Social Health Insurance is not a panacea for Malaysia's ailing healthcare system (unedited article)

The public health sector is underfunded, overstretched in terms of resources and manpower, and has been in this chronic state for a long time serving the majority of the Malaysian population.

Despite annual budget increases,  allocations to the Ministry of Health (MOH) have never exceeded 10.5% of the federal budget in the past two decades, exacerbating the strain on public health services. The government's revenue collection, a mere 16.4% of GDP in 2022, pales in comparison to the escalating federal debt.

Advocates of health financing reform argue that a shift to social health insurance (SHI) is imperative, given their scepticism about the federal government's ability to adequately prioritise and fund public health. The idea has gained traction with the recent renewed interest of discussions on a national health insurance system, and the Health White Paper tabled in Parliament in June this year also strongly hints at an insurance-based system, using terms such as strategic purchaser, benefit packages, progressive contributory scheme and the establishment of a health fund.

While SHI could potentially boost the health fund beyond MOH allocations, there are concerns about its cost-effectiveness and societal impact on public health and employment. If a country is like the United States, where people have to pay for their own health care through private health insurance and out-of-pocket spending, then SHI would be a big improvement for them. But Malaysia's current tax-based system ensures heavily subsidised healthcare based on entitlement, as simple as showing an ID card, with no other bureaucratic hurdles.

In an insurance-based system, the patient would be asked whether he or she is enrolled in the system, whether the premium has been paid, whether the service required is included in the package of benefits subscribed to, or whether any 'top-up' is required to enjoy 'more premium' health services in the private sector.

The SHI model would differ from the private health insurance model in that the SHI would be more inclusive, as it would assess community risk and not exclude people on the basis of their pre-existing medical history. However, unlike SHI, the current public health system does not require the government to spend money on additional staff to do the administrative work and campaigning to enrol people, collect premium payments and verify or underwrite medical claims from different service providers. 

According to a widely cited 2009 World Bank study, there is a 3-4% increase in per capita health spending when a country shifts from tax-based to SHI financing BUT without a corresponding improvement in health outcomes. The additional administrative costs alone are the main cause of the increase.

To put this in context, if we were to achieve the 5% of GDP public funding target for health as outlined in the Health White Paper, this means that the Health Fund would have RM78 billion to operate in 2021, of which RM58.5 billion would be for the provision of health services.

Imagine that 3% of the efficiency loss due to additional hiring of administrative staff would be a sum of RM1.8 billion that could otherwise be better spent on other health operations or development purposes.

Health fund board members and decision-makers would face intense lobbying and negotiation from the private sector. Looking at the recent history of the Covid-19 health fund's dealings with the private sector, one can only be more pessimistic about getting a fair deal and reducing costs for the public. Recently, the government couldn't even fend off vested lobbies from the tobacco and vape industries (on the Tobacco Control Bill) and private hospitals and clinics (on the mandatory drug price display policy).

Let's say the government pays for all members of the B40 household and automatically enrols them all, and all other non-B40 employees and workers have to fill the funding gap after taking into account the government's allocation, which would mean an average premium of RM224 per month or RM2688 per year, would the M40 household in particular be happy with such an additional tax-like levy on the public health service they currently enjoy?

For SHI to be more efficient, enrollment and premium collection from employees and employers is common practice. The World Bank study also found that a shift to SHI would reduce the formal sector's share of employment by 8-10%, meaning that some employers would resort to casualising certain positions to part-time or short-term contracts in order to avoid contributing to their employees' compulsory health insurance. Once again, M40 workers would be most likely the victims.

What would happen to the dynamics of healthcare consumption if there were a large shift in demand for health care to the private sector, as permitted by the SHI system, and what would happen to the funding of public hospitals in smaller towns and rural areas? Can the SHI really be realistically trusted to keep health care costs down if more and more of the population shifts to using the services of the profit-driven private health care sector? Think again.

Submission by the Consumers Association of Penang (CAP) on the Implementation of Mandatory Sale Price Display for Medicines (7 Nov 2023)

Submission by the Consumers Association of Penang (CAP) on the Implementation of Mandatory Sale Price Display for Medicines

For a long time, CAP and many other consumer groups have been calling for the mandatory display of the selling price of medicines sold in all healthcare facilities. 

We are pleased that this policy will finally be implemented, as it has been extremely unfair to consumers and patients when certain types of healthcare facilities, such as private clinics and hospitals, have been allowed to practise non-upfront price disclosure to consumers. 

The Medicines Price Monitoring Survey in Malaysia 2017 and 2020 have repeatedly found that medicines sold in private clinics and hospitals are among the most expensive. We believe that there is a causal link between the current practice of non-upfront price disclosure and high mark up. In 2020, the median markup rate for originator and generic drugs in private hospitals with inpatient facilities was 117.1% and 233.5%, respectively, while in private clinics it was 45.8% and 142.3%, respectively.

We believe that the market can only work well for society if there is price competition, comprehensive and accurate information, adequate and timely supply (of medicines) and consumers (patients) can make informed choices. This is not the case in the current pricing situation in private clinics and hospitals.

We are puzzled as to what makes medicines so special that for such a long time these manufactured goods have been given special treatment for retailers not to display prices, while we do not know of any other manufactured goods that have 'enjoyed' such a similar status. At a time when even most services in the commercial world display prices, we do not understand why private clinics and hospitals cannot do the same. 

Technically, it is certainly no excuse that they cannot produce a comprehensive list of medicines for price display, even digital ones would do. In addition the prices of their other non-medical products and services have not even been included in any price regulation policy discussion. Why is it not a technical problem? Because the APHM and MMA claim that their members have long practised detailed billing or are able to provide a price breakdown on request for a detailed receipt. This shows that all the price information is already in the system, so there is no reason for APHM and MMA to not display the prices up front? 

