The costs of accessing private and public healthcare services when you fall sick.
By Shalini Muniapan, Dr. Idlan Zakaria
29 October 2019
When you fall ill, how you access healthcare is often influenced by how much you are willing to pay. Malaysia operates a two-tiered healthcare system: it offers access to healthcare for all its citizens via public healthcare, with the option of private healthcare for those who can afford to pay more.
Public healthcare services, which are heavily subsidized by the government, can be accessed via Government General Hospitals, Government Health Clinics and Community Clinics. Private healthcare services consists of General Practitioner Clinics and Private Hospitals, both operating either as a group or chain, or as stand-alone institutions.
Cost is a major differentiating factor between the two tiers: public hospitals charge nominal amounts for initial consultation, and subsequent charges and hospitalisation is a fraction of that which is charged by private hospitals. Some Malaysians manage their healthcare costs by taking out private medical insurance, or have medical insurance provided for by their employers.
However, it is not just cost that is a concern. In his 2014 paper, Dr. David Quek highlighted that the premium Malaysians pay for when accessing private healthcare are typically in the form of shorter waiting periods, personalized service provided, ability to choose consulting doctors, and to some extent, the comfort level.
This is also reflected in the evidence from respondents to an online survey conducted by Malay Mail Online, where around 26% of respondents cited that excessive waiting hours in public clinics or hospitals were the reason for them stopping treatment; whereas 16% of those participated stated that they could not take a full day’s leave to get treatment because either their employment does not grant time off or they are not paid for it.
How much would falling ill cost you?
Costs associated with healthcare continue to be a major worry for many, and there are known incidences of people falling into financial distress and bankruptcy as a result of falling seriously ill. This is more pronounced for Malaysians post-retirement, as health costs often increases with age. The current Employees Provident Fund (EPF) savings for most Malaysians provide barely adequate amounts for comfortable post-retirement living, and a major illness could potentially put many seriously out of pocket.
The actual cost borne is of course contingent on the underlying illness. The primary healthcare treatment or a first line treatment via public healthcare would incur a fee ranging from RM1 – RM5 per visit.
Costs for accessing similar services at private hospitals are regulated by Private Healthcare Facilities & Services (Private Hospitals & Other Private Healthcare Facilities) Amendment Order 2013, where the initial consultation will cost you between RM30-RM125 for general practitioner visits, and between RM80 – RM235 for specialist consultation.
While minor ailments will not set a majority of Malaysians back significantly even if they opt for private healthcare, the difference in cost is more pronounced when one contracts a critical illness. Let’s look at some cases.
Case A: Heart Disease
Heart disease has been the leading cause of death in Malaysia for 13 years, with non-communicable diseases such as diabetes and hypertension being the main contributors in the increase of heart disease.
Treatments for heart disease such as an angiogram or one stent angioplasty in a public hospital would range between RM50 – RM200, whereas in a private hospital, it will range in between RM15,000 to RM45,000. On the other hand, a coronary bypass in public hospitals would cost RM4000; comparatively in private hospitals it will range between RM25,000 to RM80,000.
Case B: Dengue Fever
Treatment for a contagious disease such as dengue is free of charge in public hospitals. In private hospitals, the fee for such treatment will range between RM1,000 – RM3,000.
These figures are excluding additional costs for receiving treatment, such as blood tests, or any additional scans needed.
Side Note: Researching Healthcare Costs
Obtaining data for major procedures is not straightforward partly because of the quality of available information. We looked at the charges provided on the MOH website and cross-referenced this with information on a number of public hospital websites nationwide and found several differences. More consistent data on healthcare costs is very much needed.
Wherever possible we have taken the lowest and the largest figure provided to indicate the likely range of costs. There may still be differences compared to individual experiences due to treatment complexity and other individual characteristics.
Malaysia’s healthcare safety nets
The Malaysian Government in Budget 2019 rolled out two new schemes in order to widen the social safety net when it comes to healthcare, namely MySalam and Peka B40. These schemes were first offered to Malaysians who fall under the B40 income group. During Budget 2020, the MySalam scheme was expanded to include those with an annual income of RM100,000 or below.
Eligibility: Those who receive Bantuan Sara Hidup (BSH) and those with annual income of or below RM100,000, between the age of 18 to 65 years old.
Benefits: One-off payment of up to RM8,000 for those receiving BSH (RM4000 for those with annual income of up to RM100,000 a year) for the 45 critical illness listed, an increase from 36 critical illness covered from previous year.
Hospital Allowance of RM50 for 14 days or a maximum of RM700 per year.
*Note: The 36 critical illness covered are only for those diagnosed 1st January 2019 onwards.
Eligibility: Recipient must be aged 40 years old and above and is receiving Bantuan Sara Hidup (BSH).
Benefits: Health Screening, help in terms of procuring unsubsidised medical devices, cancer treatment incentives and travel allowance.
Cancer treatment incentives are only given to those who go through health screening through the scheme.
Travel allowance are only given for those receiving cancer treatment incentives and medical device.
In addition to MySalam and PekaB40, some State Governments also offer healthcare-related social protection provisions. For instance, Selangor runs a Peduli Sihat Initiative and Bantuan #SMART Sihat Selangor for those in the B40 Income Group.
Policy Questions to ponder upon:
How can we optimise Malaysia’s healthcare expenditure?
How can the out-of-pocket payments (OPP) and catastrophic health expenditure incurred by Malaysians be significantly reduced ?
What improvements and innovations in scheduling practices can help minimise the waiting time issue faced by patients accessing public healthcare?