5.2.4 Health Expenditure by Public Sources of Financing for Functions of Health Care Cross-tabulations of public sources of financing for functions of health care respond to the question of what type of health care services and products were these publicly sourced funds spent on. In 2022, majority of public sources of financing health expenditure was spent for curative care services, amounting to RM25,856 million (62.7% of PSHE). This is followed by spending for public health services (including health promotion and prevention) at RM4,823 million (11.7% of PSHE), capital formation at RM4,552 million (11.0% of PSHE), health programme administration and health insurance at RM4,334 million (10.5% of PSHE) and education and training of health personnel at RM891 million (2.2% of PSHE). The total expenditure for all other functions of health care services and products was RM800 million (1.9% of PSHE) (Table 5.2.4a and Figure 5.2.4). The trend in spending by public sources of health care financing over the past 12 years shows that the top 5 functions of health care for which the funds are being spent on are for services of curative care, public health services (including health promotion and prevention), health programme administration and health insurance, capital formation of health care provider institutions and education and training of health personnel (Table 5.2.4b and Table 5.2.4c). TABLE 5.2.4a: Public Source Health Expenditure for Functions of Health Care, 2022 MNHA Code Functions of Health Care RM Million Percent MF1 Services of curative care 25,856 62.67 MF6 Public health services (including health promotion and prevention) 4,823 11.69 MR1 Capital formation of health care provider institutions 4,552 11.03 MF7 Health programme administration and health insurance 4,334 10.51 MR2 Education and training of health personnel 891 2.16 MF5 Medical goods dispensed to out-patients 293 0.71 MF4 Ancillary services to health care 264 0.64 MR3 Research and development in health 241 0.58 MF3 Services of long-term nursing care 1 <0.01 Total 41,257 100.00 30 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
FIGURE 5.2.4: Public Source Health Expenditure for Functions of Health Care, 2022 62.7% 11.7% 11.0% 10.5% 2.2% 1.9% Services of curative care Public health services (include promotion & prevention) Capi tal formation Health programme administration & health insurance Education & trai ning of health personnel All other functions Public Sector Health Expenditure: 52% of TEH (RM41,257 Million) Sources 31 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022 TABLE 5.2.4b: Public Source Health Expenditure for Functions of Health Care, 2011-2022 (RM Million) MNHA Code Functions of Health Care 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MF1 Services of curative care 12,950 15,021 15,013 17,719 18,708 19,121 20,725 22,427 23,156 22,174 23,940 25,856 MF3 Services of long-term nursing care 1 1 0 1 1 0 0 1 1 50 1 1 MF4 Ancillary services to health care 224 228 310 268 276 260 284 287 243 244 175 264 MF5 Medical goods dispensed to out- patients 107 138 169 183 287 284 305 183 172 105 238 293 MF6 Public health services (including health promotion and prevention) 996 1,201 1,961 1,838 1,928 2,028 2,163 2,358 3,280 4,486 9,873 4,823 MF7 Health programme administration and health insurance 2,165 1,916 2,242 2,936 2,904 2,111 3,070 2,869 3,786 4,020 3,960 4,334 MR1 Capital formation of health care provider institutions 2,179 2,038 1,817 1,488 1,455 1,433 1,376 1,656 1,967 3,931 5,406 4,552 MR2 Education and training of health personnel 1,584 1,407 1,288 1,430 1,415 1,466 1,308 1,607 1,548 1,357 886 891 MR3 Research and development in health 46 56 67 58 59 51 52 57 137 237 325 241 Total 20,251 22,007 22,868 25,921 27,034 26,754 29,283 31,444 34,290 36,603 44,803 41,257 TABLE 5.2.4c: Public Source Health Expenditure for Functions of Health Care, 2011-2022 (Percent, %) MNHA Code Functions of Health Care 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MF1 Services of curative care 63.95 68.26 65.65 68.36 69.20 71.47 70.78 71.32 67.53 60.58 53.43 62.67 MF3 Services of long-term nursing care 0.00 0.01 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.14 0.00 0.00 MF4 Ancillary services to health care 1.10 1.03 1.35 1.03 1.02 0.97 0.97 0.91 0.71 0.67 0.39 0.64 MF5 Medical goods dispensed to out-patients 0.53 0.63 0.74 0.70 1.06 1.06 1.04 0.58 0.50 0.29 0.53 0.71 MF6 Public health services (including health promotion and prevention) 4.92 5.46 8.58 7.09 7.13 7.58 7.39 7.50 9.56 12.26 22.04 11.69 MF7 Health programme administration and health insurance 10.69 8.71 9.81 11.33 10.74 7.89 10.48 9.13 11.04 10.98 8.84 10.51 MR1 Capital formation of health care provider institutions 10.76 9.26 7.94 5.74 5.38 5.36 4.70 5.27 5.74 10.74 12.07 11.03 MR2 Education and training of health personnel 7.82 6.40 5.63 5.52 5.24 5.48 4.47 5.11 4.52 3.71 1.98 2.16 MR3 Research and development in health 0.23 0.26 0.29 0.23 0.22 0.19 0.18 0.18 0.40 0.65 0.72 0.58 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 32 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
