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MALAYSIA NATIONAL HEALTH ACCOUNTS

Health Expenditure Report Revised Time Series (1997-2008) & Health Expenditure Report (2009)

MALAYSIA NATIONAL HEALTH ACCOUNTS UNITPLANNING & DEVELOPMENT DIVISION MINISTRY OF HEALTH MALAYSIA 2011

Published byMalaysia National Health Accounts (MNHA) UnitPlanning & Development DivisionMinistry of HealthLevel 6-9, Block E6, Parcel E,Precint 1, Federal GovernmentAdministrative Center,62590 Putrajaya, MalaysiaWebsite: www.moh.gov.my

ISSN 1985-711

© MOH 2011. All rights reserved.First published 2011

Enquiries concerning reproduction or interpretation of the contents of this publication should be directed to the Malaysia National Health Accounts Unit, Planning & development DIvision, Ministry of Health Malaysia.

Printed in Malaysia

iHEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

Information on national health expenditure becomes more important as Malaysia moves towards attaining a developed nation status by the year 2020. Malaysia aims to achieve this in the most efficient and effective manner. Thus policy makers often refer to National Health Accounts data as part of the tangible macro-level evidence in planning as well as monitoring and evaluation of progress and outcomes of almost every activity involving financial resources.

Many countries, both developed and developing nations, are already tracking and reporting their national health expenditure using the World Health Organization (WHO) accepted National Health Accounts (NHA) methodology called the System of Health Accounts (SHA). Malaysia too uses this framework with slight modifications to suit local needs of policy makers.

The Malaysia National Health Accounts (MNHA) Unit under the Planning and Development Division of the Ministry of Health (MOH) is able to produce regular national level expenditure data. The MNHA data 1997-2009 after endorsement by the MNHA Steering Committee has been discussed during the MNHA Policy Dialogue to provide meaningful inputs for policy decisions. This has come timely as Malaysia moves towards health care delivery and financial reforms in tandem with other activities to achieve the ultimate goal of a developed nation.

I would like to take this opportunity to thank the multiple agencies and data sources for their continued support in providing the required data for the production of MNHA. Your continued support undoubtedly contributes towards the destined national achievements.

Thank you.

Datuk Kamarul Zaman Bin Md IsaSecretary General,Ministry of Health, Malaysia.

Message by theSecretary GeneralMinistry of Health Malaysia

MALAYSIA NATIONAL HEALTH ACCOUNTSii

National progress and productivity is very much dependent on the health of the people. The Malaysia National Health Accounts (MNHA) data provides vital information on the use of financial resources in ensuring affordable, equitable and accessible health care system in the country to ensure good health of the people. Health expenditure information from both the public as well as the private sector will assist policy makers in making informed decisions related to health care financing reforms.

In the past, the MNHA Unit has produced 3 reports on national health accounts spanning from 1997 to 2008. It is even more encouraging to note that the mandate given to this unit is taken seriously by further improvements in data quality. The previous data and the MNHA 2009 data is now produced using internationally accepted standardized methods for comparable time series expenditure data. The data is reported using both MNHA and SHA framework for both local and international comparisons.

This revised data now shows increasing health expenditure over the time period with public sector higher than the private sector expenditure at an average of 55:45 per cent share of total health expenditure. In the public sector, the Ministry of Health (MOH) has remained the largest funder of health services & products at an average of 80 per cent share whereas in the private sector the out-of-pocket (OOP) has remained at 30-40 per cent share of total expenditure. These are useful information in the review and planning of health care financing mechanism for the country. I congratulate the MNHA Unit upon the successful completion of the challenging task of producing comparable NHA data. I also urge continuous support from all stakeholders to assist the MNHA Unit along the pathway towards further developments and achievements.

Thank you.

Dato’ Sri Dr. Hasan Bin Abdul RahmanDirector General of Health, Ministry of Health, Malaysia.

Message by theDirector General of Health,Malaysia

iiiHEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

Over the last ten years, since the inception of NHA in 2001 as a government project under the Ministry of Health, the importance of MNHA has risen to a higher level. This is mainly due to the demand for expenditure data by policy makers especially those involved in health care financing. The need for expenditure trend analysis compelled the MNHA Unit to review all previous data as well as produce additional related data. As a result, the outputs of the revised time series MNHA 1997-2008 and the MNHA 2009, as well as two new sub-accounts, the OOP sub-account and the MOH sub-account will further support the data requirements. In addition, the unit is also for the first time reporting state disaggregation of MNHA. Furthermore, this time the NHA data is produced using both the MNHA framework as well as the SHA framework.

In spite of several challenges, the MNHA Unit has been able to complete all these tasks in two years and this is certainly quite a commendable achievement. Malaysia has set an example for other countries on the potential progress and possible refinements through institutionalization of NHA. However, none of these achievements is possible without strong support from all our stakeholders especially from those who diligently continue to submit the necessary data. Also, the senior management in the MOH constantly provides the strength to strive for the highest quality in the MNHA data.

It is hoped that the spirit and enthusiasm within the MNHA unit will spur further developments and data support to those who require it. The unit hopes to continue providing reliable and timely macro-level expenditure data to all our stakeholders.

Dr. Jameela ZainuddinHead of MNHA Unit,Planning & Development,Ministry of Health, Malaysia.

PREFACE

MALAYSIA NATIONAL HEALTH ACCOUNTSiv

The revision of the previous MNHA time series data (1997-2008) and the production of the new MNHA 2009 data under a standardized internationally accepted methodology have been possible with support from several agencies and individuals.

The funding to engage consultancy came from the generosity of the regional World Health Organization (WHO) team with support from the Western Pacific Regional Office (WPRO) in Manila. This task would not have materialized without the financial aid.

