Covid-19 was the worst public health disaster in Malaysia, with the health care system on the verge of collapse on several occasions, exposing its mistakes.
Chronic underfunding and, consequently, underinvestment, in the public health care sector has resulted in, and continues to extract, a heavy price from kneelings.
The primary lesson learned from Covid-19 has been the massive impact of inequality and structural damage on its course and outcome.
But did policy makers learn and make changes to the health care system in the future?
There is no indication that concrete measures have been taken to address basic health and healthcare issues, which include chronic underinvestment in the public healthcare sector, health inequality, health-care worker resilience, mental health, non-communicable diseases, building ventilation, and social determinants of health. .
Health: a central issue in GE15
The government has made an international commitment to universal health coverage (UHC) and the Sustainable Development Goals (SDG), whose third goal is “good health and well-being”.
The government ratified the Paris Agreement, a legally binding treaty on climate change, with the goal of limiting global warming to below 2, preferably 1.5 degrees Celsius.
Universal health coverage requires a focus on primary health care to improve access to high-quality essential services, sustainable financing and financial protection, improved access to essential medicines and health products, trained health care professionals, sound labor policies, civil society participation in national health policies, and improved monitoring and data and information.
SDG 3 requires addressing the social determinants of health, promoting cross-sectoral approaches to health, and prioritizing health in all health policies and settings.
The Paris Agreement requires an economic and social transformation, based on the best available science, to reduce greenhouse gas (GHG) emissions. Malaysia has committed to reducing greenhouse gases by 45 percent by 2030.
There has been much discussion and debate in the medical and other health care professions, as well as in civil society, about the expectations of government responsibilities towards health and health care. We discuss below some of the salient issues in these discussions.
Prioritizing health in all policies
The primary focus of the next government should be to prioritize health in all policies.
Any spending on health and healthcare should be viewed as an investment for the future rather than an expenditure item.
Increase public sector budget allocations
Malaysia’s public investment in healthcare has been chronically inadequate, with about 2 percent of GDP spent on health care, compared to 5 to 8 percent in countries of similar development status.
There are high levels of ineffective and regressive out-of-pocket health payments (about 35 percent of total health expenditure (THE), with many families insolvent due to catastrophic health expenditures, as well as private spending accounting for 47.6 percent dependent.
As such, the current public sector health budget allocation should be gradually increased to 5% over a five-year period.
Additional budget allocations are necessary to make up for years of chronic underfunding and underinvestment, such as repairs, replacements, and renovations.
However, increased health funding and allocations must be accompanied by containing cost inflation, improving efficiency and reducing waste.
Healthcare Financing Reforms
The government should create a new statutory, not-for-profit agency, accountable to Parliament, to manage all public funding for health care.
This agency will be responsible for financing and purchasing health care in a strategic and fair manner from both public and private providers.
Its strategic, effective and transparent functions should ensure a more coordinated and efficient use of service providers to meet public needs; More effective integration at all levels of care; Shifting spending from hospital care to primary care, community care, and public health.
Various options for financing include general tax, payroll tax, consumption tax, donations, cost recovery from employers, etc.
Trust and transparency are indispensable condition To secure and sustain public support for reforms.
Separate functions for the regulator and provider of the Ministry of Health
The Ministry of Health’s current dual roles have been the root cause of implementing policies that have contributed to the unfair division between the public and private sectors and even the perception of double standards. It is time to end the current approach to schizophrenia and myopia.
The separation of regulator and provider functions will allow the Ministry of Health to provide strategic and policy leadership; Strengthening and expanding its existing public health and research function; Drive the intersectoral coordination needed to promote and protect health, by monitoring the performance, quality and safety of all public and private healthcare facilities and services, as well as population-based health improvement goals.
Jobs of the existing MOH provider should be taken over by publicly owned, not-for-profit entities, with decisions being decentralized to local facility levels.
Development and coherent management of human resources
Healthcare professionals (HCPs) are the lifeblood of any health system. Existing production, employment, distribution and wages is not only inefficient and inefficient – it spoils the lives of many young Malaysians.
It should be replaced by a coherent system in which decisions are based on strategic plans based on regular and timely data.
Establishing a health care commission, similar to the police commission and other similar commissions, will go a long way towards synchronization in production, deployment, staff flexibility, and human resource management in the public sector.
Reorienting healthcare delivery
There is a compelling case for moving from hospital care to primary care, community care, and public health.
The total health expenditure of the hospital sector increased from 48.3 percent in 1997 to 55.3 percent in 2019, which is much higher than primary care. About 15 percent of hospital admissions are for conditions that can be controlled in primary care.
There is poor coordination between primary care and hospital care; As well as within and between the public and private sectors.
The drive would be to shift spending from hospital care to primary care, community care, and public health.
fit-for-purpose health laws
There are about 30 health laws listed on the Ministry of Health website. There is an overlap between some of these works with others.
For example, some sections of the Poisons (Amendment) Act 2022 are incompatible with laws on dangerous drugs, medical services, dental services, private healthcare facilities, and personal data protection laws.
It is essential to review all health laws to ensure that they are fit for purpose, avoid misinterpretation, and are consistent with the fundamental rights guaranteed by the federal constitution, universal health coverage and the third sustainable development goal.
Patient safety and quality care
Adverse events due to unsafe care are a major cause of disability and death. It is estimated that 1 in 10 patients in high-income countries is harmed while receiving hospital care, and about 50 percent of them are preventable.
Globally, about 4 in 10 patients in primary and ambulatory care are affected, and 80 percent of them are preventable. In OECD countries, about 15 percent of total hospital activity and expenditures result directly from adverse events.
Malaysian reports of 53 percent of administrative errors in public primary care clinics, 15.3 percent of adverse events and 49.7 percent of near misses in public hospitals are alarming.
The 2016 Sultana Amina hospital fire was an example of a fatal patient safety problem.
There is a need to emphasize patient safety and quality of care, as investing in patient harm reduction leads to significant savings and, most importantly, better patient outcomes. Even the simple act of involving patients, if done well, can reduce the burden of damage by 15 percent.
Improving health literacy
The health literacy of Malaysians in relation to health care, disease prevention and health promotion was 49.1 per cent, 44.2 per cent and 47.5 per cent.
Health literacy is limited among the elderly (68 percent), those with a low level of education (64.8 percent), and those with low family incomes (49.5 percent).
Measures must be taken to improve the health literacy of the public, especially vulnerable groups, to improve the health of all.
Greenhouse gas (GHG) emissions from fossil fuels are major contributors to both climates they change and air pollution. Many individual policies and measures, such as transportation, food and energy choices, can reduce greenhouse gases and produce significant health benefits.
The impact of climate change on human health in particular air pollutionwas previously taken.
Phasing out polluting energy systems, promoting public transportation and active movement, can reduce greenhouse gases and reduce the burden of air pollution.
In summary, the above are well wrapped up by the five-year goals of the Institute for Health Care Improvement, i.e., improving the health of the population, enhancing the experience of care, reducing the per capita cost of health care, job satisfaction for health care professionals, and promoting health equity.
Is there a political will?
Health is a public good with significant societal returns on investment. The role of government is essential.
Covid-19 has clearly revealed the importance of continued public investment in health.
Are political parties and politicians up to the task of addressing critical issues currently facing the healthcare system, which are clearly unsustainable? Or will they kick it in the way of the next government?
Their answer(s) will help many decide who to vote for.
Dr. Milton Lum is the past president of the Federation of Private Medical Societies of Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate, or limit an evaluation by a qualified physician. The opinions expressed do not represent the view of any organization with which the author is associated.
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