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About the Book From 2019 to 2020, the People’s Health Forum (PHF) conducted a series of roundtable discussions with various stakeholders including medical and allied health professionals, academics, civil society organizations, representatives from the Ministry of Health (MOH), patient groups, and trade unions to discuss challenges confronting the healthcare system in Malaysia and the way forward. Based on these discussions and further research, the PHF has identified the main issues confronting the Malaysian healthcare system and the reforms that are needed. These are summarized in its Blueprint on Health Reform in Malaysia. The PHF believes that the people’s interest is best served by a public healthcare system that provides equitable access to high-quality healthcare for all. The ability (or non-ability) to pay, geographical location (whether rural or urban), and citizenship status should not be barriers to accessing quality healthcare. To achieve this, the system of healthcare financing should be based on social solidarity, cross-subsidization, and sustainability over the long term. The Blueprint on Health Reform in Malaysia is available at https://twn.my/title2/books/pdf/Blueprint_Health_Reform_Malaysia.pdf CONTENTS EXECUTIVE SUMMARY 0.0. INTRODUCTION 1.0. OVERVIEW: HEALTH AND HEALTHCARE IN MALAYSIA 2.0. STRENGTHS OF THE MALAYSIAN PUBLIC HEALTHCARE SYSTEM 3.0. PROBLEMS AND CHALLENGES FOR HEALTHCARE ACCESS AND EQUITY Facilities 3.1. Infrastructure development has not kept up with patient load 3.2. Shortage of specialists in the government sector 3.3. Challenges in primary care delivery 3.4. Oversupply of medical graduates and lack of housemanship posts Utilization of care 3.5. Overcrowding of government clinics and hospitals 3.6. Rising costs of “co-payments” 3.7. Catastrophic expenditure 3.8. Barriers to the accessibility of healthcare Financing issues 3.9. Governmental allocations to health 3.10. Equitable financing Implications of COVID-19 3.11. Impact on the treatment of NCDs 3.12. The burden of “long COVID” 3.13. Strategies and costs associated with shifting of COVID-19 to an endemic phase 4.0. PHF BLUEPRINT FOR HEALTH REFORM 4.1. Health services delivery 4.1.1. Expand public healthcare infrastructure 4.1.2. Expand availability of primary care 4.1.3. Expand community-based services 4.1.4. Address barriers to access of migrant populations 4.1.5. Strengthen pandemic control capacity 4.2. Health workforce 4.2.1. Set up Public Health Services Commission 4.2.2. Increase the number of specialists in government service 4.2.3. Review medical student intake 4.2.4. Task shifting to relieve the current government healthcare burden at the primary care level 4.3. Health financing 4.3.1. Increase total expenditure on health as a proportion of GDP and increase the proportion of federal government expenditure for MOH 4.3.2. Introduce a GP capitation system 4.3.3. Reduce co-payments for implants and equipment 4.3.4. Proposals to revamp healthcare financing 4.3.5. PHF’s reservations 4.4. Health information 4.4.1. Set up data hubs for public visualization, usage and downloading health data 4.4.2. Update and publish national registries more frequently 4.4.3. Publish health information for migrant populations 4.5. Essential medicines 4.5.1. Ensure affordable medicine and treatment by making the patent system more stringent as well as imposing medicine price regulation mechanism 4.5.2. Promote local pharmaceutical industry for production of generic medicines, vaccines and medical devices 4.6. Leadership and governance 4.6.1. Guided by evidence-based and value-based healthcare policy, with the best public interest at heart 4.6.2. Show political will to address long-term issues in the right way 4.6.3. Listen to stakeholders including patient groups, consumer associations, civil society organizations and community leaders 5.0. FINAL POINTS
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