FIGURE 7.4: Health Expenditure for Health Education and Training by Sources of Financing, 2022 MOH 30.1% Non-MOH 69.9% 0 2 00 4 00 6 00 8 00 1, 00 0 1, 20 0 1, 40 0 1, 60 0 1, 80 0 Public Sources Private Sources RM Million RM891 Million (36.2%) RM1,537 Million (63.8%) 65 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022 TABLE 7.4b: Health Expenditure for Health Education and Training 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 MS1.1.1.1 Public source (MOH) 380 377 407 438 446 428 244 380 370 356 269 268 MS1 (others) Public source (non-MOH) 1,204 1,030 881 992 969 1,039 1,064 1,227 1,178 1,001 617 623 MS2 Private source 879 1,153 1,461 1,328 1,398 1,482 1,523 1,521 1,551 1,628 1,433 1,573 Total 2,463 2,560 2,749 2,758 2,813 2,949 2,831 3,128 3,099 2,984 2,319 2,465 TABLE 7.4c: Health Expenditure for Health Education and Training by Sources of Financing, 2011 - 2022 (Percent, %) MNHA Code Sources of Financing 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MS1.1.1.1 Public source (MOH) 15.44 14.74 14.81 15.89 15.86 14.51 8.63 12.14 11.94 11.94 11.59 10.88 MS1 (others) Public source (non-MOH) 48.87 40.23 32.04 35.95 34.45 35.22 37.57 39.23 38.02 33.53 26.61 25.29 MS2 Private source 35.69 45.03 53.15 48.16 49.69 50.27 53.80 48.63 50.04 54.53 61.80 63.83 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 66 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
MOH HEALTH EXPENDITURE T here are slight differences in reporting MOH health expenditures using the MNHA Framework and the government treasury accounting system used by MOH Accounts Division (AG database). This chapter aims to provide some information on MOH expenditure as a share of total expenditure on health and national GDP and enlighten the differences in expenditure reporting of MOH hospitals as the provider of health care services and MOH source of financing at MOH hospitals using the MNHA Framework. The first section in this chapter describes the proportion of MOH expenditure from TEH and MOH health expenditure as a percentage of national GDP using the MNHA Framework. The second section aims to explain some differences in NHA reporting of expenditure at hospitals based on the two dimensions of the MNHA Framework; sources of financing and functions of health care. 8.1 MOH HEAL TH EXPENDITURE – MOH SHARE OF TOTAL EXPENDITURE ON HEAL TH AND NATIONAL GDP MOH health expenditure reported in this section describes what MOH, as a ‘source of financing’, spends on health care. The expenditure of MOH as a ‘source of financing’ differs from the total MOH expenditure reported in the government treasury accounting system. The latter includes both operating and development expenditures for a particular MNHA Framework facilitates the tracking of reimbursements by various agencies, such as EPF, SOCSO, private health insurance and state government including statutory bodies. These reimbursements are deducted from the total MOH expenditure to accurately reflect the actual MOH expenditure at the healthcare provider level. Consequently, MOH expenditure as a ‘source of financing’ appears slightly lower under the MNHA Framework due to the effect of ‘addressing double counting,’ as explained in Chapter 3. Using the MNHA Framework, in 2022, a total amount of RM33,863 million (42.9% of TEH) was spent by MOH. MOH expenditure data for 2011-2022 time series shows various trends throughout the years. MOH expenditure throughout the same period was ranging between 42.9% - 49.5% of the TEH. In 2011, MOH spent RM16,496 million (45.9% of TEH), while in the year 2022, MOH spent RM33,863 million (42.9% of TEH). In relation to GDP, MOH expenditure in 2011 is equivalent to 1.8% of the national GDP, while in 2022, it is 1.9% of the national GDP (Table 8.1 and Figure 8.1). CHAPTER 8 67 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022 TABLE 8.1: MOH Share of Total Expenditure on Health and Percent GDP, 2011-2022 Year TEH, Nominal (RM Million) MOH Expenditure (RM Million) MOH Expenditure as % TEH TEH (Nominal) as % GDP MOH Expenditure as % of GDP 2011 35,953 16,496 45.88 3.94 1.81 2012 39,448 18,239 46.24 4.06 1.88 2013 41,647 19,038 45.71 4.09 1.87 2014 46,780 21,782 46.56 4.23 1.97 2015 50,256 22,737 45.24 4.27 1.93 2016 51,756 22,315 43.12 4.14 1.79 2017 56,404 24,775 43.92 4.11 1.81 2018 60,528 26,561 43.88 4.18 1.83 2019 64,336 28,903 44.93 4.25 1.91 2020 67,051 31,011 46.25 4.73 2.19 2021 77,703 38,487 49.53 5.02 2.48 2022 78,945 33,863 42.89 4.41 1.89 FIGURE 8.1: MOH Expenditure on Health and Percent GDP, 2011-2022 68 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
8.2 MOH HEAL TH EXPENDITURE - MOH HOSPITAL All programmes, projects and services under the purview of MOH, inclusive of health care services provided at all MOH hospitals, come from federal government consolidated funds. As the provider of health care services, MOH hospitals take up the largest percentage of the total MOH allocated funds. The development funds spent at MOH hospital were assigned as non-curative care expenditures, mainly for hospital facility development and renovation. Using the MNHA Framework, the operating fund spent at MOH hospitals was assigned as curative care expenditure for patient care services disaggregated based on functional classification and categorised as an in-patient, out-patient and day-care, and this was described under Section 3.2 of this report. 8.2. 