T6.3b Health Expenditure to Providers of Ambulatory Health Care by Sources of Financing, 2011-2022 (RM Million) 52 T6.3c Health Expenditure to Providers of Ambulatory Health Care by Sources of Financing, 2011-2022 (Percent, %) 52 T7.1a Total Expenditure on Health for Functions of Health Care, 2022 54 T7.1b Total Expenditure on Health for Functions of Health Care, 2011-2022 (RM Million) 55 T7.1c Total Expenditure on Health for Functions of Health Care, 2011-2022 (Percent, %) 56 T7.2a Health Expenditure for Curative Care by Sources of Financing, 2022 57 T7.2b Health Expenditure for Curative Care by Sources of Financing, 2011-2022 (RM Million) 59 T7.2c Health Expenditure for Curative Care by Sources of Financing, 2011-2022 (Percent, %) 59 T7.3a Health Expenditure for Public Health Services (including Health Promotion and Prevention) by Sources of Financing, 2022 60 T7.3b Health Expenditure for Public Health Services (including Health Promotion and Prevention) by Sources of Financing, 2011-2022 (RM Million) 62 T7.3c Health Expenditure for Public Health Services (including Health Promotion and Prevention) by Sources of Financing, 2011 - 2022 (Percent, %) 63 T7.4a Health Expenditure for Health Education and Training by Sources of Financing, 2022 64 T7.4b Health Expenditure for Health Education and Training by Sources of Financing, 2011-2022 (RM Million) 66 T7.4c Health Expenditure for Health Education and Training by Sources of Financing, 2011-2022 (Percent, %) 66 T8.1 MOH Share of Total Expenditure on Health and Percent GDP, 2011-2022 68 T8.2.1a Health Expenditure at MOH Hospitals by Sources of Financing, 2022 70 T8.2.1b Health Expenditure at MOH Hospitals by Sources of Financing, 2011-2022 (RM Million) 71 T8.2.1c Health Expenditure at MOH Hospitals by Sources of Financing, 2011-2022 (Percent, %) 71 T8.2.2a Health Expenditure at MOH Hospitals for Functions of Health Care, 2022 72 T8.2.2b Health Expenditure at MOH Hospitals for Functions of Health Care, 2011-2022 (RM Million) 74 T8.2.2c Health Expenditure at MOH Hospitals for Functions of Health Care, 2011-2022 (Percent, %) 74 T9.1a OOP Share of Total Expenditure on Health and Private Sector Health Expenditure, 2011-2022 76 T9.1b OOP Health Expenditure and as GDP Percentage, 2011-2022 77 T9.2a OOP Health Expenditure to Public and Private Providers of Health Care, 2011-2022 (RM Million) 80 T9.2b OOP Health Expenditure to Private Providers of Health Care, 2022 (RM Million, Percent, %) 81 T9.2c OOP Health Expenditure to Providers of Health Care, 2011-2022 (RM Million) 82 T9.2d OOP Health Expenditure to Providers of Health Care, 2011-2022 (Percent, %) 83 T9.3a OOP Health Expenditure for Functions of Health Care, 2011-2022 (RM Million) 85 T9.3b OOP Health Expenditure for Functions of Health Care, 2011-2022 (Percent, %) 85 T10.1 Comparison of Primary Health Care Boundaries [Global] 89 T10.2 Primary Health Care (PHC) Boundaries [Malaysia] 90 T11.1 Available Data in GHED under Various Headers 94 vii MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
LIST OF FIGURES F2.1 Total Expenditure on Health in MNHA Framework 3 F2.2 Current Health Expenditure in SHA 2011 Framework 4 F4.1 Trend for Total Expenditure on Health, 2011-2022 (RM Million & Percent GDP) 13 F4.2 Per Capita Expenditure on Health, 2011-2022 (Nominal & Constant, RM) 14 F4.3 Health Expenditure by States, 2022 (RM Million) 16 F5.0 Organogram of Health Expenditure by Sources of Financing 17 F5.1a Total Expenditure on Health by Sources of Financing, 2022 19 F5.1b Total Expenditure on Health by Sources of Financing (Public vs. Private), 2011-2022 22 F5.2.1 Health Expenditure by Public Sources of Financing, 2022 24 F5.2.2 Trend for Public Sources Health Expenditure (PSHE) as Percentage of Public Source Expenditure (PSE), 2011-2022 26 F5.2.3 Public Sources Health Expenditure to Providers of Health Care, 2022 28 F5.2.4 Public Sources Health Expenditure for Functions of Health Care, 2022 31 F5.3.1 Health Expenditure by Private Sources of Financing, 2022 34 F5.3.2 Private Sources Health Expenditure to Providers of Health Care, 2022 37 F5.3.3 Private Sources Health Expenditure for Functions of Health Care, 2022 40 F6.0 Organogram of Health Expenditure to Providers of Health Care 43 F6.1 Total Expenditure on Health to Providers of Health Care, 2022 44 F6.2 Health Expenditure at All Hospitals by Sources of Financing, 2022 47 F6.3 Health Expenditure to Providers of Ambulatory Health Care (Non-Hospital Setting) by Sources of Financing, 2022 51 F7.1 Total Expenditure on