mnha_2022.pdf

TABLE 10.2: Primary Health care (PHC) Boundaries (Malaysia) NEW OLD Provider Function Provider Function MOH Hospitals
without Specialist Basic medical and diagnostic services MOH Hospitals
without Specialist Basic medical and diagnostic services Hospitals
(Public non-MOH) Basic medical and diagnostic services Hospitals
(Public non-MOH) Basic medical and diagnostic services Hospitals (Private) Basic medical and diagnostic services Medical practitioner clinics Basic medical and diagnostic services Medical practitioner clinics Basic medical and diagnostic services Services of curative home care Services of curative home care All Providers Dental outpatient curative care All Providers Dental outpatient curative care Prevention and public health services (partial) Prevention and public health services (all) Outpatient long-term health care Outpatient home-based long- term care Pharmaceuticals and other medical non-durables (80%) Key stakeholders in Malaysia conducted extensive discussions and consultations to establish a framework for mapping the cross-tabulation of MNHA’s healthcare provider and function codes within the MNHA framework, following international recommendations. This cross- tabulation was aimed at enhancing the precision of primary healthcare spending. The main objective was to accurately represent PHC in alignment with a diverse set of agreed-upon guidelines. Discussions involved various organisations, including the Family Health Development Division (BPKK), the Public Health Development Division (BPKA), the Pharmaceutical Services Divisions, and the MNHA team of the Planning Division.   The boundaries of PHC extends beyond providing essential services to individuals, encompassing broader health determinants such as community- based disease prevention efforts as well as expenditures related to health promotion and prevention activities. Following continuous deliberations, an agreement was reached regarding the final boundaries of the National PHC, which are comprehensively outlined in Table 10.2. These conclusive arrangements underwent review by the Technical Advisory Committee and Steering Committee before receiving official endorsement. References: 1. Organisation for Economic Co-operation and Development. 2019. Deriving Preliminary Estimates of Primary Care Spending Under the SHA 2011 Framework. 2. World Health Organization. 2021. Measuring Primary Health Care Expenditure Under SHA 2011 Technical Note. 3. Hanson K. et al. 2022. The Lancet Global Health Commission on Financing Primary Health Care: Putting People at The Centre. 90 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

30.4% 69.6% Primary Health care Other funtions Total Expenditure on Health 2022: RM78,945 million Primary Health care Other functions 10.4 PRIMARY HEALTH CARE EXPENDITURE In 2022, the expenditure on primary health care (PHC) amounted to RM23,990 million, constituting 30.4% of the total health expenditure (TEH) (Figure 10.1). From this total PHC expenditure, public sources contributed 36.2%, while private sources accounted for 63.8% (Figure 10.2). The Ministry of Health (MOH) allocated RM8,020 million, representing 23.7% of its overall expenditure, towards PHC (Figure 10.3). FIGURE 10.1: Primary Health Care Expenditure as Percentage of Total Expenditure on Health, 2022 FIGURE 10.2: Primary Health Care Expenditure by Sources of Financing, 2022 Public Sources Private Sources 91 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

FIGURE 10.3: Primary Health Care Expenditure as Percentage of MOH Expenditure, 2022 23.7% 76.3% Primary Health Care Others MOH Expenditure Total MOH Expenditure : RM33,863 million Total MOH Expenditure : RM33,863 million Primary Health Care Others MOH Expenditure 92 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

G lobal Health Expenditure Database (GHED) is the largest database that provides a global reference for health expenditure data for 190 World Health Organization (WHO) member countries. On an annual basis, every member country submits their two years lag (t-2) national health expenditure data according to WHO request formats. WHO carries out its own country-level analysis and estimations in case of gaps in data based on the System of Health Accounts (SHA) framework. Available submitted country-specific NHA data and country-specific macro-level data from various sources, including the United Nations (UN), World Bank (WB), and International Monetary Fund (IMF) form the basis of WHO’s NHA analysis. The outputs of WHO analysis are then uploaded onto the GHED as the international health expenditure data of the member countries. These WHO estimations for member countries allow standardisation in NHA reporting and ensure better cross-country comparability. This is freely accessible via the related website. However, it is important to recognise that every member country, like Malaysia, may produce their own NHA reporting based on local needs. As such, the MNHA Framework with slightly different boundaries of definitions is more relevant in the Malaysian context, especially for policymakers, health planners, researchers and other interested parties. SHA is an internationally accepted methodology for analysing financial flow in the health systems of various countries. It was first published in 2000 by the Organisation for Economic Cooperation and Development (OECD) and later adopted by the WHO to inform health policy and measure health system performance. The first version of the SHA is referred to as SHA 1.0. In keeping with structural changes and further development of the health care industry during the subsequent decade, related international organisations of OECD, Eurostat, and WHO produced an updated version of the SHA, which is referred to as SHA 2011. GHED, in WHO website, accommodates NHA data reporting based on the latest SHA 2011 framework since December 2017. It was decided that for countries which have yet to migrate to this new format of NHA reporting, WHO would carry out their own analysis based on whatever available data, either in SHA 1.0 or SHA 2011 formats. Table 11.1 shows available data in the GHED under various headers, which have further disaggregated data as listed in Appendix Table A3.1 and A3.2. A total of eight developing and developed countries with potential policy relevance to Malaysia are selected from the WHO GHED database for country comparison. Comparisons were made based on 2021 as the latest available year when this report was produced. The countries included were the United States of America, United Kingdom, Australia, Republic of Korea, Singapore, Türkiye, Thailand and Indonesia. As mentioned in Section 2.3, CHE instead of TEH was used by WHO for international comparison. In 2021, based on the WHO GHED, the CHE of INTERNATIONAL NHA DATA CHAPTER 11 93 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