Dr. Ravidran P Rannan-Eliya is a well-known name not only in the MNHA Unit, but also in the Western Pacific Region (WPR), WHO, OECD, World Bank and several international agencies as the technical expert in National Health Accounts. He is often referred to as the “father of NHA” in the WPR and his immeasurable support towards MNHA Unit is beyond words. He was involved in the initial MNHA Project and again this time he was engaged as the consultant for the various tasks conducted by the MNHA Unit over the last two years. The MNHA Unit has been very fortunate for Dr. Ravi to spend his valuable time in provision of the necessary advice and guidance to ensure the production of quality data for policy makers. His patience in teaching, training and further assistance through arrangements for his expert staff to provide hands-on training to the MNHA Unit staff demonstrates his sincerity to further institutionalize NHA in Malaysia.

Gratitude is also extended to the staffs of Institute of Health Policy (IHP) in Sri Lanka especially to Mr. Sanil De Alwis, Chamara Anuranga, Tharanga Fernando and Anna Glynn-Robinson who have all spent their valuable time in earnestly teaching and guiding the MNHA Unit staff on the technical know-how and also the unwritten rules on producing reliable NHA.

There were several formal and informal discussions with Dr. Rozita Halina Tun Hussein who was the local consultant during the MNHA Project. Unreserved appreciation is extended for her technical guidance and constant encouragement. A special thanks is forwarded to the Deputy Director General of the MOH, Dato’ Dr. Maimunah Abdul Hamid, for her sincere support in ensuring quality outputs and the sustainability of MNHA Unit. She has always been available with her constant reassurance when confronted with challenges. Appreciation is also extended to the head of the Planning & Development Unit, Dato’ Dr. Hj. Abd. Rahim Hj. Mohamad and his senior deputy, Dr. Rahimah Mohd Ariffin to see to the completion of the difficult tasks.

Warm thanks is extended to all the stakeholders who have diligently submitted the necessary data and are not mentioned here because of the lengthy list. The MNHA Steering Committee is acknowledged for the endorsement of the MNHA data.

The production of this report would not have been possible if not for the endeavoring determination of the current and past MNHA Unit staff and their persistence to further develop the necessary technical expertise.

Thank You All!

AKNOWLEDGEMENT

vHEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

CONTENTS

Message by the Secretary-General, Ministry of Health, MalaysiaMessage by the Director-General of Health, MalaysiaPrefaceAknowledgementContentsList of FiguresList of TablesList of Appendix TablesList of AbbreviationsReport information

i

ii

iii

iv

v

vi

vii

ix

x

xii

1 Background 1

2 Malaysia National Health Accounts (MNHA): Summary of Framework

2

3 Methodology of Data Collection & AnalysisSummary of Methodology Summary of Data Processing

4

4

5

4 Total Health Expenditure 8

5 Total Health Expenditure by Sources of Financing 11

6 Total Health Expenditure by Providers of Health Services 43

7 Total Health Expenditure by Function of Health Services 57

8 State Expenditure 68

9 International comparison 72

Appendix TablesList of Committees and Members

75

86

MALAYSIA NATIONAL HEALTH ACCOUNTSvi

F4.1 Trend for Total Health Expenditure, 1997-2009 (RM Million & Per cent GDP) 9

F4.2 Per Capita Spending on Health, 1997-2009 (RM, Ringgit Malaysia) 10

F5.1 Total Health Expenditure by Source of Financing (Public Vs. Private), 1997- 2009 12

F5.2 Total Expenditure by Sources of Financing, 2009 14

F5.3 Total Health Expenditure by the Public Sector Sources of Financing, 2009 18

F5.4 Public Sector Expenditure by Providers of Health Services, 2009 22

F5.5 Public Sector Expenditure by Functions of Health Services, 2009 26

F5.6 Total Health Expenditure by Private Sector Sources of Financing, 2009 30

F5.7 Private Sector Expenditure by Providers of Health Services, 2009 33

F5.8 Private Sector Expenditure by Functions of Health Services, 2009 37

F5.9 Private Household Out-of-Pocket Expenditure by Providers of Health Services, 2009 41

F6.1 Total Expenditure on Health by Providers of Health Services, 2009 44

F6.2 Hospital Expenditure by Sources of Financing, 2009 48

F6.3 MOH Hospital Expenditure by Curative Care Functions of Health Services, 2009 52

F6.4 Ambulatory Care Provider (Non-Hospital Setting) Expenditure by Source of Financing 2009

55

F7.1 Total Expenditure on Health by Function of Health Services, 2009 58

F7.2 Curative Care Expenditure by Source of Financing, 2009 62

F7.3 Preventive and Promotive Public Health Programmers by Sources of Financing, 2009 64

F7.4 Education and Health Training Expenditure by Sources of Financing, 2009 66

F8.1 Total expenditure by State, 2009 69

F8.2 State Polulation and Per Capita Health Spending, 2009 70

F8.3 State Per Capita Health Spending by Public and Private Sector, 2009 71

F9.1 International Comparison of Total Health Expenditure as Per Cent GDP, 2008 73

F9.2 International Comparison of Per Capita spending on Health, 2008 73

F9.3 International Comparison of Public and Private share of Total Health Expenditure, 2008 74

F9.4 OOP as share Private sector spending Vs Private Share of Total Health Expenditure, 2008

74

FIGURES

viiHEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

T4.1 Total Health Expenditure, 1997-2009 (RM Million & Per cent GDP) 9

T4.2 Per Capita Spending on Health, 1997-2009 (RM & USD) 10

T5.1 Total Health Expenditure by Source of Financing (Public & Private Sectors), 1997-2009 12

T5.2a Total Health Expenditure by Sources of Funding, 2009 14

T5.2b Total Health Expenditure by Sources of Financing, 1997 - 2009 (RM Million) 15

T5.2c Total Health Expenditure by Sources of Financing, 1997 - 2009 (Per cent) 16

