6.3 HEALTH EXPENDITURE TO PROVIDERS OF HEALTH CARE – PROVIDERS OF AMBULATORY HEALTH CARE Providers of ambulatory health care services are the next largest provider of health care after all hospitals. Ambulatory health care comprises establishments primarily engaged in providing health care services directly to outpatients who do not require inpatient services such as medical practitioner clinics, dental clinics, family planning centres, substance abuse centres, dialysis centres, medical and diagnostic centres, ambulance providers and many other outpatient providers. Both MNHA and SHA Frameworks include providers of Traditional and Complementary Medicine under this category. In 2022, providers of ambulatory health care consumed RM16,676 million (21.1% of TEH). Of this amount, RM8,439 million (50.6% of ambulatory health care expenditure) was funded by private household OOP, public sector excluding social security funds at RM7,654 million (45.9% of ambulatory health care expenditure), private insurance enterprises (other than social insurance) at RM178 million (1.1% of ambulatory health care expenditure) and social security funds at RM175 million (1.1% of ambulatory health care expenditure). The remaining RM230 million (1.4% of ambulatory health care expenditure) by all corporations (other than health insurance) and non-profit organizations serving households (Table 6.3a and Figure 6.3). The 2011-2022 time series data shows that the expenditure in absolute RM value for ambulatory care services increased by 3-fold in the public sector and 2-fold in the private sector (Table 6.3b). TABLE 6.3a: Health Expenditure to Providers of Ambulatory Health Care by Sources of Financing, 2022 MNHA Code Sources of Financing RM Million Percent MS2.4 Private household out-of-pocket expenditures (OOP) 8,439 50.61 MS1.1 Public sector excluding social security funds 7,654 45.90 MS2.2 Private insurance enterprises (other than social insurance) 178 1.07 MS1.2 Social security funds 175 1.05 MS2.6 All Corporations (other than health insurance) 151 0.90 MS2.5 Non-profit institutions serving households (NGO) 79 0.47 Total 16,676 100.00 50 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
FIGURE 6.3: Health Expenditure to Providers of Ambulatory Health Care (Non-Hospital Setting) by Sources of Financing, 2022 50.6 % 45.9 % 1.1 % 1.1 % 0.9 % 0.5% Private household OOP Public sector excluding social security funds Private insurance enterprises (other than social insurance) Social security funds All Corporations(other than health insurance) Non-profit organizations serving households Health Expenditure to Providers of Ambulatory Health Care: 21% of TEH (RM16,676 Million) All Corporations (other than health insurance) Private insurance enterprises (other than social insurance) Public sector excluding social security funds Social sesurity funds Private household OOP Non-profit organizations serving households 51 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 6.3b: Health Expenditure to Providers of Ambulatory Health Care by Sources of Financing, 2011 - 2022 (RM Million) MNHA Code Sources of Financing 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MS1.1 Public sector excluding social security funds 2,732 3,180 3,544 4,118 4,300 4,445 4,852 5,373 6,007 6,603 11,717 7,654 MS1.2 Social security funds 13 11 11 68 74 93 99 138 144 43 159 175 Subtotal Public Sector 2,745 3,191 3,554 4,186 4,374 4,539 4,951 5,511 6,151 6,646 11,877 7,829 MS2.2 Private insurance enterprises (other than social insurance) 60 75 85 67 97 125 136 150 146 114 127 178 MS2.4 Private household out-of-pocket expenditures (OOP) 3,339 3,815 4,276 5,101 4,827 5,011 5,650 5,955 6,510 