Detailed billing is only what consumers expect, it is not the full picture of price transparency. For example, if price display is not mandatory, would a consumer be willing to go into a restaurant without the price of the food being displayed and only get the detailed bill later when you pay? Pricing is the first fundamental step in consumer protection, both sides have to agree on a price BEFORE the transaction takes place, before it can be called fair.

No one would call a price list in a restaurant menu a form of advertising, it goes against the basic understanding of advertising. The concern of some health professionals expressed in the consultation on 2 November has no basis or logic .

In most cases, the practice of not displaying prices would conceal profiteering conduct , as government agencies and consumers can only prove profiteering if previous prices and dates are known. As a consumer group CAP strongly supports that medicines should not be treated differently from other market products when it comes to price display and transparency.

During the 2 November consultation, a representative of a private hospital claimed that there are situations, for example in an emergency, where only the in-patients know which medicines are used to treat them, price labelling at the bedside will make no difference. This is a very misleading argument that ignores many other scenarios where patients do have time to plan and decide where to go for treatment and where to buy medicines. 

Some argue that medicines are only one part of the total cost of healthcare, so why focus on that? We urge them to look at cancer medicines in particular, where the patients concerned face financial catastrophe, such medicines are not 'only a part' of the total cost of treatment.

Also, with the price display mechanism in place, effective and convenient price comparison is possible, and this would put the onus on retailers not to set an exorbitant price (and hope that patients will foot the bill afterwards) and let the market moderate the range and let consumers make an informed decision with the available price information. 

Community pharmacies are unhappy with the practice of price dumping of medical products by the large chain pharmacies, and we believe that with the mandatory price display mechanism, this kind of market behaviour would be easily exposed and tantamount to anti-competitive practices, and would be subject to investigation by the Malaysian Competition Commission. Consumers may choose convenience and familiarity over a small difference in the price of medicines, similar to other commercial products sold by the local community. 

The mandatory price display mechanism and policy is truly long overdue but a fundamental element for fair market competition and consumer protection. We firmly believe that this policy is non-negotiable and will definitely be an effective market intervention to moderate excessive profits and predatory pricing by private clinics and hospitals. 

This policy is one of the most basic and achievable to meet the expectation of the National Medicines Policy (DUNAS) where it explicitly states that there is a need for a medicine pricing mechanism across the public and private sectors to ensure reasonable and affordable pricing, price transparency and that the cost of medicines will not be the barrier to access to medicines for the rakyat.

Statement made in a public consultation session on the Medicine Price Display mechanism (2 Nov 2023)

Statement by Dr. Lim Chee Han, Consumers Association of Penang and Third World Network

2 Nov 2023

Sesi Libat Urus Bersama Pihak Fasiliti Kesihatan Swasta, Farmasi Komuniti, Penyedia Insurans dan Pengguna Tahun 2023

Selamat pagi saya ucapkan kepada pengerusi majlis KSU YBhg. Dato’ Seri Ir. Dr. Zaini bin Ujang dan pembentang Puan Fatkhiah binti Haji Khalil Timbalan Pengarah Bahagian Amalan dan Perkembangan Farmasi. 

Hari ini saya mewakili persatuan Pengguna Pulau Pinang (Consumers Association of Penang) dan Third World Network untuk memberi pandangan mengenai cadangan mekanisme sebentar tadi. Memorandum bertulis saya akan dihantarkan kepada KKM nanti dengan maklumat terperinci dan data terkini. Saya seorang penyelidik dasar polisi yang telah lama mengambil berat terhadap harga ubatan, saya pun melibatkan diri dalam gabungan People’s Health Forum dan persatuan pesakit barah (Together Against Cancer). Dengan izin, saya akan teruskan ucapan saya dalam Bahasa Inggeris.

First of all, I would like to congratulate the MOH for the genuine and persistent effort to consult and engage with multi-stakeholders from the very beginning of the policy proposal on the Medicines Price Regulation Mechanism, all the way back to 2019. 

It is probably one of the best consultation processes our organisations have seen - the MOH has genuinely practised inclusivity, including the voices not only of the manufacturers and service providers who have the intention to 'sell' their products, but also of the end users, consumer groups and patient groups who have to pay for these products in order to survive or live a better quality of life. 

In every stakeholder engagement, I see the MOH leading the way in rationality and evidence-based approach. They were transparent in  the first cost-benefit analysis CBA 1.0 study conducted by the Malaysia Productivity Corporation (MPC). The study has many limitations, and MPC and MOH acknowledged the data gaps due to the industry's refusal to be transparent about prices. But the study itself at least had a credible analysis. 

However, the second CBA was funded, sponsored and essentially directed by PhAMA, with the technical committee even co-chaired by a senior member of PhAMA itself, showing a blatant conflict of interest, so it is not surprising to see the big negative results of the study - Imagine the tobacco and vape industry giving advice and technical guidance on smoking policy, how good can the policy be for public health and public interest, especially the affected groups and community? 

It is worth noting that the second industry-led CBA Steering Committee was chaired by MITI, not MOH. To date, there has been no official acknowledgement and announcement of who is the so-called independent third party consultant behind the second CBA and the full study report is not publicly available. There is nothing more ridiculous than the fact that the study claimed to have consulted patient groups, but we later found out that the patients they interviewed were from industry’s own patient assistance programme. How can these patients who benefit from PhAMA reflect the majority of patients out there? 

There are many flaws that we found in the second study, which we had submitted in a detailed response. However, the industry and vested interests continue to use the results of this CBA study to pressure the government to withhold or withdraw this Medicines price regulation mechanism policy.

