The political economy of health financing reform in Malaysia

Croke, Kevin; Yusoff, Mariana Binti Mohd; Abdullah, Zalilah; Hanafiah, Ainul Nadziha Mohd; Mokhtaruddin, Khairiah; Ramli, Emira Soleha; Borhan, Nor Filzatun; Almodovar-Diaz, Yadira; Atun, Rifat; Virk, Amrit

doi:10.1093/heapol/czz089

Cited by 23 publications

(18 citation statements)

References 30 publications

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“…As far as existing practices and conditions are concerned-from 'hidden,' if not outright illegal fees, to small-town patronage systems-political capital remains a barrier to health, especially for the marginalized majority. Ultimately, these findings suggest the same conclusion reflected in researches from other LMICs, either in the Southeast Asian region [19][20] or in other continents 21 : In the conversation of health reform, the prevailing top-down political and bureaucratic climate always plays a considerable role and should never be discounted.…”

Section: Beyond 'Out-of-pocket' Expensessupporting

confidence: 69%

The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure in the Philippines

Lasco

David

2021

Acta Med Philipp

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Objectives. Within the last two decades, studies worldwide have documented catastrophic health spending and out-of-pocket expenditure in low-and middle-income countries like the Philippines. This study sought to unpack patients and their families' lived experiences in dealing with such financial challenges.Methods. This paper stems from a multi-sited qualitative project in the Philippines involving FGDs that sought to elicit people's long-term health goals and the barriers they encounter in attaining good health. Focusing on the domain of health financing, we used principles of grounded theory to analyze how low and middle-income Filipinos pay for their health needs.Results. For many Filipinos, health financing often necessitates various actors' participation and entails predictable and unforeseen complications throughout the illness trajectory. We describe the lived realities of health financing through four domains: 'pagtitiis' (enduring the illness), 'pangungutang' (borrowing the money), 'pagmamakaawa' (soliciting help from the government and non-government channels), and PhilHealth-the State-owned national insurance agency-whose (non-)role figures prominently in catastrophic expenditure. Conclusion.Our paper illustrates how illness not only leads to catastrophic expenditure; expenditure-related challenges conversely account for poorer health outcomes. By exploring the health system through qualitative means, we identify specific points of intervention that resonate across LMICs (low and middle-income countries) worldwide, such as addressing predatory loan practices and 'hidden' costs; improving public health communications; expanding government insurance benefits; and bolstering health literacy to include health financial literacy in the school and community settings.

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Section: Beyond 'Out-of-pocket' Expensessupporting

confidence: 69%

The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure in the Philippines

Lasco

David

2021

Acta Med Philipp

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“…IJN's experience demonstrates that new institutional forms can be created and sustained within an otherwise relatively change-resistant health system. 2 Yet, this analysis also demonstrates persistent tensions between public and private missions within such a corporatized entity. Hence, governance arrangements within such entities must be carefully constructed and monitored over time to ensure an acceptable balance is maintained.…”

Section: Resultsmentioning

confidence: 86%

“…Since the 1990s, health financing reforms aimed at creating a social health insurance system have figured prominently on the government's policy agenda in Malaysia. Yet, while comprehensive financing reform failed to materialize and several attempts to implement a national health insurance program were blocked by opponents, 2 Malaysian policy makers introduced a series of measures to reduce the government's role in direct provision of health services and enhance private sector participation, with the goals of improving the system's technical efficiency.…”

Section: Introductionmentioning

confidence: 99%

Hybrid Organizations in Health Systems: The Corporatization of Malaysia’s National Heart Institute

