mnha_2022.pdf

4.3 HEALTH EXPENDITURE BY STATES Health expenditure by state allocation is assigned based on the facilities where the financial resources were used to purchase various types of health care services and products. In the event that this is not possible, it will be allocated based on the location of the agencies that represent the facilities. The sequence of states in the figures and tables below is based on the state population size in 2022 as the reference year. There are thirteen states and three Federal Territories, namely Kuala Lumpur, Labuan and Putrajaya. The state population is based on Department of Statistics Malaysia report. In 2022, Selangor had both the largest population of about 7 million people and the highest expenditure on health of RM13,046 million, as shown in Table 4.3 and Figure 4.3. FIGURE 4.2: Per Capita Expenditure on Health, 2011-2022 (Nominal & Constant, RM) 2,385 14 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

Table 4.3: State Population and Health Expenditure, 2022 State Population* Expenditure (RM Million) Selangor 7,050,300 13,046 FT KL 1,961,200 11,044 Johor 4,028,300 6,128 Penang 1,740,900 4,996 Perak 2,514,400 4,657 Sabah 3,414,900 4,600 Sarawak 2,473,500 4,492 Kedah 2,163,100 3,258 Pahang 1,614,300 2,946 Kelantan 1,830,600 2,776 N.Sembilan 1,207,900 2,478 Melaka 1,008,600 2,330 Terengganu 1,186,600 1,897 FT Putrajaya 117,000 720 Perlis 289,800 618 FT Labuan 96,900 167 **National (Unable to allocate) na 12,793 Total 32,698,300 78,945 *Source: Department of Statistics Malaysia (DOSM) **Note: Unable to allocate by states 15 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

FIGURE 4.3: Health Expenditure by States, 2022 (RM Million) 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 16 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

HEALTH EXPENDITURE BY SOURCES OF FINANCING S ources of financing for health care services and products include multiple public and private sector agencies. The public sources of health care financing are the federal government, state government, local authorities, social security funds and all other public entities. Private sources of health care financing include private insurance enterprises, managed care organisations (MCO), private household out-of-pocket (OOP), non-profit institutions, private corporations and the rest of the world. The share of both sectors to the TEH can be identified for each year in the time series. This chapter contains three main sections, namely health expenditure by all sources of financing and health expenditure specifically by both public and private sources of health care financing in Section 5.2 and Section 5.3 respectively. An overview of health expenditure by sources of financing is shown in Figure 5.0. CHAPTER 5 FIGURE 5.0: Organogram of Health Expenditure by Sources of Financing HEALTH EXPENDITURE BY SOURCES OF FINANCING Total Expenditure on Health by Public & Private Sources of Financing Health Expenditure by Public Sources of Financing Health Expenditure by Private Sources of Financing Health Expenditure by All Public Sources of Financing Health Expenditure by All Private
Sources of Financing Health Expenditure by Public Sources of Financing to Providers of Healthcare Health Expenditure by Private Sources of Financing for Functions of Healthcare Public Source Health Expenditure (PSHE) as Percentage of Public Sector Expenditure (PSE) Health Expenditure by Private
Sources of Financing to Providers of Healthcare Health Expenditure by Public
Sources of Financing for Functions of Healthcare 17 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

5.1 HEALTH EXPENDITURE BY PUBLIC AND PRIVATE SOURCES OF FINANCING Among the various sources of health care financing in 2022, Ministry of Health (MOH) sourced the highest expenditure amounting to RM33,863 million or 42.9% of TEH. This is followed by private household out-of-pocket (OOP) spending of RM29,381 million (37.2% of TEH) and private insurance enterprises (other than social insurance) spending of RM6,535 million (8.3% of TEH). Other federal agencies (including statutory bodies) spent RM3,796 million (4.8% of TEH), whereas the Ministry of Higher Education (MoHE) spent RM 1,807 million (2.3% of TEH), private MCOs and other similar entities spent RM1,087 million (1.4% of TEH) and remaining expenditure for all other agencies amounted to RM 2,475 million (3.1% of TEH) (Table 5.1a and Figure 5.1a). TABLE 5.1a: Total Expenditure on Health by Sources of Financing, 2022 MNHA Code Sources of Financing RM Million Percent MS1.1.1.1 Ministry of Health (MOH) 33,863 42.89 MS2.4 Private household out-of-pocket expenditures (OOP) 29,381 37.22 MS2.2 Private insurance enterprises (other than social insurance) 6,535 8.28 MS1.1.1.9 Other federal agencies (including statutory bodies) 3,796 4.81 MS1.1.1.2 Ministry of Higher Education (MoHE) 1,807 2.29 MS2.3 Private MCOs and other similar entities 1,087 1.38 MS1.1.2.2 Other state agencies (including statutory bodies) 587 0.74 MS2.6 All corporations (other than health insurance) 537 0.68 MS1.2.2 Social Security Organization (SOCSO) 496 0.63 MS1.1.3 Local authorities (LA) 251 0.32 MS1.1.1.3 Ministry of Defense (MOD) 194 0.25 MS1.1.2.1 (General) State government 175 0.22 MS2.5 Non-profit institutions serving households (NGO) 148 0.19 MS1.2.1 Employees Provident Fund (EPF) 88 0.11 Total 78,945 100.00 The trend of expenditure by sources of health care financing over the past 12 years shows that overall, the top 3 funders are persistently MOH, private household out-of-pocket expenditures (OOP) and private insurance (other than social insurance) (Table 5.1b and Table 5.1c). In 2022, the public and private sources of health care financing spent RM41,257 million (52.3% of TEH) and RM37,688 million (47.7% of TEH), respectively. A similar pattern is noted throughout the 2011-2022 time series, where the public sector health expenditure remains higher than the private sector health expenditure. Both public and private sector health expenditure generally showed an increasing trend throughout the 12 years (Table 5.1d and Figure 5.1b). 18 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