Malaysia was 4.4% of GDP compared to 4.1% in 2020, which was lower than other countries such as Türkiye, Thailand, Singapore, Republic of Korea, Australia, United Kingdom and United States of America but higher than our neighbouring country Indonesia (Figure 11.1). Even though SHA 2011 does not use the terms “public” or “private” sources of financing, the GHED maintains this terminology under the list of indicators under “domestic general government” and “domestic private” health expenditure (Appendix Table A3.1). Most developed countries have higher domestic government health expenditures than domestic private health expenditures (Figure 11.2). In terms of OOP health financing scheme, Malaysia is listed on first highest rank with 32.1% of CHE compare to other countries (Figure 11.3). TABLE 11.1: Available Data in GHED under Various Headers   Main Header   Sub-Header 1 Indicators 1.1 Aggregates 1.2 Financing Sources 1.3 Financing Schemes 1.4 Primary Health Care 1.5 Diseases and Conditions 1.6 COVID-19 1.7 Macro 2 Health Expenditure Data 2.1 Revenues 2.2 Financing Schemes 2.3 Health Care Functions 2.4 Diseases and Conditions 2.5 COVID-19 Spending Memorandum Items 2.6 Age 2.7 Health Care Providers 2.8 Capital Expenditure 3 Macro Data 3.1 Consumption 3.2 Exchanges Rates 3.3 Price Index 3.4 Population Source: Global Health Expenditure Database (GHED) WHO NHA on 5th February 2024 94 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

FIGURE 11.1: International Comparison of Current Health Expenditure as Percent GDP, 2021 Source: Global Health Expenditure Database (GHED) WHO NHA on 5th February 2024 Source: Global Health Expenditure Database (GHED) WHO NHA on 5th February 2024 FIGURE 11.2: International Comparison of Domestic Government and Private Health Expenditure, 2021 95 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

Source: Global Health Expenditure Database (GHED) WHO NHA on 5th February 2024 FIGURE 11.3: International Comparison of Out-of-pocket Health Financing Scheme as Percent of Current Health Expenditure, 2021 96 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

APPENDIX TABLES TABLE A1.1: Source of Data Data Sources for Public Sector Estimation PUBLIC SECTOR Main Agencies Specific Organisation Source of Data 1 Ministry of Health (MOH) Accountant-General’s Department MOH - AG DATA (expenditure) MOH - B11 MOH - B12 Ministry of Health (MOH) MOH - KWC MOH - IT MOH - Donation Perolehan MOH - Donation JKN 2 Other Ministries Ministry of Higher Education MNHA Survey - MOHE Ministry of Defence MNHA Survey - MOD 3 Other Federal Agencies National Population and Family Development Board MNHA Survey - LPPKN Department of Orang Asli Development MNHA Survey - JAKOA Public Service Department-Pension MNHA Survey - JPA Civil Defence Department MNHA Survey - JPAM Prison Department of Malaysia MNHA Survey - PENJARA Social Welfare Department MNHA Survey - JKM Department Occupational Safety and Health MNHA Survey - DOSH National Institute of Occupational Safety and Health Malaysia MNHA Survey - NIOSH National Anti-Drug Agency MNHA Survey - AADK Pilgrims Fund Board MNHA Survey - LTH National Heart Institute MNHA Survey - IJN Federal Statutory Bodies MNHA Survey - BERKANUN (Fed) Public Water Supply Department (Federal) MNHA Survey - JBA (OFA) National Sports Institute of Malaysia MNHA Survey - ISN Employee Provident Fund - HQ MNHA Survey - KWSP (0001) Employee Provident Fund - state MNHA Survey - KWSP (0002) Social Security Organization - HQ MNHA Survey - PERKESO (0001) Social Security Organization - state MNHA Survey - PERKESO (0002) Ministry of Science Technology and Innovation MNHA Survey - MOSTI Public Higher Education Institutions MNHA Survey - TRAINING (OFA-Pu) Private Higher Education Institutions MNHA Survey - TRAINING (OFA-Pr) Emergency Medical Rescue Services, Malaysia Fire and Rescue Department MNHA Survey - EMRS National Disaster Management Agency (NADMA) MNHA Survey - NADMA Majlis Keselamatan Negara (MKN) MNHA Survey - MKN 4 State Agencies State Government (General) MNHA Survey - KN Public Water Supply Department (State) MNHA Survey - JBA (state) State Statutory Body (SSB) MNHA Survey - BERKANUN (state) Public Water Supply Department (State Statutory Body) MNHA Survey - JBA (SSB) State Islamic Religious Council/Zakat Collection Centre MNHA Survey - MAIN 5 Local Authorities Local Authority - Health care Services MNHA Survey - PBT (Perkhid) Local Authority - Staff MNHA Survey - PBT (Ktgn) 97 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