Virk

Croke

Yusoff

et al. 2020

Health Systems & Reform

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Health system reforms across high-and middle-income countries often involve changes to public hospital governance. Corporatization is one such reform, in which public sector hospitals are granted greater functional independence while remaining publicly owned. In theory, this can improve public hospital efficiency, while retaining a public service ethos. However, the extent to which efficiency gains are realized and public purpose is maintained depends on policy choices about governance and payment systems. We present a case study of Malaysia's National Heart Institute (IJN), which was created in 1992 by corporatization of one department in a large public hospital. The aim of the paper is to examine whether IJN has achieved the goals for which it was created, and if so, whether it provides a potential model for further reforms in Malaysia and other similar health systems. Using a combination of document analysis and key informant interviews, we examine key governance, health financing and payment, and equity issues. For governance, we highlight the choice to have IJN owned by and answerable to a Ministry of Finance (MOF) holding company and MOF-appointed board, rather than the Ministry of Health (MOH). On financing and payment, we analyze the implications of IJN's combined role as fee-for-service provider to MOH as well as provider of care to private patients. For equity, we analyze the targeting of IJN care across publicly-referred and private patients. These issues demonstrate unresolved tensions between IJN's objectives and public service goals. As an institutional innovation that has endured for 28 years and grown dramatically in size and revenue, IJN's trajectory offers critical insights on the relevance of the hybrid public-private models for hospitals in Malaysia as well as in other middle-income countries. While IJN appears to have achieved its goal of establishing itself as a commercially viable, publicly owned center of clinical excellence in Malaysia, the value for money and equity of the services it provides to the Ministry of Health remain unclear. IJN is accountable to a small Ministry of Finance holding company, which means that detailed information required to evaluate these critical questions is not published. The case of IJN highlights that corporatization cannot achieve its stated goals of efficiency, innovation, and equity in isolation; rather it must be supported by broader reforms, including of health financing, payment, governance, and transparency, in order to ensure that autonomous hospitals improve quality and provide efficient care in an equitable way.

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“…Malaysia has implemented a strategic plan in health care namely Malaysian Plan in 2004. This program emphasized the budget allocation for health care, distributed the skillful health workers to the rural area, and strengthened hospital and community health services to reduce neonatal mortality rate (21). However, it should be noticed that the trend of NMR in Malaysia slightly increased.…”

Section: Discussionmentioning

confidence: 99%

The Trends of Neonatal Mortality Rate Among South East Asia Countries from 2000-2017

Soleman

2020

Dis. Prevention and Public Health J.

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Background: Neonatal MortalityRate (NMR) reflects the quality of health services provided by the government. It is very important to disclose the health system capability of each country in managing mother and child health programs because it is an essential health policy that should be prioritized. The health system capability of a country will determine the welfare and social guarantee because most of NMR causes are preventable. Several components such as maternal factors, neonatal and health services were determined as predictors of NMR. The objective of this study is to compare neonatal mortality trends among eight South East Asia Countries (SEAC) from 2000 to 2017. Method: A cross-sectional design was used to analyze the data regarding the causes of neonatal death between 2000 and 2017. Data were taken from World Health Organization Maternal Child Epidemiology Estimation (WHO MCEE) database.The collected data were live birth; neonatal mortality rate; and the big five of neonatal mortality etiologies in the eight SEAC. Data were then analyzed descriptively with line chart to describe the trend of NMR. Result: This study found that Indonesia had the highest neonatal mortality rate, yet the trend decreased gradually from 102.700 in 2000 to 60.986 in 2017, followed by Philippines, Vietnam, Myanmar, Cambodia, Thailand, Laos, and Malaysia respectively. On the other hand, the trend of live birth was the lowest in Indonesia and the highest in Philippines . According to the data regarding the leading cause of NMR, preterm birth was the major cause of neonatal mortality followed by birth asphyxia and congenital defects. Conclusion: Indonesia has the highest mortality rate, yet the etiology such as as premature birth, asphyxia, and congenital disorder is similar to the other eight countries.

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The political economy of health financing reform in Malaysia

Cited by 23 publications

References 30 publications

The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure in the Philippines

The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure in the Philippines

Hybrid Organizations in Health Systems: The Corporatization of Malaysia’s National Heart Institute

The Trends of Neonatal Mortality Rate Among South East Asia Countries from 2000-2017

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