FIGURE 8.2.2: Health Expenditure at MOH Hospitals for Curative Care Functions of Health Care, 2022 73 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 8.2.2b: Health Expenditure at MOH Hospitals for Functions of Health Care, 2011-2022 (RM Million) Functions of Health Care 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Curative Care 9,643 11,302 11,590 13,576 14,271 14,478 15,749 16,920 17,819 16,785 17,985 18,738 Non-Curative Care 96 265 366 269 292 319 112 76 291 2,116 2,638 2,301 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 8.2.2c: Health Expenditure at MOH Hospitals for Functions of Health Care, 2011-2022 (Percent, %) Functions of Health Care 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Curative Care 99.02 97.71 96.94 98.06 98.00 97.85 99.30 99.55 98.39 88.81 87.21 89.06 Non-Curative Care 0.98 2.29 3.06 1.94 2.00 2.15 0.70 0.45 1.61 11.19 12.79 10.94 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 74 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
OUT-OF-POCKET HEALTH EXPENDITURE M any countries often obtain household out-of-pocket (OOP) health expenditures through community surveys. However, the best approach for this estimation as used in this report is through a complex method called the integrative method, whereby the gross level of direct health spending from consumption, provision and financing perspectives are collated, followed by a deduction of third-party financial OOP Health Expenditure = (Gross OOP Health Expenditure – Third Party Payer Reimbursement)
- OOP Expenditure for Health Education & Training reimbursements by various agencies to avoid double counting. The data shown in this chapter includes OOP spending for TCM, health education and training. OOP health expenditure estimation through the integrative method is explained in Chapter 3. In brief, OOP health expenditure estimation uses the formula as follows: CHAPTER 9 75 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 9.1a: OOP Share of Total Expenditure on Health and Private Sector Health Expenditure, 2011-2022
Year
Private
Sector Health
Expenditure
(RM Million)
Total
Expenditure on
Health
(RM Million)
OOP Health
Expenditure
(RM Million)
OOP Share
of Total
Expenditure
on Health
(Percent %)
OOP Share
of Private
Sector Health
Expenditure
(Percent %)
2011
15,702
35,953
11,466
31.89
73.02
2012
17,442
39,448
12,649
32.06
72.52
2013
18,780
41,647
13,933
33.45
74.19
2014
20,859
46,780
15,373
32.86
73.70
2015
23,222
50,256
16,349
32.53
70.40
2016
25,001
51,756
17,555
33.92
70.22
2017
27,121
56,404
19,518
34.60
71.97
2018
29,084
60,528
21,302
35.19
73.24
2019
30,046
64,336
22,382
34.79
74.49
2020
30,448
67,051
22,648
33.78
74.38
2021
32,900
77,703
24,688
31.77
75.04
2022
37,688
78,945
29,381
37.22
77.96
9.1 O U T - O F - P O C K E T H E A L T H
EXPENDITURE – OOP SHARE OF
TOTAL EXPENDITURE ON HEALTH AND
NATIONAL GDP
In 2022, the OOP health expenditure amounted
to RM29,381 million, equivalent to 37.2% of the
TEH and 78.0% share of the private sector health
expenditure (Table 9.1a). The 2011-2022 time
series data shows that the household OOP health
expenditure was between 31.8% and 37.2% of TEH
(Table 9.1a and Figure 9.1a). It has remained the
largest single source of financing in the private
sector throughout the years, with an average of
73.4% of private sector health expenditure (Table
9.1a, Figure 9.1b). The OOP health expenditure from
2011 to 2022 increased from RM11,466 million to
RM29,381 million, which constitutes 1.3% of GDP
in 2011 to 1.6% of GDP in 2022 (Table 9.1b and
Figure 9.1c).