On behalf of the public interest and patient groups I must express my strong disappointment at the compromise and delayed implementation of the MOH’s  policy due to industry pressure. Many lives have been lost, I personally also know a few cases, that many have died because they were unable to afford the most effective cancer medicines, and the fact that many thousands are impoverished by the unreasonably high price of medicines due to the monopolistic market prices set by patent holders and then exorbitant mark-ups by service providers and retailers. 

We are very disappointed that  the policy has been compromised at the expense of the very community, the patients, that the industry claims to be benefiting. Shame on the industry for their uncompetitive and unfair market practices and their unchecked excessive profits, which are causing suffering to many patients. 

The MOH’s medicines price regulation policy actually starts modestly , and it is not the conventional type of price control, but a control mechanism on the maximum markup for the single-source products, up to 30% markup allowance, depending on the initial price of the product. These products represent only a small segment of the total pharmaceutical market, and it is not as if retailers and the supply chain cannot make profits from the mark-up. It is the excessive mark-up profits that the government and the patient groups concerned want to curb and control. 

I would like to point out that the 12th Malaysia Plan, Strategy B2, "Ensuring Financial Sustainability for Healthcare" explicitly states: "A price control mechanism for medicines will be introduced to protect consumers from unfair pricing" (page 4-22). The government is clearly aware of the problem and is trying to address the issue of drug prices. This must be done in the public interest; the government has a duty to protect the most vulnerable and affected community, not to help industry players maintain their excessive or even obscene profits at the expense of patients.

Ideally, a truly competitive market would help solve the problem of availability and affordability of life-saving and life-enhancing products. The 2017 MyCC Market Review report on the pharmaceutical sector clearly shows that this sector is not a free and truly competitive market due to patent laws and flawed practices in granting some patents, which give the patent holders a monopoly over the products for a long period of time. Price regulation is therefore an essential countermeasure to protect the interests of consumers and patients. 

The industry must first comply with the price transparency mechanism presented today. The government cannot compromise further on this. We urge the government to go back to the original modest proposal of controlling the mark-up on single-source products. Even this may not be enough for many patients, but it is the bare minimum that our patient and consumer groups would expect from this medicines pricing policy.

Thank you very much.

Consider This: Social Health Insurance — Weighing the Options (9 Nov 2023)

Description from Astro Awani:

The government is exploring a new healthcare financing model, shifting away from the present tax-based financing and potentially into a social health insurance scheme. Is this the best option for Malaysia to sustainably fund our healthcare sector? On this episode of #ConsiderThis Melisa Idris speaks to Special Advisor to the Minister of Health, Dr Kelvin Yii, and Dr Lim Chee Han from the Third World Network.

藥品強制展示標價政策符合大眾利益

 

強制價格展示機制和政策確實已遲來，但卻是市場公平競爭和消費者保護的基本要素。我堅信，這項政策不容討價還價，必將有效地管制市場的反競爭行為，抑制私人診所和醫院的暴利和掠奪性定價。醫藥行業必須首先接受和遵守政府這次提出的藥品強制標價機制。在這一點上，政府不能再妥協了。我敦促政府回到最初的政策倡議，即控制單一來源（市場壟斷）藥品的加價。即使這對許多患者來說或許也是不太足夠，但這已是患者和消費者團體對藥品定價政策的最低期望。

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【文／林志翰】

不曉得你會否曾有困惑、不滿或不解，為何在私人診所和醫院，藥品價錢通常要等到結單的時候才知道，又或者需要特別先洽詢？為何私人醫療機構業者不能如藥劑店或其他商品和服務項目業者展示標價，這樣的安排和設計合理嗎？

作者代表消費人協會和癌癥病患協會日前出席政府針對實施藥品強制展示標價政策的公開咨詢會，在場聽到許多業者和協會的強烈反對，而有所感慨。長期以來，許多其他消費者團體一直呼籲所有醫療設施必須強制展示藥品售價。這項政策終於得以實施是一個大好消息，因為私人診所和醫院一直被默許不向消費者公開價格，這對消費者和病患來說是極不公平的。

馬來西亞二〇一七年和二〇二〇年藥品價格監測調查報告多次發現，私人診所和醫院出售的藥品是最昂貴的。我認為，目前不預告價格的做法與高加價（mark up）之間存在因果關係。在二〇二〇年，在設有住院設施的私人醫院，原廠藥和仿製藥的加價率中位數（median）分別為 117.1%和 233.5%，而私人診所則分別為 45.8%和 142.3%。

消費者團體一般認為，只有在價格競爭、信息全面且準確、（藥品）供應充足與及時、消費者（病患）能夠做出知情選擇的情況下，市場才能為社會發揮良好作用。而目前私人診所和醫院的藥品定價情況並非如此。

藥物並無特殊地位

我感到困惑的是，藥品為何如此特殊，以至於長期以來，這些藥品一直享有零售商不需展示價格的特殊待遇。而我卻不知有任何其他製成品「享有」類似的地位。當市場上大多數服務項目都展示價格的時候，我不明白為何私人診所和醫院不能這樣做。

技術上而言，私人醫療業者說不能提供一份全面的藥品價格清單，即使是數碼清單也不行，這肯定是個借口。為何說這非關技術問題？因為大馬私人醫院協會（APHM） 和大馬醫藥協會（MMA）聲稱其會員長期以來一直提供詳細賬單，或者能夠在病人要求下領取詳細收據時提供價格明細。這表示所有價格資料已在系統內，APHM 和 MMA 沒有理由不能預先展示價錢？