TABLE A1.2: Source of Data Data Sources for Private Sector Estimation PRIVATE SECTOR Main Agencies Specific Organisation Source of Data 1 Private Insurance Central Bank of Malaysia MNHA Survey - BNM Insurance Agencies MNHA Survey - INSURAN 2 Managed Care Organization MCO Agencies MNHA Survey - MCO 3 Out of Pocket (Gross Spending) MOH user charges MOH - AG DATA (Revenue) IJN user charges MNHA Survey - IJN MOE user charges MNHA Survey - KPT Private Hospital (MNHA) MNHA Survey - PRIVATE HOSPITAL Private Hospital (DOSM) DOSM Survey - PRIVATE HOSPITAL Private Clinic (Medical), DOSM DOSM Survey - PRIVATE MEDICAL CLINIC Private Clinic (Dental), DOSM DOSM Survey - PRIVATE DENTAL CLINIC Private Haemodialysis Centre (MNHA) MNHA Survey - PRIVATE HEMO (0001) Pharmacy Division, MOH MNHA Survey - FARMASI (0001) IQVIA MNHA Survey - FARMASI (0002) Medical supplies HIES, DOSM DOSM Survey - HES DATA Medical durables/prostheses/equipments HIES, DOSM DOSM Survey - HES DATA Ancillary services HIES, DOSM DOSM Survey - HES DATA Private TCM HIES, DOSM DOSM Survey - HES DATA Public Higher Education Institutions MNHA Survey - TRAINING (OOP-Pu) Private Higher Education Institutions MNHA Survey - TRAINING (OOP-Pr) 4 Out-of Pocket (Third Party Deductions) Insurance Agencies MNHA Survey - INSURAN Central Bank of Malaysia MNHA Survey - BNM Private Corporations MNHA Survey - PRIVATE CORPORATION Employees Provident Fund MNHA Survey - KWSP Social Security Organization MNHA Survey - PERKESO Federal Statutory Bodies MNHA Survey - BERKANUN (Fed) State Statutory Body MNHA Survey - BERKANUN (state) FOMEMA/UNITAB MEDIC - OOP data MNHA Survey - UNITABMEDIC GROWARISAN - OOP data MNHA Survey - GROWARISAN 98 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

PRIVATE SECTOR Main Agencies Specific Organisation Source of Data 5 Non-Governmental Organization Non-Governmental Organizations MNHA Survey - NGO 6 Corporations Limited and Private Limited Corporations MNHA Survey - PRIVATE CORPORATION Labour Force Survey, DOSM DOSM Survey - CORPS_DOS (0002) Industrial Survey, DOSM DOSM Survey - CORPS_DOS (0001-non med) Private Hospital staff, DOSM DOSM Survey - CORPS_DOS (0001-hosp) Private Clinic Medical, DOSM DOSM Survey - CORPS_DOS (0001-clinic) Private Clinic Dental, DOSM DOSM Survey - CORPS_DOS (0001-dental) Private Water Supply Department MNHA Survey - JBA (corp) FOMEMA/UNITAB MEDIC MNHA Survey - UNITABMEDIC GROWARISAN MNHA Survey - GROWARISAN Public Higher Education Institutions MNHA Survey - TRAINING (Corp-Pu) Private Higher Education Institutions MNHA Survey - TRAINING (Corp-Pr) Information Technology Corporations CORPS - IT 7 Rest of the world International Organizations in Malaysia MNHA Survey - Rest 8 Other National Surveys DOSM-Population survey General-DOS General_DOS (0001) DOSM-GDP & GDP Deflator General-DOS General_DOS (0002) DOSM-Household Consumption General-DOS General_DOS (0003) 99 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022