T5.3a Total Health Expenditure by Public Sector Sources of Funding, 2009 18

T5.3b Total Health Expenditure by Public Sector Sources of Financing, 1997 - 2009 (RM Million)

19

T5.3c Total Health Expenditure by Public Sector Sources of Financing, 1997–2009 (Per cent) 20

T5.4a Public Sector Expenditure by Providers of Health Services, 2009 22

T5.4b Public Sector Expenditure by Provider of Health Services, 1997-2009 (RM Million) 23

T5.4c Public Sector Expenditure by Provider of Health Services, 1997-2009 (Per cent) 24

T5.5a Public Sector Expenditure by Function of Health Services, 2009 26

T5.5b Public Sector Expenditure by Function of Health Services, 1997-2009 (RM Million) 27

T5.5c Public Sector Expenditure by Function of Health Services, 1997-2009 (Per cent) 28

T5.6a Total Health Expenditure by Private Sector Sources of Financing, 2009 30

T5.6b Total Health Expenditure by Private Sector Sources of Financing, 1997 – 2009 (RM Million)

31

T5.6c Total Health Expenditure by Private Sector Sources of Financing, 1997 – 2009 (Per cent)

31

T5.7a Private Sector Expenditure by Providers of Health Services, 2009 33

T5.7b Private Sector Expenditure by Providesr of Health Services, 1997 - 2009 (RM Million) 34

T5.7c Private Sector Expenditure by Provider of Health Services, 1997 - 2009 (Per cent) 35

T5.8a Private Sector Expenditure by Function of Health Services, 2009 37

T5.8b Private Sector Expenditure by Function of Health Services, 1997-2009 (RM Million) 38

T5.8c Private Sector Expenditure by Function of Health Services, 1997-2009 (Per cent) 39

TABLES

MALAYSIA NATIONAL HEALTH ACCOUNTSviii

T5.9a Private Household Out-of-Pocket Expenditure by Provider of Health Services, 2009 41

T5.9b Private Household Out-of-Pocket Expenditure by Provider of Health Services, 1997-2009

42

T5.9c Private Household Out-of-Pocket Expenditure by Provider of Health Services, 1997-2009 (Per cent)

42

T6.1a Total Health Expenditure by Providers of Health Services, 2009 44

T6.1b Total HealthExpenditure by Provider of Health Services, 1997-2009 (RM Million) 45

T6.1c Total Health Expenditure by Provider of Health Services, 1997-2009 (Per cent) 46

T6.2a Hospital Expenditure by Sources of Financing, 2009 48

T6.2b Hospital Expenditure by Sources of Financing, 1997-2009 (RM Million) 49

T6.2c Hospital Expenditure by Source of Financing, 1997-2009 (Per cent) 50

T6.3a MOH Hospital Expenditure by Curative Care Function of Health Services, 2009 52

T6.3b MOH Hospital Expenditure by Curative Care Function of Health Services, 1997-2009 (RM Million)

53

T6.3c MOH Hospital Expenditure by Curative Care Function of Health Services, 1997-2009 (Per cent)

53

T6.4a Ambulatory Care (non-hospital) Expenditure by Source of Financing, 2009 55

T6.4b Ambulatory Care (non-hospital) Expenditure by Source of Financing, 1997-2009 (RM Million)

56

T6.4c Ambulatory Care (non-hospital) Expenditure by Source of Financing, 1997-2009 (Per cent)

56

T7.1a Total Expenditure on Health by Function of Health Services, 2009 58

T7.1b Total Expenditure on Health by Function of Health Services, 1997-2009 (RM Million) 59

T7.1c Total Expenditure on Health by Function of Health Services, 1997-2009 (Per cent) 60

T7.2 Curative Care Expenditure by Source of Financing, 1997- 2009 (RM Million) 63

T7.3 Preventive and Promotive Public Health Expenditure by Source of Financing, 1997 -2009 (RM Million)

65

T7.4a Education and Training Expenditure by Source of Financing, 1997 – 2009 (RM Million) 67

T7.4b Education and Training Expenditure by Source of Financing, 1997 - 2009 (Per cent) 67

T8.1 State Population and Health Expenditure, 2009 69

T8.2 State Polulation and Per Capita Health Spending, 2009 70

T8.3 State Per Capita Health Spending by Public and Private Sector, 2009(RM, Ringgit Malaysia)

71

ixHEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

A1 Sources of Data 75

A2 Comparison of MNHA to SHA Framework (OECD 2000) with SHA Tables 78

A2.1a Classification of Total Expenditure on Health by Source of Financing 78

A2.1b Classification of Total Expenditure on Health by Providers of Health Services 79

A2.1c Classification of Total Expenditure on Health by Function of health Services 80

A3 Current Expenditure on Health by Function of Care, Provider Industry and Source of Funding, 2009 (RM Million)

81

A4 Current Expenditure on Health by Function of Care and Provider Industry, 2009 (RM Million)

82

A5 Total Health Expenditure by Provider Industry and Financing Agent, 2009 (RM Million)

83

A6 Current Health Expenditure by Provider Industry and Financing Agent, 2009 (RM Million)

84

A7 Total Expenditure on Health, Including Health-Related Functions, 2009 (RM Million)

85

APPENDIX TABLE

MALAYSIA NATIONAL HEALTH ACCOUNTSx

AADK Agensi Anti Dadah Kebangsaan (National Anti-Drug Agency)

AG Accountant-General

APHM Association of Private Hospital Malaysia

BNM Bank Negara Malaysia (Central Bank of Malaysia)

