Kuala Lumpur, 16 April 2018 – A comparison by the Galen Centre for Health and Social Policy of the Pakatan Harapan and Barisan Nasional manifestos released ahead of the Malaysian 14th General Election, revealed a mixture of strengths and weaknesses from the perspective of healthcare. Of note, was the absence and lack of emphasis on structural reforms in both manifestos, particularly to address long term financing of the public healthcare system, which signal a lack of understanding and appreciation of the urgency for action to be taken to address this issue.

Commenting on the findings, Chief Executive Azrul Mohd Khalib said, “Over the past decade, Malaysia’s public healthcare system, accessed by over 70 percent of the population, has had to deal with an increasingly worrying health burden of non-communicable diseases, new and re-emerging diseases, an ageing population and increased complexity and diversity of health needs. Government hospitals, clinics and health facilities under continuous strain from growing public demand, are encountering problems of insufficient supply and funding. The mechanism of fees and public funding which supports the system has remained practically unchanged since 1982. The current arrangement is simply unsustainable and in urgent need of reform. Both manifestos appear to not recognise this.”

“The issue extends beyond just increasing the national budget allocation for healthcare. The Pakatan Harapan manifesto pledges an ambitious increase to 4 percent of GDP, representing an estimated RM 16.32 billion, additional to the existing allocation. However, the combined cost of sustaining and improving current infrastructure, rising medical costs and the sheer number of new items promised in this document threaten to overwhelm the proposed increase. This would make the majority of pledges less likely to be realised. There are just too many of them. A strong positive are the pledges of improving the quality and coverage of healthcare in Sabah and Sarawak. The proposal to decentralise healthcare decisions to these state governments is also an innovative idea which should be seriously considered, regardless of the election outcome.”

“The Barisan Nasional manifesto appears to take a cautious approach with an eye towards consolidation and sustainability of the current healthcare system. It emphasises building and improving upon existing physical infrastructure and manpower, increasing coverage and quality of service delivery. The strengthening of general health systems and services, including investments in digital health, in infectious disease prevention and control expertise, and in rural health services, is much needed and will yield long term institutional benefits. However, it could have been further improved with a pledge to address the issue of recruitment and retention of healthcare professionals which needs urgent attention.”

“The past experience of 1Care is a stark reminder that public support and commitment must be earned and secured in order for any major reform of the healthcare system to succeed. Therefore, the lack of mention of the proposed Voluntary Health Insurance Scheme in the ruling coalition’s manifesto is a critical omission, as it is a key component of current proposed reforms,” emphasised Azrul.

“In comparison to many democracies around the world, healthcare is rarely a major election issue in Malaysia. We must avoid taking our healthcare system for grant and expecting it to somehow sort itself out. We have been lucky thus far. This coming general election provides an opportunity for Malaysians to ask those running for office, not only their fixes for existing problems, but also their plans for the future of the country’s healthcare.”

 

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A comparison of the Barisan Nasional and Pakatan Harapan health-related manifesto pledges can be viewed here.