1 MOH Health Expenditure - MOH Hospital, Sources of Financing In 2022, both the public and private sector sources of financing at MOH hospitals totalled to RM21,039 million. Various financiers were tracked through MOH hospitals accounting systems, and sources of financing codes were assigned for payments made through private household out-of-pocket, private health insurance and other types of sources of financing. As a result, RM20,469 million (97.3% of total expenditure at MOH hospitals) was sourced from MOH. A small amount of RM569 million (2.7% of total expenditure at MOH hospitals) was accounted for by other financiers such as private household OOP at RM304 million, other state agencies (including statutory bodies) at RM92 million, private insurance enterprises (other than social insurance) at RM91 million, Social Security Organisation (SOCSO) contributed RM42 million, other federal agencies (including statutory bodies) at RM31 million and the remaining non-MOH expenditure at RM9 million (Table 8.2.1a). The 2011-2022 time series expenditure on sources of financing shows a similar trend with MOH as the highest financier followed by non- MOH (Table 8.2.1b and Figure 8.2.1). The time series data on MOH as the source of financing shows that the expenditure increased by 2-fold in absolute RM value, with an average of 97.3% of the total health expenditure at MOH hospitals (Table 8.2.1c). 69 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022 TABLE 8.2.1a: Health Expenditure at MOH Hospitals by Sources of Financing, 2022* MNHA Code Sources of Financing RM Million Percent Ministry of Health (MOH) MS1.1.1.1 Ministry of Health (MOH) 20,469 97.29 Non-Ministry of Health (non-MOH) MS2.4 Private household out-of-pocket expenditures (OOP) 304 1.45 MS1.1.2.2 Other state agencies (including statutory bodies) 92 0.44 MS2.2 Private insurance enterprises (other than social insurance) 91 0.43 MS1.2.2 Social Security Organisation (SOCSO) 42 0.20 MS1.1.1.9 Other federal agencies (including statutory bodies) 31 0.15 MS2.5 Non-profit institutions serving households (NGO) 2 0.01 MS1.1.3 Local authorities (LA) 2 0.01 MS1.1.2.1 (General) State government 2 0.01 MS1.2.1 Employees Provident Fund (EPF) 1 0.01 MS2.6 All corporations (other than health insurance) 1 0.01 Non-MOH Sub-total 569 2.71 Total 21,039 100.00 Note: *MOH Hospital Provider codes include MP1.1a, MP1.2a and MP1.3a FIGURE 8.2.1: Health Expenditure at MOH Hospitals by Sources of Financing, 2011-2022 (RM Million) 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 276 236 273 235 285 405 418 461 558 823 729 569 70 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 8.2.1b: Health Expenditure at MOH Hospitals by Sources of Financing, 2011-2022 (RM Million) Sources of Financing 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Ministry of Health (MOH) 9,462 11,331 11,683 13,610 14,277 14,392 15,442 16,535 17,552 18,078 19,894 20,469 Non-Ministry of Health (non-MOH) 276 236 273 235 285 405 418 461 558 823 729 569 Total 9,739 11,567 11,956 13,845 14,562 14,797 15,860 16,995 18,110 18,901 20,623 21,039 TABLE 8.2.1c: Health Expenditure at MOH Hospitals by Sources of Financing, 2011-2022 (Percent, %) Sources of Financing 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Ministry of Health (MOH) 97.16 97.96 97.72 98.30 98.04 97.26 97.36 97.29 96.92 95.65 96.46 97.29 Non-Ministry of Health (non- MOH) 2.84 2.04 2.28 1.70 1.96 2.74 2.64 2.71 3.08 4.35 3.54 2.71 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 71 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
8.2.2 MOH Health Expenditure - MOH Hospital, Functions of Curative Care This section provides further information on patient care services at MOH hospitals. Functions of curative care services provided in MOH hospitals are further categorised as in-patient curative care, out-patient curative care and day-cases of curative care. Under the MNHA Framework, these types of services were inclusive of allopathic as well as some traditional and complementary health care services. In 2022, RM21,039 million was spent at MOH hospitals. Of this amount, RM18,738 million (89.1% of total expenditure at MOH hospitals) was for curative care services (Table 8.2.2a). In the same year, the expenditure for curative care services at MOH hospitals showed that RM11,995 million (64.0%) was spent for in-patient curative care services. This was followed by RM5,397 million (28.8%) for out-patient curative care services and RM1,346 million (7.2%) for day cases of curative care services (Figure 8.2.2). The 2011-2022 time series data shows that in absolute RM value, the curative care services expenditure in 2022 increased by two-fold compared to the expenditure in 2011 (Table 8.2.2b). The curative care services expenditure in time series shows an average of 95.8% spending at the MOH hospitals (Table 8.2.2c). TABLE 8.2.2a: Health Expenditure at MOH Hospitals for Functions of Health Care, 2022 MNHA Code Functions of Health Care RM Million Percent Curative Care MF1.1 In-patient curative care 11,995 57.01 MF1.3 Out-patient curative care 5,397 25.65 MF1.2 Day cases of curative care 1,346 6.40 Sub-total (Curative care) 18,738 89.06 Non-Curative Care MR1 Capital formation of health care provider institutions 2,293 10.90 MF6.4 Prevention of non-communicable disease 8 <0.01 Sub-total (non-Curative care) 2,301 10.94 Total 21,039 100.00 72 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022