DOS Department of Statistics

DOSH Department of Occupational Safety and Health

DOSM Department of Statistics Malaysia

EPF Employees Provident Fund

EPU Economic Planning Unit

FOMEMA Foreign Worker’s Medical Examination Monitoring Agency

GDP Gross Domestic Product

HC ICHA code for function of health services

HF ICHA code for sources of funding for health services

HP ICHA code for providers of health services

HQ Headquarters

ICHA International Classification for Health Accounts

IHP Institute of Health Policy

IMS Intercontinental Medical Supply

LA Local Authorities

LIAM Life Insurance Association of Malaysia

LMIC Low and Middle Income Countries

MARA Malaysia Amanah Rakyat (Council of Trust for Indigenous People)

MCO Managed Care Organization

MDC Malaysian Dental Council

MF MNHA Code for Functions of Health Service

MMC Malaysia Medical Council

MNHA Malaysia National Health Accounts

MOD Ministry of Defence

MOF Ministry of Finance

MOH Ministry of Health

ABBREVIATIONS

xiHEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

MOHE Ministry of Higher Education

MOSTI Ministry of Science Technology and Innovation

MP MNHA Code for Providers of Health Services

MR MNHA Code for Health-Related Functions

MS MNHA Code for Sources of Financing

NGO Non-Government Organization

NHA National Health Accounts

NHHES National Household Health Expenditure Survey

NIAM National Insurance Association of Malaysia

NIOSH National Institute of Occupational Safety and Health

OECD Organization for Economic Co-operation and Development

OOP Out-of-Pocket

PCDOM Primary Care Doctor’s Organization Malaysia

PIAM Persatuan Insurans Am Malaysia (General Insurance Association of Malaysia)

PSD Public Service Department

RM Ringgit Malaysia (Malaysia Currency)

ROW Rest of The World

SHA System of Health Accounts

SOCSO Social Security Organization

TCM Traditional Complementary Medicines

TEH Total Expenditure on Health

UK United Kingdom

UMMC University Malaya Medical Centre

UNDP United Nations Development Programme

USD US Dollar

Vs Versus

WHO World Health Organization

WP Wilayah Persekutuan (Federal Territories)

WPR Western Pacific Region

WPRO Western Pacific Regional Office

MALAYSIA NATIONAL HEALTH ACCOUNTSxii

This fourth publication on the Malaysia National Health Accounts (MNHA) has two sets of data, the reviewed past year time series data (1997-2008) and the new 2009 MNHA data. Together, these thirteen years data from 1997 to 2009 are the result of revised standardized methodology. The present sets of data are comparable between the years and can be used for future projections. They were produced under the technical guidance from Dr. Ravindra P Rannan-Eliya and his team. Internationally acceptable National Health Accounts (NHA) methodology was used to produce these new data.

It was very challenging for the MNHA team, under multiple constraints, to reconstruct and re-compile the raw data and then carry out the necessary analysis. Although the analysis was conducted based on the MNHA framework, constant references were made to the SHA Manual, Guide to Producing NHA in Low and Middle Income Countries (LMIC), OECD Private Expenditure Guideline, WHO document on estimating OOP spending for NHA and several other NHA technical guides for definitions and methodology.

The reporting format follows closely the MNHA framework and is kept similar to previous reporting format. The “Malaysia National Health Accounts: Health Expenditure Report Revised Time Series 1997-2008 and Health Expenditure Report 2009” has a total of nine chapters. Chapter 1 gives the background to the report followed by Chapter 2 on the summary of the MNHA framework and Chapter 3 on the methodology that was used. Chapters 4 to 7 provide details of the health expenditure based on the MNHA framework. Chapter 8 shows state disaggregation of health expenditure and Chapter 9 contains some international comparisons.

Most of the data for 2009 are exhibited in diagrammatic and table formats followed by tables on the 1997-2009 time series data. All data are in nominal values and reported in Ringgit Malaysia (RM) unless stated otherwise. However, it should be noted that the best method for annual comparisons is based on data that has been adjusted for inflation, preferably using the Gross Domestic Product (GDP) deflator.

Chapter 4 contains the Total Health Expenditure (TEH) trends from the year 1997 to 2009, as a percentage of gross domestic products (GDP), and the per capita expenditures for the same period. Chapter 5 is lengthy and contains data on the major categories of the sources of financing, namely the public sector and the private sector. It also contains expenditure of the various agencies under these two sectors. Both sector data is then separately cross-tabulated with the dimensions of providers and functions. Every set of data is also accompanied by a similar time series data.

REPORT INFORMATION

xiiiHEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

Chapter 6 and 7 provides data on the total health expenditures by providers and functions of health services. In addition, Chapter 6 also shows data on separate cross-tabulations between Ministry of Health (MOH) hospital expenditure with functions of health services. Similarly, Chapter 7 provides data on separate cross-tabulations of curative care, expenditures for preventive and promotive public health programmes and expenditures for education and training by sources of financing. Chapter 8 shows state disaggregation of health expenditure and Chapter 9 contains some international comparisons of MNHA data with NHA data from neighboring and regional countries as well as some developed country.

The appendix tables at the end of the report shows examples of data source and a very brief comparison of MNHA and SHA framework. Some data are also produced using SHA classification and displayed as SHA Tables.

It is important to note that the data shown in this report is based on the methodology stated under Chapter 3. Tables and figures are used to display the NHA data. Some of the figures on propotions have been adjusted to total up to 100 per cent. Components on tables may not add to total of 100 per cent due to rounding up.

As is the case in all reported NHA data from any country, refinements in internationally accepted methodology and inputs from new additional data source may lead to future changes in the figures. Therefore, it is advisable to refer to the most recent published MNHA data for policy decisions and research purposes.