詳細賬單只是消費者的一般正常期望，這並不是價格透明（price transparency）全貌的依據。舉例說，若不強制要求展示價格，那麽消費者是否願意進入一家不展示菜價的餐館，而在付款時才拿到詳細賬單呢？定價是消費者權益保護的第一步，買賣雙方必須在交易前就貨品或服務價格達成一致協議，才能稱得上公平。

沒有人會把餐館菜單上的價格表稱為廣告，這樣的說法違背了一般人對廣告的基本理解。一些私人醫療業者在公開咨詢會中表達這政策會違反醫藥廣告規定的擔憂是沒有道理和邏輯的。

很多時候，不展示價格的做法會掩蓋牟取暴利的行為，因為只有在知道過去的價格，並且了解資料來源日期的情況下比較，政府機構和消費者才能舉報和證明該商家有牟取暴利的行為。作為一個消費者團體代表，我強烈支持在價格展示和透明度方面，不應將藥品與其他產品區別對待。

在同場的公開咨詢會上，一家私人醫院代表聲稱，在某些情況下，例如在急診中，病人入院時才知道治療他們的藥物。因此，在床邊貼上價格標簽也不會有任何區別。這個說法非常誤導人，因為該代表忽略了許多其他情況下，病人確實有時間規劃和決定去哪裡治療和去哪裡買藥品。如此，病人才能貨比三家，不會對不正確的選擇，造成重大的財務後果。

讓市場調節價格幅度

有些業者認為，藥品只是治療總成本的一部分，為何要把重點放在藥品呢？我敦促他們特別關註癌癥藥物。癌癥患者往往因購買有效藥物而面臨財政災難，這些藥物並不「只是」總治療費用的一部分。

同時，有了價格展示機制，消費者和病人就可以有效和方便地查詢和比較價格，這將使藥品零售商有責任不再制定過高的價格，並且希望病人能事後買單。而這將讓市場來調節價格幅度，並讓消費者根據現有的價格信息做出明智的決定。

社區藥店對大型連鎖藥店的醫藥產品價格傾銷行為感到不滿。我相信，在強制價格展示機制下，這種市場行為很容易被揭露，等同於反競爭行為，會受到馬來西亞競爭委員會的調查和制裁。其實，消費者更可能會選擇方便和熟悉的當地社區小藥房，而不會因為價格上的小差異而棄之遠去。這情況與當地社區銷售的其他商業產品類似。

私人醫療業者和藥廠等既得利益集團持續性向政府施壓，要求暫停或撤銷藥品價格監管機制政策，而自從二〇一九年衛生部的政策因這些利益集團的壓力而一再延遲、讓步和妥協。對此，我深感失望。許多生命已經逝去，我個人也認識一些已逝世的病患例子。許多人因為買不起最有效的癌癥藥物而死亡，還有成千上萬的人因為專利持有者制定的壟斷性市場價格以及供應商和零售商的高昂加價，而導致不合理的高藥價而陷入貧困。

我感到最不忿的是，這些業者聲稱他們在乎病患群體要讓後者受益。但最後到頭來患者的利益卻受到損害和不公平對待。缺乏競爭力和不公平的市場行為以及不受約束的暴利給許多患者帶來了痛苦，這些業者的行為是可恥的。

強制價格展示機制和政策確實已遲來，但卻是市場公平競爭和消費者保護的基本要素。我堅信，這項政策不容討價還價，必將有效地管制市場的反競爭行為，抑制私人診所和醫院的暴利和掠奪性定價。

這項政策是國家藥品政策（DUNAS）裡的最基本和可實現的政策之一。國家藥品政策明確指出，有必要在公共和私營領域建立藥品定價機制，以確保合理和負擔得起的定價、價格透明度以及藥品成本不會成為人民得到治療的障礙。

醫藥行業必須首先接受和遵守政府這次提出的藥品強制標價機制。在這一點上，政府不能再妥協了。我敦促政府回到最初的政策倡議，即控制單一來源（市場壟斷）藥品的加價。即使這對許多患者來說或許也是不太足夠，但這已是患者和消費者團體對藥品定價政策的最低期望。

原文鏈接：https://contemporary-review.com.my/2023/11/07/1-554/

政府支持中小微型企业的理性政策基础

您是否在中小微型企业（MSMEs）工作？很有可能，因为大约有一半的雇用人口──即48.2%的总就业人口，是由这些中小微型企业创造工作机会的。但在2022年，中小微型企业在马来西亚的国内生产总值（GDP）中仅占据了38.4%，出口额也只有10.5%。政府一般认为这在劳动生产率方面不理想，并期望中小微型企业能做得更多更好。 

当然，在这117万家中小微型企业中，必然有一部分企业希望挑战自我，力图超越中小型企业规模发展至大企业或上市公司，但事实上更多的企业却在为生存而挣扎。这就是市场需求对创业精神的残酷考验。

中小微型企业与外国联营公司（Foreign Affiliates，由外国投资者作为大股东控制的公司）在业绩表现上存著显著的差距，这差距应归因于后者的雄厚资本和进步技术以及广阔的全球供应网络所带来的优势，这些优势尤其在跨国公司中显而易见。

在我国，虽然外国联营公司仅有2087家，却在2021年占据了GDP的17.7%。中小微型企业在2022年仍未恢复到2019年或者说是疫情发生前的GDP水平，而外国联营公司却早已在2021年迅速反弹至疫情前的水平。

让我们来探讨并对比一下制造业。在2021年，中小微型企业雇佣的员工人数几乎是外国联营公司的四倍，然而，就GDP产值而言，外资联营公司仍然居于领先地位，占该领域GDP的36.8%，比中小微型企业多出2.2%或80亿令吉。若政府注重中小微型企业的产量和出口表现，那么制造业领域里的中小微型企业将是政府应当合作的对象。 

