Rash Behari Bhattacharjee
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August 13, 2019 09:36 am +08
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The Edge Financial Daily
KUALA LUMPUR: Spending on public health must increase significantly to meet the strong growth in demand for treatment, but budget constraint poses a formidable challenge for the expected delivery of health services, says a health policy analyst.
While the ministry of health (MoH) wishes to gradually increase its budget from the current RM29 billion, representing 2.2% of gross domestic product (GDP) to RM79.1 billion, or 4% of GDP in 2023, the increase in its allocation under the federal budget is likely to look much flatter (see figure 1 — 4% GDP growth of MoH budget).
As for the rising demand for public healthcare services, this is clearly seen in attendance figures at public hospitals and health ministry facilities, says Penang Institute senior analyst Dr Lim Chee Han.
For the 2008-17 period, the ministry’s records showed that attendance escalated by 86.4% at these hospitals and facilities, he said at the People’s Health Forum Roundtable on Healthcare Financing last Wednesday (see figure 2 — % growth rate in public healthcare sector).
“Public healthcare supplies and facilities are struggling to meet the rising demand,” said Lim.
MoH data showed while utilisation of health services had grown strongly during the period, the supply of facilities had lagged behind, he said.
Between 2008 and 2017, the number of public hospitals grew by 7.7%, beds 12% and health clinics and community clinics by 5.6%, said Lim.
The government’s budget constraint is seen in the health ministry’s expenditure on medicine from 2008-17, increasing modestly from RM1.5 billion in 2008 to RM2.38 billion in 2017.
In percentage terms, expenditure fell 7.13% year-on-year (y-o-y) in 2009, 2.58% in 2015 and 9.28% in 2016. However, in 2017, procurement rose by 13.05% (see figure 3 — MoH medicine expenditure 2008-17).
Against this backdrop, the question arises whether it is feasible for the Pakatan Harapan coalition to deliver on its election promise of increasing the MoH’s budget to 4% of GDP by the end of its first term in government, Lim asks.
Comparing the MoH’s proposed budget of RM79.09 billion in 2023 to the projected allocation under the status quo, Lim shows that the ministry’s targeted sum would take up 20.4% of the federal budget in that year, rather than a likely 9.7% or RM37.41 billion.
To address the constraint on the MoH’s allocation for development expenditure, Lim proposes that 40% of the ministry’s budget allocation be earmarked for development expenditure y-o-y (see figure 4 — A proposal to address the shortage of development expenditure).
This would make additional funding available for hospital facilities, new hospitals, restructuring, upgrading and repairs, as well as information technology and communications facilities, said Lim.
Another speaker, Dr Rozita Halina Hussein, MoH senior deputy director of planning, noted that the public health sector had to deal with a rising number of chronic and complicated cases, while private health facilities saw a proportionally larger share of acute, self-limiting conditions.
This pointed to a need to relook the allocation of funding for health education as compared to that for treatment. More emphasis is needed on measures to prevent the incidence of non-communicable diseases, she said.
The roundtable, held at the Faculty of Economics and Administration, Universiti Malaya, was the second in a series of four that are being organised by the People’s Health Forum, an advocacy group of non-governmental organisations and individuals promoting universal healthcare as a basic right.
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