MALAYSIA NATIONAL HEALTH ACCOUNTS1

Malaysia National Health Accounts (MNHA) started as a project by the Ministry of Health (MOH) with strong support from the Economic Planning Unit (EPU) of the Prime Minister’s Department. This Malaysia National Health Accounts Project (2001-2005) was funded mainly by the United Nations Development Programme (UNDP) and resulted in the production of the Malaysia National Health Accounts Project, Report on The MNHA Classification System (MNHA Framework) and the first MNHA report, Malaysia National Health Accounts Project, Health Expenditure Report (1997–2002). The outputs of this project were instrumental in the establishment of the Malaysia National Health Accounts (MNHA) Unit under the Planning & Development Division of MOH. Subsequently the MNHA Unit produced two other reports, MNHA Health Expenditure Report (1997-2006) and MNHA Health Expenditure Report (2007 & 2008). Together the three reports provided MNHA data spanning from 1997-2008.

The MNHA data provides a wealth of useful macro-level health expenditure information especially for policy makers. The importance of these data was elevated with the renewed need and interest in health financing reform for the country. When data from the three published reports were merged to produce various expenditure trending, some fluctuations were noted in the data. This had to be addressed before the production of the 2009 annual MNHA data. The consultant who was involved in the initial MNHA Project, Dr. Ravindra P Rannan Eliya, was re-engaged as the consultant to assist in the production of comparable annual time series expenditure data as well as the expected 2009 MNHA data. This time the Regional World Health Organization (WHO) in Malaysia stepped in to assist with the funding for the consultancy.

The consultancy has resulted in this publication containing comparable annual data of high quality produced by using internationally accepted NHA methodology. The data is presented in much the same manner as in the previous publications to ease understanding and permit comparisons. The chapters in this publication covers some general expenditure overviews followed by expenditure reports using the standard NHA framework, which is, expenditures by sources of funding, expenditures by providers of health services & products, and expenditures by functions of health services & products. Additional state expenditure disaggregation was carried out for the first time and reported in this publication. Tables and figures are used to display the NHA data. Some of the figures on proportions have been adjusted to total up to 100 per cent. Components on tables may not add to total of 100 per cent due to rounding up. For those who require references to trends over time periods, whenever possible, the revised 1997 to 2009 time series data is inserted between the detailed 2009 cross-sectional data. It is reminded that most of the data are in nominal Ringgit Malaysia (RM) values unless indicated otherwise.

Background

CHAPTER 1

2HEALTH EXPENDITURE REPORT Revised Time Series (1997-2008) & Health Expenditure Report (2009)

Malaysia National Health Accounts (MNHA): Summary Of Framework

National Health Accounts are basically standard sets of tables containing comprehensive, consistent, comparable, compatible and timely national health expenditure over a specified period. The System of Health Accounts SHA (OECD, 2000 Version 1.0) has been adopted by the World Health Organization (WHO) as a basis for international data collection and comparison. It proposes an integrated system of comprehensive and international comparable accounts and provides a uniform framework basic accounting rules and asset of tables for reporting health expenditures data. It also provides a more complete picture of the performance of the nation’s health system and the needs of government, private sector analysts and policy makers for health planning purposes.

The SHA (OECD 2000 Version 1.0) also proposes an International Classification for Health Accounts (ICHA) in three dimensions namely, health care sources of funding including public and private, health care service providers and health care functions. The MNHA framework was based on the SHA (OECD 2000 Version 1.0) classification with some modification to local suit need.

2.1. TOTAL EXPENDITURE ON HEALTH (TEH)

The OECD SHA defines the concept of total expenditure on health (TEH) as a standardized definition of which areas of health spending are to be measured and reported in national totals. In the MNHA framework, TEH comprises the expenditures from both the public and private sectors.

2.2. THE MNHA CLASSIFICATION

The SHA (OECD, 2000 Version 1.0) classifies all health system spending using a tri-axial-system, known as the International Classification for Health Accounts (ICHA), which categorizes health expenditure by:

• source of financing• provider of health services• function of health services

The MNHA framework is based on the SHA (OECD, 2000 Version 1.0) classification with some minor modifications to suit local needs (Appendix Tables A2, A2.1a, A2.1b, and A2.1c). Similar to the SHA classification, the MNHA classifies all expenditures into three main entities:

• source of financing (MS)• provider of health services (MP) • function of health services (MF)

CHAPTER 2


Source of financing is defined as entities that directly incur the expenditure and hence control and finance the amount of such expenditure. It includes the public sector spending inclusive of the federal government, state government, local authorities, and social security funds, and the private sector consisting of private health insurance, managed care organizations, out-of-pocket expenditure, non-profit institutions, and corporations.

Provider of health services is defined as entities that produce and provide health care goods and services. It is categorized as hospitals, nursing and residential care facility providers, ambulatory care providers, retail sale and medical goods providers, public health program providers and general health administration.

Functions of health services include core functions of health care (e.g. curative care, rehabilitative care, long term nursing care, ancillary services, outpatient medical goods, public health services, and health administration and health insurance) and health related functions (e.g. education and training of health personnel, and research and development).

This information is then processed by statistical software Stata (Version 11). The Stata allows tracking of results and compilation of estimated data based on the identified classifications to generate meaningful data.


Methodology Of Data Collection And Analysis

3.1. SUMMARY OF METHODOLOGY

The method of data collection and analysis followed closely the method used in the first cycle of data collection whereby detailed definitions of what constitute health expenditure, institutional entities, and types of disaggregating were drawn up based on inputs from several documents, committee meetings, and consultative advice from sources within and outside the MOH. The result of such consultations included the production of a manual, Malaysia National Health Accounts Project: Methodology of Data Collection and Analysis that became the main reference material in this cycle of data collection for 1997-2009 national health expenditures.

Both primary and secondary data were used in this analysis. Primary data were obtained through studies, through states visit data retrieval and other primary datasets. The secondary data were retrieved through various data sources (Appendix Table A1). All these data were then coded according to the MNHA classification adapted from the SHA (OECD, 2000 Version 1.0) classification (Appendix Tables A2.1a, A2.1b, and A2.1c). Data were entered as federal and state-level data.