76
MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
FIGURE 9.1a: OOP Share of Total Expenditure on Health, 2011-2022 (Percent, %)
TABLE 9.1b: OOP Health Expenditure and as GDP Percentage, 2011-2022
Year
OOP Health Expenditure
(RM Million)
OOP Health Expenditure
as % GDP
2011
11,466
1.26
2012
12,649
1.30
2013
13,933
1.37
2014
15,373
1.39
2015
16,349
1.39
2016
17,555
1.40
2017
19,518
1.42
2018
21,302
1.47
2019
22,382
1.48
2020
22,648
1.60
2021
24,688
1.59
2022
29,381
1.64
77
MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
73.0 72.5 74.2 73.7 70.4 70.2 72.0 73.2 74.5 74.4 75.0 78.0 0 10 20 30 40 50 60 70 80 90 1 00 20 11 20 12 20 13 20 14 20 15 20 16 20 17 20 18 20 19 20 20 20 21 20 22 OOP % Private Sector Health Expenditure OOP Share of Private Sector Health Expenditure FIGURE 9.1b: OOP Share of Private Sector Health Expenditure, 2011-2022 (Percent, %) 73.0 72.5 74.2 73.7 70.4 70.2 72.0 73.2 74.5 74.4 75.0 78.0 OOP Share of Private Sector Health Expenditure FIGURE 9.1c: OOP Health Expenditure and as GDP percentage, 2011-2022 (RM Million, Percent %) 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 78 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022 9.2 O U T - O F - P O C K E T H E A L T H EXPENDITURE TO PROVIDERS OF HEALTH CARE This section cross tabulates OOP health expenditure with providers of health care. Health providers are defined as entities that produce and provide health care goods and services, which benefit individuals or population groups. These providers could be either public or private providers of health care. The government heavily subsidizes the majority of public sector healthcare services for patients in this country, even if the government outsources any of the services to private providers of health care. However, under the provision of public sector services, there are some components of health care services and several products like prostheses, which are purchased by patients from private providers of health care. When patients seek private sector services, they are often at liberty to purchase these services or products separately. The private providers of health care include several categories of standalone private facilities such as private hospitals, private medical clinics, providers of medical appliances, TCM providers, private dental clinics, community pharmacies and private laboratories. OOP is the mode of payment for services either in the public or private sector. Furthermore, the final amount reported under OOP health expenditure includes expenditure reported by this mode for health education and training. Throughout the 2011-2022 time series, OOP health expenditure to providers of health care generally shows an increasing pattern (Table 9.2a and Figure 9.2a). In 2022, of the total RM28,232 million of OOP health expenditure to private providers of health care, private hospitals consumed the largest share at RM13,696 million (48.5%), followed by private medical clinics at RM5,995 million (21.2%), community pharmacies at RM4,599 million (16.3%), private dental clinics at RM1,416 million (5.0%), TCM providers at RM795 million (2.8%), retail sale and other suppliers of medical goods and appliances at RM498 million (1.8%), private medical and diagnostic laboratories at RM41 million (0.1%) and the balance, RM1,191 million (4.2%) comprised of other private providers of health care such as private institutions, private haemodialysis and other of ambulatory care services (Table 9.2b and Figure 9.2b). The 2011-2022 time series data shows an average of 94.3% of OOP health expenditure occurred at private providers of health care, with an increasing expenditure pattern (RM value) at various private providers. The highest increase in absolute amount is seen at private hospitals, from RM5,359 million in 2011 to RM13,696 million in 2022, a difference of RM8,337 million. Similarly, there is an increase in spending at community pharmacies from RM1,407 million in 2011 to RM4,599 million in 2022. The OOP health expenditure at private medical clinics showed a fluctuating trend, with an expenditure of RM5,995 million in 2022. The time series data also shows a fluctuating pattern of OOP health expenditure at public providers with an average of 5.7% throughout the years (Table 9.2c and Table 9.2d). 