副财长务实和敏锐

财政部第二副部长沈志强上周表示，政府将在2024财政预算案中重点关注中小型企业，这是一件令人欣喜的事情。许多政治人物更关心的似乎是国家吸引外国直接投资（FDI）的能力，然而沈志强却意识到，国内直接投资（DDI）才是国家经济发展的重要组成部分，尤其是来自中小型企业的投资。

这说明了沈志强副部长的务实态度和敏锐观察力。他关注中小型企业，认为这些企业需要来自各方的大力支持，尤其是政府的扶持。他进而宣称，政府将致力于帮助该行业实现可持续发展，以推动国家经济增长。毕竟许多企业在几年前的疫情中受到了严重打击。 

政府对中小微型企业的关注十分合理，因为它们雇佣了半数劳动力。因此，政府必须明白，如果中小微型企业运营良好，那么劳动力人口便可以获得更稳定的工作和拥有更良好的前景。这样一来，才能吸引并留住人才，从而推动公司的业绩更上一层楼。

消除贫穷、关注劳动工资

首相兼财政部长安华对即将由团结政府发布的第二份财政预算案作出了承诺，表示2024年的预算案将重点关注中小微型企业。他强调，政府正努力推动创业发展，将其视为消除贫困的重要政策之一。这是基于一个假设，即中小微型企业能够创造更多就业机会，从而雇佣贫困家庭的成员，并在最低工资保障下为他们提供更为稳定的收入。

政府也提出了一项累进工资计划（Progressive wage scheme），迄今为止，这已公开给私营机构自愿采纳。该计划是以激励表现（incentive）为基础，以及与生产力水平相挂钩。

或许政府已意识到，劳动工资占国内生产总值的比重偏低，仅为32.4%，这是导致许多家庭陷入经济困境的一个重要问题。对于本地社区经济发展，这并不是一个积极正面的现象，因为消费者没有过多的可支配收入。那么，试问如果当地民众的购买力没有增强，我们应该如何扶持中小微型企业呢？

创业的知识和技能极其宝贵，因为并非所有的中小微型企业管理者都接受过这方面的系统培训。许多中小微型企业经常将“现金流”问题视为经营难题；但若他们不知道如何妥善处理财务问题，还可能因为看不透市场需求低迷而生存困难，那么政府提供再多的企业贷款也无济于事。

数码科技优化业务势在必行

另一方面，中小微型企业已经开始采用数码科技来优化业务，尤其是在行政和营销方面。许多企业已转向使用电子银行/电子商务、会计以及销售点（POS）软件。这些数码服务面对高度的市场竞争，即使是中小微型企业也应该能负担得起。大多数中小微型企业更倾向于将更多的预算投入数码营销上，尤其是社交媒体平台，而减少在报纸或广告看板等传统实体广告上的投入。

中小微型制造业企业面临的另一个挑战是运营──它们的员工往往更多地从事体力劳动，这与外国联营公司的情况不同，后者常掌握资金投入到最新的尖端技术如设备和机器上，以提高生产效率。许多现代设备通过电子传感器优化操作，从而减少人为错误，而且相比于手工劳动，它能减轻工人的疲劳。因此，中小微型制造业企业可能需要在新技术的资本投入上获得帮助以提高效率。

随著2024年财政预算案即将来临，政府既然已对中小微型企业作出了承诺，且让我们拭目以待那些将帮助中小微型企业发展的政策与措施。

刊登于《東方日報》《群議良策》專欄2023年10月11日 

東方臉書鏈接

Government's sensibility to support MSMEs (Unedited article)

 Are you employed by one of the micro, small and medium enterprises (MSMEs)? The chances are probably 1 in 2 - about 48.2% of total employment is contributed by MSMEs. However, MSMEs account for only 38.4% of Malaysia's GDP and 10.5% of exports in 2022. Policymakers often see this as less than ideal in terms of labour productivity and challenge them to do more.

Surely, among the 1.17 million MSME establishments, there must be companies that would like to challenge themselves to grow beyond small and medium size, but many more are struggling to survive, which is the harsh reality of entrepreneurship subject to market demand.

There is a gulf in performance when comparing MSMEs with foreign affiliates (companies controlled by foreign investors as majority shareholders), which should show what capital and technological advances as well as an extensive global supply network can do for companies, especially multinationals. Foreign affiliates have only 2087 establishments in Malaysia, but already contributed 17.7% of GDP in 2021. MSMEs have not yet recovered to their 2019 or pre-pandemic GDP levels in 2022, but foreign affiliates have done so quickly in 2021.

Let's examine and compare the manufacturing sector. In 2021, MSMEs employed and engaged almost 4 times more workers than foreign affiliates, but in terms of GDP output, foreign affiliates come out on top, contributing 36.8% of sectoral GDP, 2.2% or RM8 billion more than MSMEs. If the government is concerned about MSME output and export performance, this is the sector the government can work with.

It's good to know that the government will focus on SMEs in Budget 2024, according to Deputy Finance Minister II Steven Sim. More often than not, many politicians seem more concerned with highlighting the country's ability to attract foreign direct investment (FDI). Recognising domestic direct investment (DDI) as an important component of the country's economic development, especially that which comes from the SME sector, shows the Deputy Minister's practicality and sensibility. Sim's concern for SMEs is also evident in his comment that the sector needs a lot of support from various parties, especially from the government. He said the government would help make the sector more sustainable for the country's economic growth, as many businesses were hit hard by the pandemic years ago.

It makes sense for the government to look at MSMEs, because they employ half the workforce, so the government should know that if MSMEs are doing well, then the working population will have more stable jobs and better prospects. Then the talent can be retained, taking the companies to higher levels of performance.