The sets of data from each source were processed differently depending on the availability and completeness of data. Data classification was carried out based on the tri-axial MNHA entities of sources, providers and functions. The MNHA framework enables health expenditure disaggregates to the lowest possible level under the three entities of sources, providers and functions. Cross-tabulations of the entities and their important subcomponents results in more detailed analysis of health expenditures.

The processes of data entry and analysis were carried out using Microsoft Excel Program and statistical software Stata (Version 11). The initial MNHA data preparation, analysis, and coding were done in Microsoft Excel spreadsheets and the output data files were uploaded into the Stata after data cleaning and program verification to produce the final tables and figures. Although Stata allows detailed analysis of the MNHA, these report only highlights the important findings, which will be of use in future health policy development and health planning of the country.

CHAPTER 3


3.2. SUMMARY OF DATA PROCESSING

The methods used for data processing varied according to the availability, completion and sources of data as follows:

3.2.1 Public Sector

(i) Ministry of Health (MOH)Health expenditure data of the MOH (1997-2009) were obtained from the Accountant-General Office, Ministry of Finance (MOF). This expenditure was assigned the provider and function codes based on the MNHA framework.

(ii) Ministry of Higher Education (MOHE)The function of the university hospitals under the MOHE includes provision of health care services, health related training and research. Health expenditures of these institutions were mainly for curative care services. Other than these institutions, data (1997-2009) on the cost of training health professionals were obtained from various training colleges, Public Services Department (PSD), and other agencies.

(iii) Other Federal Agencies (including statutory bodies)The agencies under “Other Federal Agencies” currently consists of seventeen public agencies inclusive of National Anti-Drug Agency, Prison Department, Civil Defense Department, Salary and Allowances and Pension Department of Public Services Department National Heart Institute of Malaysia, Social Welfare Department of Malaysia, Department of Orang Asli Affairs, National Population and Family Development Board Malaysia, National Institute of Occupational Safety and Health Malaysia (NIOSH), Department of Occupational Safety and Health Malaysia (DOSH), National Sports Institute Of Malaysia, Ministry of Science Technology and Innovation (MOSTI), Pilgrims Fund Board and Pusat Pungutan Zakat. The Other Federal Agencies expenditure was mainly for curative care, retail sales and medical goods and research.

(iv) Local Authorities Most local authorities provide preventive care services such as disease control and food quality control. However, in addition to these, City Councils such as Kuala Lumpur City Hall (Dewan Bandaraya Kuala Lumpur), Penang City Hall, Kuching City Hall and Ipoh City Council also provide curative care service.

(v) (General) State GovernmentThis consists of health expenditure by all thirteen state governments. Three geographical areas of the country come under the Federal Territories and include Kuala Lumpur, Putrajaya and Labuan. Most of the state expenditure was mainly for curative care, ancillary services and environmental health such as for water treatment.


(vi) Ministry of Defense (MOD)The Ministry of Defense provides health services through its army hospitals and Armed Forces Medical and Dental Centre (Rumah Sakit Angkatan Tentera and Pusat Pergigian Angkatan Tentera). The total health expenditure of this ministry (1997-2009) was captured from these sources, together with a study to estimate the proportions of this expenditure for disaggregation to providers and functions of health care services. The MOD expenditure was mainly for curative care services.

(vii) Social Security Funds There are two major organizations providing social security funds – the Employees Provident Fund (EPF) and the Social Security Organization (SOCSO), both of which are mandated by the government. In both, samplings of the medical bill claims were done to obtain health expenditures disaggregation to providers and functions and health care services.

(viii) Other State Agencies (including statutory bodies)The data (1997-2009) on the number of employees and the health expenditure for state statutory bodies were collected from various sources. In addition, the MNHA Survey of state agencies including the statutory bodies provided data on per capita spending as well as expenditure disaggregation to provider and function of health care services.

3.2.2 Private Sector

(i) Household Out-of-Pocket (OOP) ExpenditureThe private household OOP expenditure estimation is complex and challenging. MNHA framework uses the Integrative Approach of consumption, provision and financing perspectives with necessary adjustments to avoid double counting of expenditures. Expenditure data is summated from both production and consumption side sources, with deductions of the reimbursable and others already included under other sources of funding. The approach includes the capture of the gross revenues from various sources such as the user charges of MOH hospital, university hospitals, National Heart Institute, revenues of private hospital, private medical clinic and private dental clinic, sales of pharmaceutical and other medical supplies, ancillary services, sales of traditional medicine and revenues of traditional treatment providers.

The summation of all these revenues is considered as the gross spending (OOP expenditure and non-OOP expenditure). In order to obtain the net OOP spending, all the refundable payments by insurance, private corporation, SOCSO, EPF, Statutory bodies, FOMEMA or other parties exclusive of direct OOP payment are subtracted. The balance is assumed as the estimated private OOP expenditure.


(ii) Private Corporations/Private Companies About one fifth of the population works in the private sector and gain medical benefits through the private employer benefit scheme. The average per capita health expenditure was calculated based on the survey conducted by Department of Statistic Malaysia (DOSM) on various types of industries. The proportions of providers and functions estimated based on analysis and via MNHA questionnaires sent to the selected private companies.

(iii) Private Health InsuranceThe health expenditure of private health insurance is calculated based on the Medical Health Insurance data from the Central Bank of Malaysia. The proportion for providers and functions of health services is obtained via the MNHA Survey of sampled insurance companies.

(iv) Non-Governmental Organization (NGO)Besides social activities, the non-governmental organizations (NGOs) are also involved in health related activities. Health expenditure incurred by the NGOs is obtained through the MNHA Survey of these organizations which enables the expenditure disaggregation to providers and functions of health care services.

(v) Managed Care Organization (MCO)Under the provisions of the existing law, only insurance companies are allowed to undertake ‘health risk’. In Malaysia most of the organizations considered as MCOs are third party payers. The data obtained from these third party payers were data mainly related to health administration of health insurance.