6,415 6,891 8,439 MS2.5 Non-profit institutions serving households (NGO) 19 21 21 18 20 22 45 41 66 70 53 79 MS2.6 All Corporations (other than health insurance) 488 672 819 939 1,426 1,493 1,365 1,330 991 628 670 151 Subtotal Private Sector 3,906 4,582 5,201 6,125 6,370 6,651 7,196 7,476 7,713 7,226 7,741 8,847 Total 6,650 7,773 8,756 10,311 10,744 11,189 12,147 12,987 13,864 13,872 19,618 16,676 TABLE 6.3c: Health Expenditure to Providers of Ambulatory Health Care by Sources of Financing, 2011 - 2022 (Percent, %) MNHA Code Sources of Financing 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MS1.1 Public sector excluding social security funds 41.07 40.91 40.47 39.94 40.02 39.73 39.94 41.37 43.33 47.60 59.73 45.90 MS1.2 Social security funds 0.19 0.14 0.12 0.66 0.69 0.83 0.81 1.07 1.04 0.31 0.81 1.05 Subtotal Public Sector 41.27 41.05 40.59 40.60 40.71 40.56 40.76 42.43 44.37 47.91 60.54 46.95 MS2.2 Private insurance enterprises (other than social insurance) 0.90 0.96 0.97 0.65 0.91 1.12 1.12 1.16 1.05 0.82 0.65 1.07 MS2.4 Private household out-of-pocket expenditures (OOP) 50.21 49.08 48.83 49.47 44.92 44.79 46.51 45.85 46.96 46.24 35.13 50.61 MS2.5 Non-profit institutions serving households (NGO) 0.28 0.26 0.24 0.17 0.19 0.19 0.37 0.32 0.47 0.50 0.27 0.48 MS2.6 All Corporations (other than health insurance) 7.34 8.64 9.36 9.11 13.27 13.34 11.24 10.24 7.15 4.52 3.42 0.90 Subtotal Private Sector 58.73 58.95 59.41 59.40 59.29 59.44 59.24 57.57 55.63 52.09 39.46 53.05 Total 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 52 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
HEALTH EXPENDITURE FOR FUNCTIONS OF
HEALTH CARE
T
his chapter describes the types of health goods
and services purchased with the financial
resources. Health expenditure for functions of
health care is categorised into two, namely the
‘core functions of health care’ (MF) and ‘health-
related functions’ (MR).
This chapter has four sections. Section 7.1
describes health expenditure according to MNHA
classification of all functions of health care for
2022, followed by time series data for 2011-2022
in RM Million and percentage. Section 7.2 explains
services of curative care expenditure, Section
7.3 is regarding public health services (including
health promotion and prevention) expenditure
and Section 7.4 describes expenditure for health
education and training.
7 . 1 HEAL TH EXPENDITURE FOR ALL
FUNCTIONS OF HEAL TH CARE
In 2022, the expenditure for services of curative
care amounted to RM51,930 million (65.8%
of TEH). This was followed by medical goods
dispensed to out-patient at RM6,502 million
(8.2% of TEH), health programme administration
and health insurance at RM6,351 million (8.0%
of TEH), capital formation of health care provider
institutions at RM5,912 million (7.5% of TEH), and
public health services (including health promotion
and prevention) at RM5,181 million (6.6% of TEH). A
total of RM2,465 million (3.1% of TEH) was spent
for education and training of health personnel,
and the remaining RM604 million (0.8% of TEH)
was spent on all the other functions (Table 7.1a
and Figure 7.1).
The 2011-2022 time series data shows that the
expenditure in absolute RM value for services of
curative care increased by 2-fold, medical goods
dispensed to out-patients increased by 3-fold
and health programme administration and health
insurance increased by 2-fold. Despite a decrease
in the public health services (including health
promotion and prevention) as percentage of TEH
in the year 2022, when compared to pre pandemic
year at 2019, there were significant increases
seen in absolute RM value from RM4,077 million
to RM5,181 million (Table 7.1b and Table 7.1c).