FIGURE 5.1a: Total Expenditure on Health by Sources of Financing, 2022 42.9% 37.2% 8.3% 4.8% 3.1% 2.3% 1.4% MOH Private household OOP Private insurance Other federal agencies All other agencies MoHE MCO Total Health Expenditure (TEH): RM 78,945 Million MOH Private household OOP Private insurance All other agencies MoHE MCO Other federal agencies Total Health Expenditure (TEH): RM78,945 Million 19 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

TABLE 5.1b: Total Expenditure on Health 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 Ministry of Health (MOH) 16,496 18,239 19,038 21,782 22,737 22,315 24,775 26,561 28,903 31,011 38,487 33,863 MS1.1.1.2 Ministry of Higher Education (MoHE) 1,245 1,311 1,261 1,376 1,314 1,279 1,256 1,371 1,642 1,464 1,721 1,807 MS1.1.1.3 Ministry of Defence (MOD) 140 172 175 186 169 154 132 103 150 135 197 194 MS1.1.1.9 Other federal agencies (including statutory bodies) 1,813 1,678 1,677 1,805 1,886 2,020 2,076 2,120 2,244 2,531 2,833 3,796 MS1.1.2.1 (General) State government 90 105 78 86 90 97 111 150 124 207 249 175 MS1.1.2.2 Other state agencies (including statutory bodies) 129 137 189 212 346 385 392 467 502 504 535 587 MS1.1.3 Local authorities (LA) 142 150 188 164 178 138 154 194 249 264 247 251 MS1.2.1 Employees Provident Fund (EPF) 39 38 42 46 52 56 58 67 83 79 102 88 MS1.2.2 Social Security Organisation (SOCSO) 157 176 219 264 261 310 329 410 394 409 434 496 MS2.2 Private insurance enterprises (other than social insurance) 2,614 2,774 2,916 3,203 3,623 3,846 4,085 4,313 4,875 4,960 5,533 6,535 MS2.3 Private MCOs and other similar entities 243 302 287 437 626 831 879 922 993 927 1,040 1,087 MS2.4 Private household out-of- pocket expenditures (OOP) 11,466 12,649 13,933 15,373 16,349 17,555 19,518 21,302 22,382 22,648 24,688 29,381 MS2.5 Non-profit institutions serving households (NGO) 314 365 81 44 74 91 97 97 95 292 249 148 MS2.6 All corporations (other than health insurance) 1,064 1,352 1,564 1,803 2,550 2,678 2,542 2,449 1,702 1,620 1,391 537 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 20 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022

TABLE 5.1c: Total Expenditure on Health 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 Ministry of Health (MOH) 45.88 46.24 45.71 46.56 45.24 43.12 43.92 43.88 44.93 46.25 49.53 42.89 MS1.1.1.2 Ministry of Higher Education (MoHE) 3.46 3.32 3.03 2.94 2.62 2.47 2.23 2.27 2.55 2.18 2.21 2.29 MS1.1.1.3 Ministry of Defence (MOD) 0.39 0.44 0.42 0.40 0.34 0.30 0.23 0.17 0.23 0.20 0.25 0.25 MS1.1.1.9 Other federal agencies (including statutory bodies) 5.04 4.25 4.03 3.86 3.75 3.90 3.68 3.50 3.49 3.77 3.65 4.81 MS1.1.2.1 (General) State government 0.25 0.27 0.19 0.18 0.18 0.19 0.20 0.25 0.19 0.31 0.32 0.22 MS1.1.2.2 Other state agencies (including statutory bodies) 0.36 0.35 0.45 0.45 0.69 0.74 0.69 0.77 0.78 0.75 0.69 0.74 MS1.1.3 Local authorities (LA) 0.39 0.38 0.45 0.35 0.35 0.27 0.27 0.32 0.39 0.39 0.32 0.32 MS1.2.1 Employees Provident Fund (EPF) 0.11 0.10 0.10 0.10 0.10 0.11 0.10 0.11 0.13 0.12 0.13 0.11 MS1.2.2 Social Security Organisation (SOCSO) 0.44 0.45 0.53 0.57 0.52 0.60 0.58 0.68 0.61 0.61 0.56 0.63 MS2.2 Private insurance enterprises (other than social insurance) 7.27 7.03 7.00 6.85 7.21 7.43 7.24 7.13 7.58 7.40 7.12 8.28 MS2.3 Private MCOs and other similar entities 0.68 0.77 0.69 0.93 1.25 1.60 1.56 1.52 1.54 1.38 1.34 1.38 MS2.4 Private household out-of- pocket expenditures (OOP) 31.89 32.06 33.45 32.86 32.53 33.92 34.60 35.19 34.79 33.78 31.77 37.22 MS2.5 Non-profit institutions serving households (NGO) 0.87 0.93 0.19 0.09 0.15 0.18 0.17 0.16 0.15 0.44 0.32 0.19 MS2.6 All corporations (other than health insurance) 2.96 3.43 3.75 3.85 5.07 5.17 4.51 4.05 2.65 2.42 1.79 0.68 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 21 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022