could also increase the current tax incentives for working adults to further encourage them to go for health screening. 

“We hope there will also be allocations to enhance primary care delivery in government healthcare facilities and in the private sector through public-private collaborations,” he said. 

The pandemic has witnessed important role of private health- care with 8,000 over private general practitioners in the country. Therefore, the government should take advantage of this wide distribution of private GP clinics in the delivery of healthcare through community programmes. 

Apart from that, MMA also deeply concerned over the rising cases of both communicable diseases and non-communicable diseases (NCDs) among the public. 

“It is hope that more allocation available so that we can prevent, promote and do enforcement under the MoH’s Inspectorate Unit. 

Tax Incentives 

Furthermore, to encourage Malaysians to adopt a healthy lifestyle, the government should increase the tax incentives for those regularly engaging in sports and fitness activities, as well as for purchases of sports equipment, MMA said. 

Meanwhile, former Deputy Health Minister Dr Lee Boon Chye suggested that there must be a substantial increase in the budget with at least 5% of the total GDP for the healthcare sector and an additional 2% for other expenses related to healthcare. 

“Overall, it should achieve about 7% of the GDP and we are expecting approximately RM30 billion this year. 

“However, it is hoped that it can be increased further between RM60 billion and RM70 billion in a year,” he said to The Malaysian Reserve. 

He added that the allocation should be utilised for the primary care for the NCDs such as heart disease, cancer, chronic respiratory disease and diabetes, which are the leading cause of death worldwide and represent an emerging global health threat. 

“As the result of Covid-19 and health crisis, many treatments were delayed such as elective surgery and we have seen many loopholes in the healthcare system,” he said. 

The pandemic has witnessed important role of private healthcare with 8,000 over private general practitioners in the country (pic: AFP)

Healthcare System Reformation

At the same time, the Gopeng MP also calls for the urgent need to reform the healthcare system by addressing the issue given as there is also pent-up demand for the overall health services. 

Other than that, he said allocation is also needed in strengthening the human resource including both clinical and non-clinical staff. 

“Furthermore, we do expect there is a substantial allocation for an electronic medical report to ensure the healthcare sector has proper medical records and be more systematic. 

“At the moment the electronic medical report is only present in major hospitals but it should be introduced nationwide,” he explained. 

Lastly, Dr Lee suggested the computerisation of the service in MoH to improve efficiency. 

Six New Initiatives 

Separately, MoH has recently submitted an application for six new initiatives totalling RM3.4 billion to MoF to be included in Budget 2023. 

Its Minister Khairy Jamaluddin Abu Bakar said the application was presented through an engagement session with Finance Minister Tengku Datuk Seri Zafrul Tengku Abdul Aziz on Aug 30. 

The six initiatives are the strengthening of the healthcare and wellness programme, improvement and repair of MoH’s health facilities, improving the effectiveness of healthcare treatment, replacement of critical and obsolete medical assets, digitalisation of healthcare services and appreciation incentives for medical personnel. 

Khairy stressed that good health can be achieved through adequate and functioning healthcare facilities. He said the application was rational as it would help provide services to always keep Malaysians healthy and give the best treatment to those who are sick. 

“However, the ministry is also aware that if this application is approved, it does not mean we will implement it next year. Perhaps, it may take up to five years, and we also understand the country’s financial situation. 

“But I feel that this matter can be implemented, for example, through an increase in revenue collection or through re-rationalising the allocation, especially in rationalising the petroleum subsidy to the targeted groups,” he said. 

Mental Health Allocation 

Meanwhile, University Malaya (UM) senior consultant in psychiatry Dr Muhammad Muhsin Ahmad Zahari said the allocation for mental health should be no less than 5% of the total health budget in the upcoming Budget 2023. 

“For example, in 2020, Australia allocated 7.6%, Singapore (3%), Thailand (2.3%) whereas Malaysia allocated only 1.1% of the total health budget for mental health,” he said. 

Apart from that, the focus also should be given on capacity building such as increasing the number of mental health personnel such as psychiatrists and clinical psychologists. 

He noted that as of now, the mental health personnel ratio in the country is far below than World Health Organisation’s standard. 

“It is estimated that mental illness such as depression will contribute to the highest in term of the burden of disease in next decade, therefore the government must gear towards this increment,” he added. 

Big Loophole in Suicide-related Events

To make matter worse, Dr Muhammad Muhsin revealed that currently there is a big loophole in data collection of suicide-related events in response to mental health. 

As such, Dr Muhammad Muhsin urged the government to implement a comprehensive suicide attempt registry and effective framework to deal with this problem including the data pertaining to suicide attempts, and this is in line with the effort to decriminalise suicidal behaviour to ensure those with emotional crisis will receive psychological and psychiatric care. 

Additionally, he said it is now timely to review the old Mental Health Act to ensure the provision is up to date with the progress and development in the field of mental health service. 

The act should be complemented with well-equipped and high-standard nursing homes and also, more community mental health services. 

Other than that, Muhammad Muhsin also suggested more allocation given especially in the multi-sectorial, to come up with integrated approaches to dealing with addiction problems, especially drug-related. 

“People who have drug-related addiction should not be treated as criminals but rather as persons who need medical or psychiatric attention,” he said. 

  • This article first appeared in The Malaysian Reserve weekly print edition.