Prime Minister and Finance Minister Anwar Ibrahim had also made the pledge about the unity government's upcoming second national budget, saying that Budget 2024 would focus on MSMEs. He pointed to the government's efforts to promote entrepreneurship as one of the ways to end poverty, presumably on the assumption that job creation by MSMEs would hire from poor households, giving them a more stable income with the guarantee of a minimum wage.

The government has also proposed a progressive wage scheme, so far voluntarily adopted by private sector entrepreneurs, which Anwar says is incentive-based and linked to productivity levels. Perhaps the government has realised that the low contribution of labour wages to GDP, at 32.4 per cent, is a problem that leaves many households in financial difficulty, which does not bode well for the local economy as they do not have much disposable income. So how can we help MSMEs if local people do not have more purchasing power?

Entrepreneurship knowledge and skills can be valuable, as not all MSME managers are well trained in this area. MSMEs often cite 'cash flow' as a problem for their business; the government SME loan may not help if the MSME does not know how to manage its financial problem and may find that its business is not viable due to poor market demand.

It is also safe to say that the adoption of digital solutions for MSMEs is already underway, mostly in terms of administration and marketing, many have turned to e-banking/e-commerce, accounting and point-of-sale (POS) software. These services can be competitive and are now more affordable even for MSMEs. Most MSMEs would prefer to allocate more budget to digital marketing, especially on social media platforms, and less to physical advertising such as newspapers or billboards.

Another hurdle for MSMEs in the manufacturing sector is operations - they tend to have more workers to do the manual labour and, unlike their foreign counterparts, have the capital to invest in the latest cutting-edge technology such as equipment and machinery to produce more efficiently. Many of the modern machines can optimise the operation through electronic sensors, thus reducing human error, and workers may be less tired compared to the manual work they used to do. MSMEs in the manufacturing sector may need a helping hand in capital investing in new technology.

With the government's promises to the MSME sector in Budget 2024, let's look forward to the measures to help MSMEs.

Government right to support MSMEs

 

Chances are you are employed at a micro-, small- or medium-sized enterprise (MSME). Data show that MSMEs hire about 48.2% of the working population in Malaysia.

However, MSMEs accounted for only 38.4% of the GDP and 10.5% of exports in 2022. Policymakers see this as less than ideal in terms of labour productivity.

Among the 1.17 million MSMEs in the country, there must be some companies that would like to challenge themselves to grow, but many more are struggling to survive, which is the harsh reality of entrepreneurship subject to market demand.

There is a gulf between the performance of local MSMEs and their foreign affiliates (companies with foreign investors as majority shareholders), which show what a large capital, technological advancements, and an extensive global supply network can do for companies.

Foreign affiliates have only 2,087 establishments in Malaysia but contributed 17.7% of GDP in 2021. Local MSMEs have yet to return to their pre-pandemic GDP levels in 2022 but foreign affiliates had done so quickly in 2021.

In 2021, MSMEs employed nearly four times as many workers as foreign affiliates in the manufacturing sector. However, in terms of GDP output, foreign affiliates outperformed MSMEs, contributing 36.8% of sectoral GDP, which is 2.2% or RM8 billion more than what local MSMEs contributed.

If the government is concerned about MSME output and export performance, this is the sector where the government can focus its efforts.

It’s good to know that the government will prioritise SMEs in Budget 2024, as announced by Deputy Finance Minister II Steven Sim. Often, politicians seem more preoccupied with foreign direct investment.

The deputy minister showed practicality and sensibility in recognising domestic direct investment, particularly in the SME sector, as a crucial component of the country’s economic development.

Sim’s concern for SMEs is also evident in his statement that the sector requires significant support, especially from the government. He emphasised that the government would help make the sector more sustainable for the country’s economic growth, given the challenges many businesses faced due to the pandemic in recent years.

It makes sense for the government to focus on MSMEs because they employ half of the workforce. Therefore, the government should understand that if MSMEs thrive, the working population will have more stable jobs and better prospects. This, in turn, will enable talent retention and elevate companies to higher levels of performance.

Prime Minister Anwar Ibrahim, who is also the finance minister, has also pledged that next year’s national spending plans will have a significant focus on MSMEs. He has highlighted the government’s efforts to promote entrepreneurship as a means to alleviate poverty, assuming that job creation by MSMEs will provide stable incomes for poor households with a guaranteed minimum wage.

The government has also proposed a progressive wage scheme, which private sector entrepreneurs have voluntarily adopted. Anwar has stated that this scheme is incentive-based and linked to productivity levels.

Perhaps the government has realised that the low contribution of labour wages to GDP, at 32.4%, is a problem that leaves many households in financial difficulty. It does not bode well for the economy when households lack significant disposable income.

So, how can we help MSMEs in the face of a lack of purchasing power?

Entrepreneurship knowledge and skills can be valuable because not all MSME managers are well-trained in these areas.

MSMEs often cite “cash flow” as a problem for their business. A government loan may not be helpful if the MSME does not know how to manage its financial issues, potentially leading to an unviable business due to poor market demand.

It is worth noting that the adoption of digital solutions for MSMEs is already underway, particularly in terms of administration and marketing. Many have embraced e-commerce, accounting, and point-of-sale software. These services have become more competitive and affordable, even for MSMEs.

Most MSMEs would prefer to allocate more of their budget to digital marketing, especially on social media platforms, and less to physical advertising, such as newspapers or billboards.

Another challenge for MSMEs in the manufacturing sector is their operations. They tend to rely more on manual labour, unlike their foreign counterparts, who have the capital to invest in cutting-edge technology and machinery to enhance efficiency.