Health for Functions of Health Care, 2022 54 F7.2 Health Expenditure for Curative Care by Sources of Financing, 2022 58 F7.3 Health Expenditure for Public Health Services (including Health Promotion and Prevention) by Sources of Financing, 2022 61 F7.4 Health Expenditure for Health Education and Training by Sources of Financing, 2022 65 F8.1 MOH Expenditure on Health and Percent GDP, 2011-2022 68 F8.2.1 Health Expenditure at MOH Hospitals by Sources of Financing, 2011-2022 (RM Million) 70 F8.2.2 Health Expenditure at MOH Hospitals for Curative Care Functions of Health Care, 2022 73 F9.1a OOP Share of Total Expenditure on Health, 2011-2022 (Percent, %) 77 F9.1b OOP Share of Private Sector Health Expenditure, 2011-2022 (Percent, %) 78 F9.1c OOP Health Expenditure and as GDP Percentage, 2011-2022 (RM Million, Percent, %) 78 F9.2a OOP Health Expenditure to Public and Private Providers of Health Care, 2011-2022 (RM Million) 80 F9.2b OOP Health Expenditure to Private Providers of Health Care, 2022 81 viii MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
F9.3a OOP Health Expenditure for Functions of Health Care, 2022 86 F9.3b OOP Health Expenditure for Functional Proportion, 2011 & 2022 87 F10.1 Primary Health Care Expenditure as Percentage of Total Expenditure on Health, 2022 91 F10.2 Primary Health Care Expenditure by Sources of Financing, 2022 91 F10.3 Primary Health Care Expenditure as Percentage of MOH Expenditure, 2022 92 F11.1 International Comparison of Current Health Expenditure as Percent GDP, 2021 95 F11.2 International Comparison of Domestic Government and Private Health Expenditure, 2021 95 F11.3 International Comparison of Out-of-Pocket Health Financing Scheme as Percent of Current Health Expenditure, 2021 96 ix MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
LIST OF APPENDIX TABLES A1.1 Source of Data (Data Sources for Public Sector Estimation) 97 A1.2 Source of Data (Data Sources for Private Sector Estimation) 98 A2.1 Classification of Total Expenditure on Health by Sources of Financing 100 A2.2 Classification of Total Expenditure on Health to Providers of Health Care 101 A2.3 Classification of Total Expenditure on Health for Functions of Health Care 102 A3.1 WHO Indicators and Data - Malaysian Health Expenditure from Global Health Expenditure Database (GHED) 103 A3.2 Malaysia Current Health Expenditure by Revenues and Health Care Financing Schemes from Global Health Expenditure Database (GHED) 104 A3.3 Malaysia Current Health Expenditure for Functions of Health Care from Global Health Expenditure Database (GHED) 105 A3.4 Macro Data from Global Health Expenditure Database (GHED) 106 x MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
AADK Agensi Anti Dadah Kebangsaan (National Anti-Drug Agency) AG Accountant General AGD Accountant General’s Department of Malaysia BNM Bank Negara Malaysia (Central Bank of Malaysia) CHE Current Health Expenditure COICOPS Classification of Individual Consumption by Purpose CORPS Corporations DOSH Department of Occupational Safety and Health DOSM Department of Statistics Malaysia EPF Employees Provident Fund EMRS Emergency Medical Rescue Services EPU Economic Planning Unit FOMCA Federation of Malaysia Consumers Association FOMEMA Foreign Worker’s Medical Examination Monitoring Agency FT Federal Territory GDP Gross Domestic Product GHED Global Health Expenditure Database HC ICHA code for functions of health services HC.R ICHA code for health-related services HER Health Expenditure Report HES Household Expenditure Survey HIES Household Income and Expenditure Survey HF ICHA code for sources of financing for health services HP ICHA code for providers of health services HQ Headquarters ICHA International Classification for Health Accounts IJN Institut Jantung Negara (National Heart Institute) IMF International Monetary Fund ISN Institut Sukan Negara (National Sports Institute) IT Information Technology JAKOA Jabatan Kemajuan Orang Asli (Department of Orang Asli Development) JBA Jabatan Bekalan Air (Water Supply Department) JHAQ Joint Health Accounts Questionnaire JKM Jabatan Kebajikan Masyarakat (Social Welfare Department) JPA Jabatan Perkhidmatan Awam (Public Service Department) KL Kuala Lumpur KN Kerajaan negeri (State government) KWAP Kumpulan Wang Persaraan KWC Kumpulan Wang COVID-19 LA/PBT Local authorities (Pihak berkuasa tempatan) LPPKN Lembaga Penduduk dan Pembangunan Keluarga Negara (National Population and Family Development Board) LTH Lembaga Tabung Haji (Pilgrims Fund Board) LIST OF ABBREVIATIONS xi MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