CHAPTER 7
53
MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 7.1a: Total Expenditure on Health for Functions of Health Care, 2022
MNHA Code
Functions of Health Care
RM Million
Percent
MF1
Services of curative care
51,930
65.78
MF5
Medical goods dispensed to out-patients
6,502
8.24
MF7
Health programme administration and health insurance
6,351
8.04
MR1
Capital formation of health care provider institutions
5,912
7.49
MF6
Public health services, including health promotion and prevention
5,181
6.56
MR2
Education and training of health personnel
2,465
3.12
MF4
Ancillary services to health care
315
0.40
MR3
Research and development in health
284
0.36
MF3
Services of long-term nursing care
5
0.01
Total
78,945
100.00
FIGURE 7.1: Total Expenditure on Health for Functions of Health Care, 2022
65.8%
8.2%
8.0%
7.5%
6.6%
3.1%
0.8%
Services of curative care
Medical goods dispensed to out-
patients
Health programme administration
& health insurance
Capital formation of health care
provider institutions
Public health services, include
health promotion & prevention
Education & training of health
personnel
All other functions
Total Health
Expenditure (TEH):
RM 78,945 Million
Total Health
Expenditure (TEH):
RM78,945 Million
Services of curative care
Medical goods dispensed to out-
patients
Health programme administrations
& health insurance
Capital formation of health care
provider in stitutions
Public health services, include
health promation & prevention
Education & training of health
personnel
All other functions
54
MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 7.1b: Total Expenditure on Health for Functions of Health Care, 2011-2022 (RM Million) MNHA Code Functions of Health Care 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MF1 Services of curative care 23,238 26,172 27,191 31,405 33,487 34,927 38,420 41,021 43,292 41,796 45,287 51,930 MF2 Services of rehabilitative care 1 0.02 na na na na na na na na na na MF3 Services of long-term nursing care 15 19 1 2 1 4 1 4 1 53 4 5 MF4 Ancillary services to health care 296 314 407 380 354 300 328 331 351 301 219 315 MF5 Medical goods dispensed to out-patients 2,242 2,477 2,730 3,298 3,932 4,248 4,520 5,242 4,815 4,752 5,565 6,502 MF6 Public health services (including health promotion and prevention) 1,577 1,925 2,804 2,771 3,223 3,401 3,469 3,640 4,077 5,283 10,604 5,181 MF7 Health programme administration and health insurance 3,632 3,545 3,586 4,248 4,468 3,839 4,780 4,440 5,237 5,853 6,424 6,351 MR1 Capital formation of health care provider institutions 2,430 2,355 2,089 1,831 1,890 2,016 1,986 2,632 3,319 5,758 6,919 5,912 MR2 Education and training of health personnel 2,463 2,560 2,749 2,758 2,813 2,949 2,831 3,128 3,099 2,984 2,319 2,465 MR3 Research and development in health 58 81 90 87 87 71 68 91 146 270 362 284 Total 35,953 39,448 41,647 46,780 50,256 51,756 56,404 60,528 64,336 67,051 77,703 78,945 55 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 7.1c: Total Expenditure on Health for Functions of Health Care, 2011 - 2022 (Percent, %) MNHA Code Functions of Health Care 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MF1 Services of curative care 64.63 66.35 65.29 67.13 66.63 67.48 68.11 67.77 67.29 62.33 58.28 65.78 MF2 Services of rehabilitative care 0.00 0.00 na na na na na na na na na na MF3 Services of long-term nursing care 0.04 0.05 0.00 0.00 0.00 0.01 0.00 0.01 0.00 0.08 0.01 0.01 MF4 Ancillary services to health care 0.82 0.80 0.98 0.81 0.71 0.58 0.58 0.55 0.55 0.45 0.28 0.40 MF5 Medical goods dispensed to out-patients 6.24 6.28 6.56 7.05 7.82 8.21 8.01 8.66 7.48 7.09 7.16 8.24 MF6 Public health services (including health promotion and prevention) 4.39 4.88 6.73 5.92 6.41 6.57 6.15 6.01 6.34 7.88 13.65 6.56 MF7 Health programme administration and health insurance 10.10 8.99 8.61 9.08 8.89 7.42 8.48 7.33 8.14 8.73 8.27 8.04 MR1 Capital formation of health care provider institutions 6.76 5.97 5.02 3.92 3.76 3.90 3.52 4.35 5.16 8.59 8.90 7.49 MR2 Education and training of health personnel 6.85 6.49 6.60 5.90 5.60 5.70 5.02 5.17 4.82 4.45 2.98 3.12 MR3 Research and development in health 0.16 0.21 0.22 0.19 0.17 0.14 0.12 0.15 0.23 0.40 0.47 0.36 Total 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 100.00 56 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022