79 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 9.2a: OOP Health Expenditure to Public and Private Providers of Health Care, 2011 - 2022 (RM Million) Provider name 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Public Providers 628 691 1,013 995 1,086 1,222 1,222 1,148 1,160 1,310 1,024 1,148 Private Providers 10,838 11,957 12,920 14,378 15,263 16,333 18,295 20,154 21,222 21,338 23,664 28,232 Total 11,466 12,649 13,933 15,373 16,349 17,555 19,518 21,302 22,382 22,648 24,688 29,381 FIGURE 9.2a: OOP Health Expenditure to Public and Private Providers of Health Care,2011-2022 (RM Million) 10,838 11,957 12,920 14,378 15,263 16,333 18,295 20,154 21,222 21,338 23,664 28,232 628 691 1,013 995 1,086 1,222 1,222 1,148 1,160 1,310 1,024 1,148 0 5000 10000 15000 20000 25000 30000 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 RM Million Private Providers Public Providers 30,000 25,000 20,000 15,000 10,000 5,000 0 80 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 9.2b: OOP Health Expenditure to Private Providers of Health Care, 2022 (RM Million, Percent %) Provider Name RM (Million) Percent Private hospitals 13,696 48.51 Private medical clinics 5,995 21.23 Private pharmacies 4,599 16.29 Private dental clinics 1,416 5.02 All other private sector providers of health care 1,191 4.22 Traditional and Complementary Medicine (TCM) providers 795 2.82 Retail sale and other suppliers of medical goods and appliances 498 1.77 Private medical and diagnostic laboratories 41 0.15 Total 28,232 100.00 FIGURE 9.2b: OOP Health Expenditure to Private Providers of Health Care, 2022 48.5% 21.2% 16.3% 5.0% 4.2% 2.8% 1.8% <1% Private hospitals Private medical clinics Private pharmacies Private dental clinics All other private providers TCM providers Retail sale of medical goods & appliances Private medical & diagnostic labs OOP Health Expenditure to Private Providers: 95% of OOP Health Expenditure (RM23,428 Million) Private hospital 48.5% <1% 1.8% 2.8% 4.2% 5.0% 16.3% Private medical clinics Private pharmacies Private dental clinics All other private providers Retail sale of medical goods & appliances TCM Providers Private medical & diagnostic labs RM28,232 Million 21.2% 81 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 9.2c: OOP Health Expenditure to Providers of Health Care, 2011-2022 (RM Million) Provider Name 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Private hospitals 5,359 5,613 5,736 6,034 6,801 7,411 8,512 9,216 10,093 10,265 11,436 13,696 Private medical clinics 2,272 2,654 3,055 3,767 3,237 3,308 3,804 4,011 4,487 4,474 4,782 5,995 Private pharmacies 1,407 1,580 1,842 2,360 2,625 2,749 2,922 3,734 3,292 3,392 3,955 4,599 Private dental clinics 509 560 592 646 851 914 1,017 1,086 1,152 1,096 1,207 1,416 Traditional and Complementary Medicine (TCM) providers 394 412 424 452 534 624 658 667 667 627 686 795 Retail sale and other suppliers of medical goods and appliances 321 326 325 334 424 523 562 578 588 552 602 697 Private medical and diagnostic laboratories 43 59 78 108 72 33 35 35 35 33 36 41 All other private sector providers of health care 534 754 869 678 719 772 786 829 907 900 960 993 Sub-Total (Private Providers) 10,838 11,957 12,920 14,378 15,263 16,333 18,295 20,154 21,222 21,338 23,664 28,232 Public hospitals 259 253 334 309 358 445 440 431 460 514 473 520 Public medical clinics 45 50 44 48 47 47 43 43 45 69 39 37 Public institutions providing health- related services 324 388 634 638 669 716 724 657 635 713 493 574 Public dental clinics na na na na 13 14 16 17 20 11 15 18 Provision and administration of public health programmes (MOH) na na na na na na na na na 4 4 na Sub-Total (Public Providers) 628 691 1,013 995 1,086 1,222 1,222 1,148 1,160 1,310 1,024 1,148 Total 11,466 12,649 13,933 15,373 16,349 17,555 19,518 21,302 22,382 22,648 24,688 29,381 82 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022