MAIN Majlis Agama Islam Negeri (Zakat Collection Centre) MCO Managed Care Organisation MF MNHA code for functions of health care MKN Majlis Keselamatan Negara Malaysia (Malaysian National Security Council) MNHA Malaysia National Health Accounts MOD Ministry of Defence MOF Ministry of Finance MOH Ministry of Health MoHE Ministry of Higher Education MOSTI Ministry of Science Technology and Innovation MP MNHA code for providers of health care MR MNHA code for health-related functions MS MNHA code for sources of financing NA Not Available NADMA National Disaster Management Agency (Agensi Pengurusan Bencana Negara) NCU National Currency Unit NGO/NPISH Non-Governmental Organization/Non-profit institutions serving households NHA National Health Accounts NIOSH National Institute of Occupational Safety and Health NRI Non-residual items OECD Organisation for Economic Co-operation and Development OFA Other federal agencies OOP Out-of-pocket PC Primary Care PHC Primary Health Care PPE Personal protective equipment PSD Public Service Department PSE Public Sector Expenditure PSHE Public Sector Health Expenditure RI Residual items RM Ringgit Malaysia (Malaysia Currency) RMK Rancangan Malaysia ROW Rest of the world SHA System of Health Accounts SHA 1.0 System of Health Accounts, Version 1.0 (published in 2000) SHA 2011 System of Health Accounts, 2011 Edition SOCSO Social Security Organisation SOP Standard Operating Procedure SSB State statutory body TCM Traditional and Complementary Medicine TEH Total Expenditure on Health UKAS Unit Kerjasama Awam Swasta (Public Private Partnership Unit) UN United Nations UNDP United Nations Development Programme USA United States of America WHO World Health Organization WB World Bank xii MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
Malaysia is an upper middle-income country with a health care system that delivers a comprehensive range of services through a combination of public and private health care providers. MNHA Framework is based on the SHA 1.0 classification with some minor modifications to suit local policy needs Macro level health expenditure information 12 years of National Health Expenditure data (2011-2022) EXECUTIVE SUMMARY OF 2022 TEH as % of GDP CHE as % of GDP MOH Expenditure OOP Expenditure TEH Per Capita Public Source of Financing Private Source of Financing Curative Care services Total Expenditure on Health (TEH) as percentage of Gross Domestic Product (GDP) Current Health Expenditure (CHE) as percentage of GDP as % of TEH as % of TEH as % of TEH as % of TEH Per capita expenditure on health expenditure as % of TEH 4.4% 3.9% 42.9% 37.2% RM 2,414 52.3% 47.7% 65.8% TEH RM78,945m (Total Expenditure on Health) xiii MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
REPORT INFORMATION This report contains twelve years of national health expenditure data from 2011 to 2022, estimated using standardised and internationally acceptable National Health Accounts (NHA) methodology. The ‘Malaysia National Health Accounts: Health Expenditure Report 2011-2022’ has a total of eleven (11) chapters. CHAPTER 1: BACKGROUND Provides a comprehensive background of MNHA’s establishment and subsequent productions of annual series of MNHA Health Expenditure Reports. CHAPTER 2: MALAYSIA NATIONAL HEAL TH ACCOUNTS (MNHA) SUMMARY OF FRAMEWORK Explains the MNHA Framework which is based on the SHA 1.0 classification. It further unravels the three main entities of the framework: Sources of financing (MS), Providers of health care (MP) & Functions of Health care (MF). CHAPTER 3: METHODOLOGY OF DATA COLLECTION AND ANAL YSIS Explains the general methodology that includes data collection, analysis and data processing techniques used for various agencies. CHAPTER 4: TOTAL EXPENDITURE ON HEAL TH Encompasses Total Expenditure on Health (TEH) trends from year 2011 to 2022 as percentage of Gross Domestic Product (GDP), Per capita health expenditures for the same time period and stable disaggregation of health expenditure. CHAPTER 5: HEAL TH EXPENDITURE BY SOURCES OF FINANCING Shows data on the major categories of the sources of financing, namely the public and private sectors, which are separately cross tabulated with the dimensions of providers and functions of health care. Also contains Public Source Health Expenditure (PSHE). xiv MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022 Colour Scheme for Charts/Figures: Public sectors Private sectors Private & public sectors CHAPTER 6: HEAL