THERE were great hopes for Budget 2024 with the Health White Paper promising a focus on prevention, health promotion and equity. 

Overall, the budget increased by 1.4% in the face of an inflation rate beneath 2% and estimated 4%-5% GDP growth. Indeed the 15% increase in budget allocation to health is much lauded and we really do hope that this increase will continue year-on-year for the next few years until healthcare spending arrives at 5% of GDP in Budget 2027, as indicated by a recent statement released by the Malaysian Health Coalition. 

However, when it comes to overall spending on older adults, Budget 2024 appears “underwhelming”. While there is an increase in health budget, there is no specific ring-fenced funding dedicated to the development of health services for older persons or for the treatment of dementia. 

Malaysia, like any other country in the world has a commitment to the United Nations (UN) Decade of Health Ageing (2021-2030) as well as the Global Action Plan for Dementia (2017-2025). 

Yes, 2025! Yet, the budget for 2024 remains silent with regards to dementia funding. 

The much-awaited National Dementia Action Plan has yet to see the light of day despite rumblings of a revival from the initial promises made in 2019 and then in 2021, when it was publicly announced that a former prime minister (PM) has dementia. Without specific allocations for services for older adults, it is likely that their funding will be drawn from allocation to general medicine, which has been offered a 1.7% increase in funding, mental health (1.9% increase), family health development (3.8% rise) and disease control (1.9%). Funding for geriatric medicine will be drawn from general medicine, while funding for dementia services could be obtained from general medicine, mental health, family health development and disease control. Funding for disease prevention and community-based care in older adults will also be obtained from the family health development, with the Older Persons Sector in the Ministry of Health (MoH) sitting 

within the Family Health Division. However, other areas with larger increases, including dental (2.5%), pharmacy (3.9%) and food safety, may also indirectly benefit older adults who are major users of the first two services particularly. Further, a 52% increase is observed in the federal pensioners’ medical treatment, which is great news for federal pensioners who for some time have been experiencing difficulties in obtaining funding for more expensive treatments.

In addition, the new allocation of RM1.65 billion towards new policies is much welcomed, and we sincerely hope that the new policies will accurately reflect the needs of our population, with some directly involving new policies for older adults and dementia. Nevertheless, apart from government pensioner’s medical treatment, the 15% increase in funding does not seem to be reflected in allocations that are likely to directly impact on older adults’ community care and support services. Dedicated funding for older adults does, however, exist in the budget and this can be found in the allocation for the Ministry of Women, Family and Community Development, which receives an allocation of RM3.5 billion in total, less than 1/10th of the RM41.2 billion to be received by the MoH. 

The Department of Welfare is nested within this ministry and appears to be allocated RM923 million for social care funding for older adults, of which RM905 million is allocated toward socio-economic support for older persons. Of the remaining funds, specific allocations were made for senior citizens’ activity centres, which has increased by 2%, transport services (no change) and home help services, which has seen a 13% funding cut. 

Rumah Seri Kenangan, which is our government-funded residential care facilities and daycare services will, on the other hand, see welcome increases of funding of 38% and 75% respectively. 

In totality, however, older persons’ allocation has increased from by 1% from RM91.3 billion last year — which in real terms represents a funding cut considering 2% inflation and also the actual increase in individuals aged 60 years and over — which will exceed four million by 2024 from 3.8 million in 2023. This also does not reflect the overall budget increase let alone the 15% increase in health funding. 

Instead, funds appear to have been shifted from the emphasis on home-based and community care provision to daycare and residential care; though the injection in funds for both these areas are very much needed. 

The figures may be hard to digest, but the major concerns will include the lack of recognition of the gulf between health and social care, as well as the fact that older persons’ needs tend to exceed that of social care and pension funding. Integrated approaches backed up by a policy that merges both health and social care will ensure resource allocation supports the development of balanced service systems and is not directed to acute healthcare at the expense of prevention, primary and community services. 

Without this approach we will continue to see imbalances in allocation between health and social care. These imbalances, will in turn, lead to inappropriate use of hospital facilities for care provision and avoidable admissions which leads to inefficient use of resources, negatively affecting the quality of life of older adults and those that care for them. 

The rise in non-communicable diseases and obesity in our population will give rise to an older generation at high risk for dementia. Strategies for prevention and treatment are a major public health concern. 

The budget, unfortunately, does not reflect the government’s commitment to either dementia care, which is needed by the World Health Organisation by 2025 as well as the UN Decade for Healthy Ageing, for which three years has lapsed without a clear indication of government policies in this direction. 

The apparent lack of focus on older adults may, however, reflect the need for structural reforms to meet the needs of an ageing population. 

Malaysia bears the crown as the best affordable retirement destination internationally. With good weather and excellent healthcare, Malaysia has every chance of capitalising on the Silver Economy, not only to ensure it’s a great place to grow old, but also as a source of foreign revenue in health tourism and retirement living. 

Eleven months is not really enough time to effect structural change, but with the promises of the Health White Paper and the Ageing National Blueprint, we certainly hope that this budget will at least fund the processes that will lead to much-needed structural reform to effectively deliver the population ageing agenda and ensure Malaysia is able to capitalise effectively on population ageing. 

• Prof Tan Maw Pin is the president of the Malaysian Society of Geriatric Medicine, while Prof Shahrul Bahyah Kamaruzzaman is the president of the Malaysian Healthy Ageing Society. 

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