FPMPAM Statement Budget 2013 – Allocation for Ministry of Health

We welcome the increase in allocation for health in the 2013 budget.

The first comment is, are we putting sufficient money into public healthcare with regards to the allocation for health – is it adequate to meet real needs?

The increase of 14.3% over the 2012 allocation may appear to be large quantitatively, but is just not sufficient when rates/percentages are used to compare. For a more balanced analysis, it must be noted that in 2008 the public healthcare expenditure was RM17B and this budget’s allocation of R19B is just 11% increase from 2008. 11% increase over 5 years works out to be 2.5% per year and this is barely enough to cover the increase in cost due to inflation.

This is also reflected in the public healthcare expenditure as percentage of GDP and per capita which continue to remain at low level :

Public HC spending as
percentage of GDP
Public HC expenditure
per capita
RM:596( increase 28%)
RM:669 (increase 12.2%)
(Table 1)

Developed countries with good health systems spend around 8% of GDP on healthcare. At this point of over national development we should be spending at least 7% of our GDP on healthcare.

The success of the 1Malaysia clinic is a reflection of the basic issue that the urban areas have been neglected in terms of provision of kelinik kesihatan (KK). Many semi-urban areas have become very urbanized, yet number of KKs is static does not reflect the norm of MOH for KKs which is one KK for 15,000 to 20, 000 population.

The basic assumption is that urban folks can afford GP care paid out-of-pocket. However, the socio-economic demography of the urban population has significantly changed over the years. The previous assumption about urban folks is now proven wrong In fact the urban poor is now bigger due to inflation and migration and it is important that more money be put in to redress the imbalance.

The writing was already on the wall when hospital OPDs is congested and there is long waiting time. In some places, OPDs which previously catered for 100 patients per day with 2 consultation rooms now have to deal with 500 patients using two doctors per room .With this level of service accommodation, privacy and patient confidentiality are compromised. In some places squatter type extension are used to make more rooms and waiting area.

1 Malaysia clinics can indeed serve the urban poor, but we are of the view that such clinics should be located in areas where it can be easily accessed by the urban poor and should not be located in areas that are well serviced by existing GPs and primary care clinics. Putting 1 Malaysia clinics into under-serviced areas is a good way to improve accessibility and coverage.

However, RM 20M for 70 new 1M clinic is insufficient. It works out to be RM 280K per new clinic. This is barely enough to set up a clinic. One can estimate the operational cost for 5 staff at RM2K per staff, with doctor at RM 5K per month, will require at least RM 180K per year. This does not include cost of rental, electricity, equipment, etc. It would be more cost effective to outsource more primary care to the existing GP clinics that can provide it cheaper than the public service.

The RM100M allocated to upgrade the 350 clinic nationwide and to improve dialysis services is part of the plan to convert the three tier system of the Merdeka era rural health unit into a two tier system. We are aware that this program is already well behind schedule as this conversion recommendation was adopted in 1979. Hence, this financial stimulus is long overdue.

The provision of SOCSO money for regular preventive health checks is good. This should be outsourced to existing primary care clinics to cut cost. It will be in line with the move to have public-private partnership in healthcare delivery. However, screening alone is not enough. Without proper patient follow-up treatment and surveillance programs this good effort will be wasted.

We support the provision of more pre-service allowance not only for trainees but across the board but this increase must be tied up with increased productivity.

Dr. Steven Chow



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