Total Health Expenditure

The total health expenditure (TEH) for Malaysia during 1997-2009 ranged from RM8,045 million in 1997 to RM33,691million in 2009 (Figure 4.1 and Table 4.1). The health spending as a share of Gross Domestic Product (GDP) for the same period ranged from 2.85 per cent to 4.96 per cent of GDP. Overall, the per capita spending on health ranged from RM370 (USD119) in 1997 to RM1208 (USD387) in 2009 (Figure 4.2 and Table 4.2).

CHAPTER 4


Table 4.1: Total Health Expenditure, 1997-2009 (RM Million & Per cent GDP)

Spending Total Health Expenditure, Nominal

(RM Million)

Total Health Expenditure,

Constant (RM Million)

Total Expenditure as % GDP

Total GDP, Nominal (RM Million)* Year

1997 8,045 13,232 2.85 281,795

1998 8,751 13,267 3.09 283,243

1999 9,711 14,716 3.23 300,764

2000 11,635 16,414 3.26 356,401

2001 13,182 18,896 3.74 352,579

2002 14,588 20,277 3.81 383,213

2003 18,399 24,757 4.39 418,769

2004 19,912 25,274 4.20 474,048

2005 20,131 24,421 3.85 522,445

2006 24,227 28,294 4.22 574,441

2007 26,389 29,382 4.11 642,049

2008 30,601 30,876 4.12 742,470

2009 33,691 33,691 4.96 679,938

Source: *Department of Statistics Malaysia

FIGURE 4.1: Trend for Total Health Expenditure, 1997 - 2009 (RM Million & Per cent GDP)

2.85

8,045 8,7519,711

11,63513,182

14,588

18,39919,912 20,131

24,227

3.09 3.23 3.26

3.74 3.81

4.39

3.854.22 4.114.20

(RM

bill

ion)

-

-

-

-

-

-

-

-

-1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

5,000

0

10,000

15,000

20,000

25,000

30,000

35,000

40,000

1.00

2.00

3.00

4.00

5.00

(% G

DP

)

30,60133,6914.12

4.96

26,389

Total Expenditure on Health (RM MIllion) Total Expenditure as % GDP


FIGURE 4.2: Per Capita Spending on Health, 1997 - 2009 ( Ringgit Malaysia, RM )

RM

370 392424

495446

590

727769 760

903

971

1,111

1,208

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

200

400

600

800

1,000

1,200

1,200

Table 4.2: Per Capita Spending on Health, 1997-2009 (RM & USD)

Spending / Population Total Health

Expenditure, Nominal

(RM Million)

Total Health Expenditure,

Constant (RM Million)

Per Capita Spending,

Nominal (RM)

Per Capita Spending,

Constant (RM)

Per Capita Spending, Nominal (USD)**

Total Population*

Year

1997 8,045 13,232 370 608 119 21,769,300

1998 8,751 13,267 392 594 126 22,333,500

1999 9,711 14,716 424 642 136 22,909,500

2000 11,635 16,414 495 699 159 23,494,900

2001 13,182 18,896 546 783 175 24,123,400

2002 14,588 20,277 590 820 189 24,727,100

2003 18,399 24,757 727 978 233 25,320,000

2004 19,912 25,274 769 976 247 25,905,100

2005 20,131 24,421 760 922 244 26,476,900

2006 24,227 28,294 903 1,055 290 26,831,500

2007 26,389 29,382 971 1,081 311 27,186,000

2008 30,601 30,876 1,111 1,121 356 27,540,500

2009 33,691 33,691 1,208 1,208 387 27,895,300

Source: * Department of StatisticsNote: ** Exchange rate at RM3.1175=USD1 (BNM website in Sept 2011)


Total Health Expenditure by Sources of Financing

The various sources of financing for health care services and products include multiple agencies in the public as well as the private sector. In the public sector these sources of financing include federal government, state government, local authorities and social security funds. In the private sector these sources of financing include private insurance enterprises, managed care organizations, private household OOP, not-for-profit institutions, and private corporations (Appendix Table A2.1a).The share of both these two sectors to the total health spending can be identified for each year.

In 2009, the health spending of the public and private sector was RM18,401 million and RM15,291 million respectively (Figure 5.1 and Table 5.1). This translates to a public:private share of 55:45 and a similar pattern is noted throughout the time series from 1997 to 2009. During this period, both the public sector and private sector spending shows an upward trend but the public share of health spending remained higher than the private share except that in the year 2005 when there was a slight drop in public spending and as a share of total health expenditure.

CHAPTER 5


Public Sector Private Sector

FIGURE 5.1: Total Health Expenditure by Source of Financing (Public vs. Private), 1997-2009

RM

Mill

ion

3,504 3,873 4,288

5,156 5,5136,278

7,543

8,820

9,904

11,012

12,291

14,077

15,291

18,401

16,524

14,098

13,216

10,22711,09210,856

8,3107,669

6,479

5,4244,8794,540

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

2,000

0

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000

20,000

TABLE 5.1 : Total Health Expenditure by Source of financing By Public & Private Sectors, 1997-2009

