Manifestations of reorientation
The shift away from the universal welfare model of public health care has been
manifested in a number of policy decisions. These have included moves to generate
greater income from co-payments, the promotion of private insurance and savings
for health care costs, and the encouragement of health service provision as a
benevolent act by non-government organizations, charitable bodies and firms.
Other manifestations have been the corporatization of some hospitals, the privatization of some services and the active fostering of the commercial private health care
sector.
For some years the government has indicated its intention to overhaul its policies
on subsidies for health care in public institutions. The government is concerned that
only about 5% of hospital operating costs are met through co-payments and that
many of the patients enjoying heavily subsidized treatment can afford to pay a
greater share of the costs. Moves to increase charges in public hospitals and
government health clinics have been supported by the Malaysian Medical Association which wants such charges to be the same in both the public and private sectors.
To date, however, substantial fee increases have not been introduced for
Malaysians, although some haemodialysis services have been transferred to private
providers with an attendant rise in fees.
Among the schemes for financing health care recently articulated in public policy
have been savings, private insurance and employer-funded private coverage. In
order to enable patients to be able to pay a greater share of the costs of their
treatment in public hospitals, or to seek treatment in private hospitals, the
government instituted reforms to the Employees Provident Fund (EPF), Malaysia’s
compulsory retirement fund in which 23% of an employee’s wages are held. In 1994
a scheme was introduced allowing up to 10% of an individual’s EPF balance to be
drawn upon to pay for medical treatment of critical conditions such as heart
diseases, kidney failure and cancer. In keeping with the government’s desire to
promote a family-based welfare system, the scheme can also be used to pay for the
medical care of members of the immediate family of the fund-holder. In the 1996
Budget, tax relief for approved pension funds and life insurance premiums were
increased by RM 2000 to a total of RM 7000 in order to encourage savings for
health and health insurance coverage [17]. The government has also stated its
intention to require all larger companies to provide free or subsidized health care to
their workers as part of their terms of employment [18]. These comparatively minor
policy changes have occurred despite the government’s oft-stated intention ultimately to introduce some form of national health insurance system.
As part of its vision of the ‘‘Caring Society’’, the Malaysian government has
intensified its appeals to both the corporate sector and philanthropic bodies to