TH EXPENDITURE TO PROVIDERS OF HEAL TH CARE Provides data on the Total Expenditure on Health to providers of health care. This chapter includes cross-tabulation data of sources with hospital and source with ambulatory care. There is also a section regarding Primary Care (PC) and Primary Health Care (PHC) expenditure. CHAPTER 7: HEAL TH EXPENDITURE FOR FUNCTIONS OF HEAL TH CARE Provides data on the Total Expenditure on Health for functions of health care. Data on separate cross-tabulations of curative care function, expenditures for public health programmes (including health promotion and prevention) and expenditures for health education and training by sources of financing are also presented in this chapter. CHAPTER 8: MOH HEAL TH EXPENDITURE Shows Ministry of Health’s (MOH) expenditures as share of TEH and as percentage of GDP. Also contains data on separate cross-tabulations between MOH hospital expenditure with MOH as a source of financing and functions of health care. CHAPTER 9: OUT-OF-POCKET HEAL TH EXPENDITURE Shows OOP as a share of total and private sector expenditures, as percentage of GDP, as well as cross-tabulations of OOP to providers and to functions of health care. CHAPTER 10: PRIMARY HEAL TH CARE (PHC) EXPENDITURE Compares new and old boundaries for reporting of Primary health care expenditure. Also shows Total PHC expenditure as a percentage of TEH as wall as PHC share of Total MOH expenditure. CHAPTER 11: INTERNATIONAL NHA DATA Contains international comparisons of Malaysia’s NHA data with NHA data from neighbouring and regional countries as well as some developed countries obtained from GHED. xv MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022 BACKGROUND N ational Health Accounts (NHA) are systems that track and quantify the flow of health expenditure throughout the health system. This tool can provide a better understanding of the financial dimensions within any country’s health system because it is based on standardised definitions and accounting methods. The origins of NHA development began with a study to compile comparable health services expenditure of six countries in the 1960s. The importance of health accounts is evident with the increasing number of countries participating in tracking the flow of health expenditures. In Malaysia, discussions on initiating the NHA in Malaysia began as early as 1999. Upon securing the funds from the United Nations Development Programme (UNDP) in 2001, the Ministry of Health (MOH) Malaysia, in a concerted effort with the Economic Planning Unit (EPU) of the Prime Minister’s Office, launched the “Malaysia National Health Accounts (MNHA) Project”. The project’s outcome was a report on the MNHA Classification System (MNHA Framework) and the first MNHA Health Expenditure Report (HER). The completion of the MNHA project put forth the benefits of having a health account as an evidence-based tool in making health policy decisions, leading to the establishment of the MNHA Section under the Planning & Development Division of MOH. After its institutionalisation, the MNHA Section, under the guidance of an international consultant, proceeded to further standardise the methodology used. Following this, health expenditure time series reports were published annually. From 2022 onwards, MNHA will be publishing National Health Expenditure time series data based on the duration of the 3 most recent Rancangan Malaysia (RMK) cycles. This year’s report will consist of data covering the years for RMK-10, RMK-11 & RMK- 12 (2011-2022). The chapters in this publication encompass health expenditures by sources of financing, expenditures to providers of health care, and expenditures for functions of health care analysed based on the MNHA Framework. In addition to this, a chapter containing international NHA data extracted from the Global Health Expenditure Database (GHED) is included. We would like to inform the readers regarding the colour scheme used in the charts of this report. All public sectors are highlighted in blue, while private sectors are red. Purple is used for the combination of both private and public sectors. Components on tables may not add to the total of 100% due to rounding up. Due to the methodology in which NHA data are produced, the data in the most current report replaces all annual data stated in previous publications. It is reminded that most of the data are in nominal Ringgit Malaysia (RM) values unless indicated otherwise. CHAPTER 1 1 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022