The number of health facilities in Malaysia has not kept up with the pace of population growth (Figure 1). The ratio of public hospitals to 100,000 population dropped from 0.53 in 2006 to 0.48 in 2016, while the bed-to-100,000 population ratio has barely improved, dropping slightly from 145.5 in 2006 to 144.4 in 2016.
Looking at the growth rate of the indicators of both public health demand and supply from 2011 to 2016, it can be deduced that the supply of physical facilities has not caught up with the demand (Figure 6), while the health workforce is trying to match the rising demand to spread out workload burden.
If the government does not manage to slow down the demand for public healthcare services, i.e. reduce the incidents of communicable and non-communicable diseases, then it has no choice but to allocate appropriate resources, both financial and human resources, to cater to needs.
Malaysia spent an equivalent of 4% GDP on health in 2015, which is lower than the world average at 6.8% but higher than Indonesia (3.3%) and Thailand (3.8%) (Figure 2). This would indicate that our health expenditure is either efficiently utilised or just insufficient.
In terms of government expenditure on health as percentage share of total government expenditure, the Malaysian federal government contributed 8.3% in 2015 – more than Indonesia (7.4%), the Philippines (7.4%), Brazil (7.7%) and Vietnam (7.9%). However, it spent less on health than the world average (9.9%). Countries such as China (10.1%), South
Africa (14.1%) and Thailand (16.6%) may be lagging behind Malaysia in terms of GDP per capita, but their governments spent more on health, reflecting the commitment level of the various governments towards public health.
Most, if not all, health matters are placed under the purview of the Ministry of Health (MOH). In fact, the 2018 federal budget allocated for the MOH is the third highest after the Ministry of Education and Ministry of Finance, amounting to RM26.6bil. From 2010 to 2018, the MOH received increments in budget amount almost every year, except in 2016 (Figure 4). The proportion of MOH allocation over the total federal budget stands at 9.5%, which is the highest since 2008.
However, most of the budget allocation goes to the operation expenditure, from 75.7% in 2010 to 93.1% in 2018. As a direct outcome, the amount and percentage share allocated for development has shrunk over the years, hitting the nadir in 2017 at merely 5.4%. This probably explains why there were few new additions and expansions of hospitals and health facilities, the MOH development budget being the primary constraint.
Figure 5 shows the operating expenditure allocation of the MOH by department. The bigger the portion of allocation a department receives, the more significant functions and priorities a particular department plays. The Medical Care department was allocated a lion’s share of 53%, followed by the Public Health department (19%).
From the National Health & Morbidity Survey 2015 study, the overall impression shows that Malaysians are satisfied using public hospital services (81% gave a “Good” or “Excellent” rating) (Figure 6). However, the major issues for public hospitals identified in the survey were: “Waiting time to see doctor”, where 21% of respondents gave “Poor”/”Very poor” ratings; and “Ability to ask for private room/share with less people” (15%) – the former indicates a shortfall of doctors, while the latter reveals insufficient physical capacity, e.g. beds and rooms, to accommodate some requests.