Many modern machines can optimise operations with electronic sensors, reducing human error,and making work less physically demanding for employees.

MSMEs in the manufacturing sector may require assistance in investment in new technology.

As the government is committed to boosting MSMEs in Budget 2024, we can look forward to aid and measures to elevate the sector.

175th article for Agora@TMI column, published on The Malaysian Insight, 9 Oct 2023 

从联邦直辖区历史看“吉隆坡回归雪州”倡议

 

上周，八打灵再也国会议员李健聪在国会参与第12大马计划中期检讨辩论时，大胆提出了一项建议，即让吉隆坡“回归”雪兰莪州，引起了公众议论纷纷。在他为时约两分钟的演说，健聪透露，这样做的目的是为了要让首都城市能摆脱土地发展限制，与雪州合并以产生经济协同效应。

这样，吉隆坡就可以继续以繁荣且可持续的方式发展，综合公共交通、提供可负担房屋，并统筹整个城市规划，使得吉隆坡可以与区域大都市如新加坡、印尼的雅加达和越南的河内竞争。另外，李健聪也认为此举将第二张选票还给吉隆坡居民，让他们能有代表参与雪州议会，并享受雪州政府提供的福利与津贴。

坦白说，我认为这是一个非常浪漫的想法。健聪认为这是可行的，或许在技术上是这样，但在现实操作中并非如此，即便当初1974年吉隆坡从雪兰莪州分离出来成为联邦直辖区也非易事。考虑是否应将吉隆坡重新并入雪州，我们就得回顾历史，理解为何吉隆坡需要被分离，其中涉及的因素和过程中的代价，皆值得参考。

当年吉隆坡分离最大的导因是1969年大选带来的震撼结果：联盟首次失去了国会的2/3议席，还有槟城（州政权易手）、雪兰莪及霹雳（悬峙议会）的多数议席，这都成为引发513种族冲突的导火线。当年，在野党民政党和民主行动党在雪州大有斩获，特别是在首都——也是雪州首府的吉隆坡（在8个州议席中赢了7席）。

联盟领袖担心，日后若雪州与联邦政权不同调，而吉隆坡又是雪州的首府，可能会引发政治纷争和僵局，从而影响甚至限制国家和首都吉隆坡的发展。再者，即使没有513事件，在马来亚独立初期，联邦政府和首相东姑阿都拉曼已意识到这个局面，早已有讨论和计划协助雪州迁移和建立新首府。

在1958年，联邦政府内阁批准拨款200万令吉给雪州政府，建议将巴生附近的581英亩园丘土地发展为新首府。可惜雪州政府不同意，他们认为该地山丘和斜坡过多，会大幅增加建筑成本，而且由于地点距离吉隆坡较远，不利于商务活动来往。后来，雪州政府选择了Sungai Renggam地区，也就是后来被称为莎阿南的地方，并计划通过建造联邦大道连接两地。

一个大都市的诞生

起草马来亚宪法的莱德委员会曾在1957年建议吉隆坡设为联邦政府能独立管理和施政的行政中心。因此，从1960年开始，联邦政府在吉隆坡市中心开始征地，并在同年通过联邦首都法案来落实这一任务。

513事件为联邦政府和雪州苏丹提供了一个方便的借口，以尽快完成吉隆坡土地分割事宜。然而在1970年，首相阿都拉萨积极拉拢在野党加入并扩大联盟（后来更名为国阵），已成功招揽了民政党和霹雳州的人民进步党，政治危机得以解除，按理说并不需要分割吉隆坡。

事实上，雪州苏丹对于割让吉隆坡一事不太乐意──毕竟，吉隆坡是我国的首座城市。原本市政局的管理范围有93平方公里，但到了1974年，割让转移到联邦直辖区的范围占地扩大到243平方公里。这版图增加的面积已预计了吉隆坡的未来发展，因此，在签署1974年联邦直辖区吉隆坡协议后，海峡时报隔天头条标题为：一个大都市（metropolis）的诞生。

原本联邦政府在1971年计划一并把八打灵也纳入吉隆坡，但遭到当地居民的强烈反对，其中的原因是吉隆坡的门牌税是八打灵的两倍。而州政府也不愿轻易把州内仅有的主要工业区拱手让人。在签署协议之前，当局至少召开了近百场会议和辩论，并接收了多份建议书、意见和方案。毕竟，当时这仍是个敏感且复杂的大课题，政府必须谨慎行事。

此外，值得注意的是，雪州苏丹当初开出的条件是联邦政府必须答应赔偿以资助迁移首府、建设新首府莎阿南的各种主要政府建筑和设施，如州政府大厦、州议会、莎阿南蓝顶大清真寺、图书馆等。联邦政府对州政府的赔偿有两种形式：（一）补偿州政府失去来自吉隆坡的收入，约为每年1830万令吉；（二）补偿州政府在吉隆坡内的建筑和产业，通过协商谈判，最终在1981年确定总值为35亿令吉，其中一大部分后来被用来资助莎阿南体育馆的建设。

因此，问题来了，若联邦政府现在要将吉隆坡归还给雪州，是要无偿转让，还是需要按照当初的条件，如考虑吉隆坡目前的收入和土地与资产的价值？雪州政府能否承担得起？2020年吉隆坡市政厅的收入约为20亿令吉，而雪州政府2023年预算案也仅预计20亿令吉收入。

地方投票权

回到健聪的提议，我认为地名如“雪隆”和“巴生谷”已在我国华社家喻户晓，基本上国人已不太过于关注区分雪州和吉隆坡。2010年推出的国家经济转型计划（Economic Transformation Programme，ETP）设定的国家主要经济区域（National Key Economic Area，NKEA）包括大吉隆坡区-巴生谷（Greater Kuala Lumpur/Klang Valley），并在2011年推出大吉隆坡区-巴生谷公共交通大蓝图，展望未来20年的规划。

