การปฏิรูประบบสุขภาพของประเทศมาเลเซีย

Abstract

Health systems reform in Malaysia(phase II)Malaysia had been recognised as one with the best economy and healthcare system in the region. The health services were subsidised by the governmental budget as social welfare. The poor or needy received the services free-of-charge. Without a national health insurance scheme, the consequence is economic burden of the country since people are over-dependent on the government, so-called dependency syndrome. Although there is a number of population is under the employees provident fund and social security organisation. This situation still forced the government to set up a healthcare reform policy during the 4th Malaysian Plan (1981-1985). It started from non-medical services, such as laundry, catering, and hospital maintenance at selected hospitals were contracted out. A following policy was that the government support the setting up of private medical facilities, such as hospitals and clinics, to cater for those who can afford such services. As the private sector expanded, it has drawn upon the staff resources of the public sector where wages were less attractive. In 1992, the National Health Institute was established as a corporatised organisation. The aim was to create a good working environment with attractive payment when comparing to those of private sector. Two year after this corporatisation, the goverment medical store was privatised. In 1997, non-medical services at 71 hospitals were privatised. The rest was the target of the year 2000 (the end of the 7th Malaysian Plan). In spite, a national health insurance scheme is a part of the national plans but it is not placed yet. To gather with no clear evaluation and control programs of those organisations reformed, the consequent negative effect is higher medical fee. Some of patients are enable to pay. People and relating organisations have complained via mass media. Ad hoc advocated body was formed up against the government reform plan and request people participation. Finally, in the end of 1999, the health minister declared to stop the planned privatisation and to revise the reform particularly the national health insurance scheme.