5.3 HEALTH EXPENDITURE BY PRIVATE SOURCES OF FINANCING This section describes health expenditure according to MNHA classification of private sources of health care financing for the year 2022, followed by time series data for 2011-2022. 5.3.1 Health Expenditure by All Private Sources of Financing In 2022, private sector health expenditure was RM37,688 million or 47.7% of TEH. Analysis of the private sources of health care financing showed that the highest contribution was by private household out-of-pocket (OOP) expenditure amounting to RM29,381 million or 78.0% of private sector health expenditure. The subsequent highest spending was by private insurance enterprises (other than social insurance) which included personal, family and company insurance/Takaful policies, at RM6,535 million (17.3% of private sector health expenditure). Private MCOs and other similar entities contributed RM1,087 million (2.9% of private sector health expenditure). The remaining private sources of health care financing spent RM684 million or 1.8% of private sector health expenditure (Table 5.3.1a and Figure 5.3.1) The trend of expenditure by private sources of health care financing over the past 12 years shows that the top 2 funders are persistently private household OOP expenditure and private insurance enterprises (other than social insurance) (Table 5.3.1b and Table 5.3.1c). Private household OOP expenditure, as the largest contributor in the private sector, had progressively increased expenditure more than 2-fold, contributing RM11,466 million in 2011 to RM29,381 million in 2022. This private household OOP expenditure contributed to 70-78% of private sector health expenditure since 2011. TABLE 5.3.1a: Health Expenditure by Private Sources of Financing, 2022 MNHA Code Sources of Financing RM Million Percent MS2.4 Private household out-of-pocket expenditure (OOP) 29,381 77.96 MS2.2 Private insurance enterprises (other than social insurance) 6,535 17.34 MS2.3 Private MCOs and other similar entities 1,087 2.89 MS2.6 All corporations (other than health insurance) 537 1.42 MS2.5 Non-profit institutions serving households (NGO) 148 0.39 Total 37,688 100.00 33 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
FIGURE 5.3.1: Health Expenditure by Private Sources of Financing, 2022 Private household OOP Private insurance Private MCO All other private sector agencies 34 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
TABLE 5.3.1b: Health Expenditure by Private Sources of Financing, 2011-2022 (RM Million) MNHA Code Sources of Financing 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 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 expenditure (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 15,702 17,442 18,780 20,859 23,222 25,001 27,121 29,084 30,046 30,448 32,900 37,688 TABLE 5.3.1c: Health Expenditure by Private Sources of Financing, 2011-2022 (Percent, %) MNHA Code Sources of Financing 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 MS2.2 Private insurance enterprises (other than social insurance) 16.65 15.91 15.53 15.36 15.60 15.38 15.06 14.83 16.22 16.29 16.82 17.34 MS2.3 Private MCOs and other similar entities 1.55 1.73 1.53 2.10 2.70 3.32 3.24 3.17 3.30 3.04 3.16 2.89 MS2.4 Private household out-of- pocket expenditure (OOP) 73.02 72.52 74.19 73.70 70.40 70.22 71.97 73.24 74.49 74.38 75.04 77.96 MS2.5 Non-profit institutions serving households (NGO) 2.00 2.09 0.43 0.21 0.32 0.37 0.36 0.33 0.31 0.96 0.76 0.39 MS2.6 All corporations (other than health insurance) 6.78 7.75 8.33 8.64 10.98 10.71 9.37 8.42 5.67 5.32 4.23 1.42 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 35 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022
5.3.2 Health Expenditure by Private Sources of Financing to Providers of Health Care Cross-tabulations of private sector sources of financing to providers of health care respond to the question of where these privately sourced funds were spent or who provided the health care services and products. In 2022, majority of private sources of financing health expenditure was at hospitals (inclusive of general hospitals, psychiatric hospitals and speciality hospitals) with a spending of RM19,729 million (52.3% of private sector health expenditure). This is followed by providers of ambulatory health care at RM8,847 million (23.5% of private sector health expenditure), retail sale and other providers of medical goods at RM5,320 million (14.1% of private sector health expenditure), general health administration and insurance at RM2,017 (5.3% of private sector health expenditure) and institutions providing health-related services at RM1,522 million (4.0 % of private sector health expenditure). The remaining expenditure to all other providers of health care services and products was RM253 million or 0.7% of private sector health expenditure (Table 5.3.2a and Figure 5.3.2). The trend in spending by private sources of health care financing over the past 12 years show that the top 3 providers of health care where the funds are being spent are at hospitals, providers of ambulatory health care and providers of retail sales and medical goods (Table 5.2.3b and Table 5.2.3c). Expenditure for these 3 provider categories show more than a 2-fold increase since 2011. TABLE 5.3.2a: Private Sources Health Expenditure to Providers of Health Care, 2022 MNHA Code Providers of Health Care RM Million Percent MP1 All hospitals 19,729 52.35 MP3 Providers of ambulatory health care 8,847 23.48 MP4 Retail sale and other providers of medical goods 5,320 14.12 MP6 General health administration and insurance 2,017 5.35 MP8 Institutions providing health-related services 1,522 4.04 MP7 Other industries (rest of the Malaysian economy) 229 0.61 MP5 Provision and administration of public health programmes 8 0.02 MP9 Rest of the world (ROW) 12 0.03 MP2 Nursing and residential care facilities 4 0.01 Total 37,688 100.00 36 MALAYSIA NATIONAL HEALTH ACCOUNTS HEALTH EXPENDITURE REPORT 2011-2022