这说明，跨州跨地方政府的区域性发展规划并非不可行，也不一定要将吉隆坡重新纳入雪州，才能改善公共交通和房屋供应情况。即使在所谓“精明雪州”倡议下，各个计划如公共巴士、地方基础设施和房屋建设依然存在不少问题，其效率和优越性并未超越吉隆坡市政厅的管理。

我绝对赞成吉隆坡居民应有地方投票权。既然希盟竞选宣言已承诺要率先举行吉隆坡市长选举，然后在吉隆坡推行地方选举选出市议员。我认为应优先实施这些，而不是复杂且难度极高的吉隆坡回归雪州方案。若吉隆坡能够成功做到，这将为全国各州恢复地方选举提供了一个良好范例，这难道不是更好、一举多得的政策选择吗？健聪，请继续在国会推动地方选举，加油！

刊登于《東方日報》《群議良策》專欄2023年9月20日 

東方臉書鏈接

主要參考資料來源：

An Anguish Cession: Issues during the Shaping of the Federal Territory of Kuala Lumpur, 1974

https://www.researchgate.net/publication/286702161_An_Anguish_Cession_Issues_during_the_Shaping_of_the_Federal_Territory_of_Kuala_Lumpur_1974

LENS: KL  Story time: The formation of the first Federal Territory, and then some…

https://www.thevibes.com/articles/culture/59902/story-time-the-formation-of-the-first-federal-territory-and-then-some

Reform electoral system for diversity of representation

 

Were the voters in the six state elections happy with the results? Did their vote produce the desired outcome?

Votes for the losing side did nothing more than contribute to the statistics. Those whose parties lost must have felt that their votes were “wasted”.

Due to malapportionment, urban seats such Kinrara and Subang Jaya have about six times more voters than Sabak Bernam, the smallest seat in Selangor. The landslide wins of by more than 50,000 votes in the two urban seats count for only two seats in the state assembly, so even the voters on the winning side would feel that their votes were heavily diluted.

Malaysia’s first-past-the-post (FPTP) electoral system has many weaknesses and is increasingly out of step with the diversity of voices in a democracy.

Because of its “winner takes all” design, it is not equitable for voters who wish to express and translate their support for specific political parties or candidates into representation in the state assembly. Consequently, it does not uphold the fundamental principles of electoral democracy, which include the notion of “one person, one vote, one value,” for equitable outcomes.

Most notably, I believe the suppression of third parties and alternative voices is particularly concerning as the system consistently encourages tactical voting, where voters are prompted to select the side most likely to win.

Hence, the election results often fail to reflect the true extent of support for third parties and alternative candidates, as they would in a proportional electoral system.

Election campaigns often see the two main coalition parties vilifying each other and instilling fear among their target constituencies.

Perikatan Nasional exploited the concerns of Malay-Muslims about losing power to the DAP-led coalition of Pakatan Harapan (PH), which propagated fearmongering among non-Malay communities regarding the “green wave.”

This left voters feeling disconnected and despondent – and confronted with the challenging decision of choosing the “lesser of two evils”.

The two major coalitions, especially PH and its supporters, would accuse third parties such as Muda and Parti Sosialis Malaysia (PSM) of splitting the votes.

Such statements are undemocratic and show disrespect for the voters’ rights and desire for alternative representation.

Due to the prevalence of tactical voting and fear-mongering, the number of votes for Muda and PSM in the recent state elections may not accurately reflect the level of support for the two parties.

In the recent Selangor elections, Muda and PSM secured a median of 3.45% and 2.15% of the vote, respectively, in the seats they contested.

Although they did not win any of the seats and forfeited their deposits (the threshold being 12.5%), the electoral pact won a total of 34,009 votes across 18 seats. Their vote share also exceeded the median of other third parties (1%), independents (1.2%), and spoiled votes (0.5%).

Hence, Muda and PSM effectively constituted the third political force.

Contrary to some beliefs, there was a weak but statistically significant positive correlation between the vote share of Muda-PSM and that of PH-Umno. In other words, the trend suggests that Muda-PSM received more votes and performed slightly better in traditional PH strongholds.

Instead of acting as “spoilers,” Muda-PSM were shown to be drawing votes away from PH’s primary opponent and stood poised to replace PN as the second-largest party in those constituencies.

It is true that in the two constituencies (Dengkil and Sungai Kandis) that transitioned from PH to PN-Bersatu, PSM and Muda received more votes than the margin of victory.

However, it would be presumptuous to claim these votes as PH’s if PSM and Muda had not contested.

Some oppose altering the FPTP system, contending that a proportional representation system would exacerbate societal fragmentation and encourage radical political forces.

Yet, when we examine the state of party politics in Malaysia today, we already observe numerous well-established political parties, resulting in a “fragmented” political landscape.

Moreover, even mainstream parties have radical factions and can contribute to the polarisation of our society.

So, what do we stand to lose by allowing voters to cast their ballots for their preferred party and have those cumulative votes directly translate into a specific number of seats and public funding support (provided the votes surpass a certain threshold)?

Shouldn’t democracy encompass inclusivity, valuing the choices of the minority and celebrating the diversity of representative voices?

I’m sick of being forced to eat a “less rotten” apple. Could I not have a healthy watermelon or papaya?

If we could change the electoral system to one of proportional representation, there will be more fresh fruits  available for the choosing and every voter will contribute to making them available.

170th article for Agora@TMI column, published on The Malaysian Insight, 4 Sep 2023