Year

Sources of Financing

Public Sector Private Sector Total

RM Million Per cent RM Million Per cent RM Million

1997 4,540 56.44 3,504 43.56 8,045

1998 4,879 55.75 3,873 44.25 8,751

1999 5,424 55.85 4,288 44.15 9,711

2000 6,479 55.69 5,156 44.31 11,635

2001 7,669 58.18 5,513 41.82 13,182

2002 8,310 56.96 6,278 43.04 14,588

2003 10,856 59.00 7,543 41.00 18,399

2004 11,092 55.70 8,820 44.30 19,912

2005 10,227 50.80 9,904 49.20 20,131

2006 13,216 54.55 11,012 45.45 24,227

2007 14,098 53.42 12,291 46.58 26,389

2008 16,524 54.00 14,077 46.00 30,601

2009 18,401 54.62 15,291 45.38 33,691


Sources of Financing

In 2009, among the various agencies under the sources of financing, the Ministry of Health (MOH) had the highest expenditure amounting to RM14,713 million or 44 per cent share of total health expenditure (Figure 5.2 and Table 5.2a). This was followed by private household out-of-pocket (OOP) spending of RM11,986 million or 36 per cent share of total health expenditure. After MOH and OOP expenditure, the next highest spending was by Ministry of Higher Education (MOHE) at RM2,328 million and private insurance at RM1,968 million occupying a share of 7 and 6 per cent respectively. The federal agencies including federal statutory bodies spent RM929 million whereas corporations (excluding their corporate health insurance) spent RM899 million contributing to about 3 per cent each of the total share of all national health expenditure. All the remaining sources of financing spent less than RM500 million per agency or under 1 per cent of the total health expenditure.

The 1997 to 2009 time series expenditure of all sources of financing shows MOH as the highest financier followed by OOP and MOHE (Table 5.2b and Table 5.2c). The time series data trend shows that prior to 2002, after MOH, OOP, and MOHE, the fourth highest source of financing was by corporations (excluding their corporate health insurance) followed by health insurance. This trend reversed after 2002 with private insurance expenditure occupying the fourth and the corporations (excluding their corporate health insurance) occupying the fifth highest share of total health expenditure.


FIGURE 5.2: Total Health Expenditure by Sources of Financing, 2009

44%

36%

7% 7%6%

MOH Private household

OOP

Private insurance

All Other agencies

MOHE

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Per

cen

t of T

EH

TABLE 5.2a: Total Health Expenditure by Sources of Funding, 2009

MNHA code Sources of Financing, 2009 RM Million Per cent

MS1.1.1.1 Ministry of Health (MOH) 14,713 43.67

MS2.4 Private household out-of-pocket expenditures (OOP) 11,986 35.58

MS1.1.1.2 Ministry of Higher Education (MOHE) 2,328 6.91

MS2.2 Private insurance enterprises (other than social insurance) 1,968 5.84

MS1.1.1.9 Other federal agencies (including statutory bodies) 929 2.76

MS2.6 All Corporations (other than health insurance) 899 2.67

MS2.5 Non-profit organizations serving households (NGO) 367 1.09

MS1.1.3 Local Authorities 131 0.39

MS1.2.2 Social Security Organization (SOCSO) 93 0.28

MS1.1.2.1 (General) State Government 84 0.25

MS2.3 Private MCOs and other similar entities 66 0.20

MS1.1.1.3 Ministry of Defence (MOD) 57 0.17

MS1.2.1 Employee Provident Funds (EPF) 40 0.12

MS1.1.2.2 Other state agencies (including statutory bodies) 26 0.08

MS9 Rest of the world 4 0.01

Total 33,691 100.00


TAB

LE 5

.2b

: To

tal H

ealt

h E

xpen

dit

ure

by

So

urce

s o

f Fi

nanc

ing

, 199

7 -

2009

(RM

Mill

ion)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Min

istr

y of

Hea

lth (M

OH

)3,

707

4,03

3 4,

450

5,36

7 6,

251

6,67

0 9,

013

8,91

7 8,

060

10,8

38

11,2

43

13,0

36

14,7

13

MS

1.1.

1.2

Min

istr

y of

Hig

her

Edu

catio

n (M

OH

E)

525

517

612

706

890

1,01

8 1,

133

1,22

9 1,

301

1,43

0 1,

681

1,97

9 2,

328

MS

1.1.

1.3

Min

istr

y of

Def

ence

(MO

D)

15

7 10

12

22

36

20

24

25

26

58

10

8 57

MS

1.1.

1.9

Oth

er fe

dera

l age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)20

1 21

6 23

5 26

2 34

8 40

2 47

9 68

5 60

6 65

7 80

8 1,

059

929

MS

1.1.

2.1

(Gen

eral

) Sta

te G

over

nmen

t32

36

31

33

37

41

44

50

57

65

81

85

84

MS

1.1.

2.2

Oth

er s

tate

age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)5

5 10

9

10

11

11

13

15

15

16

17

26

MS

1.1.

3Lo

cal A

utho

ritie

s36

37

40

46

50

65

75

77

82

89

10

2 11

5 13

1

MS

1.2.

1E

mpl

oyee

Pro

vide

nt F

unds

(EP

F)7

15

20

24

32

36

43

56

61

46

52

49

40

MS

1.2.

2S

ocia

l Sec

urity

Org

aniz

atio

n (S

OC

SO

)12

13

15

20

28

30

39

39

20

48

57

76

93

MS

2.2

Priv

ate

Insu

ranc

e en

terp

rises

(oth

er th

an s

ocia

l ins

uran

ce)

295

365

421

516

599

718

964

1,12

4 1,

084

1,24

6 1,

413

1,70

9 1,

968

MS

2.3

Priv

ate

MC

Os

and

othe

r si

mila

r en

titie

s48

50

52

55

58

61

64

72

81

91

79

69

66

MS

2.4

Priv

ate

hous

ehol

d ou

t-of

-poc

ket e

xpen

ditu

res

(OO

P)

2,57

6 2,

835

3,15

5 3,

864

4,05

6 4,

655

5,62

9 6,

719

7,66

7 8,

582

9,55

4 11

,050

11

,986

MS

2.5

Non

-pro

fit o

rgan

izat

ions

ser

ving

hou

seho

lds

(NG

O)

99

108

111

136

144

163

186

207

236

259

294

338

367

MS

2.6

All

Cor

pora

tions

(oth

er th

an h

ealth

insu

ranc

e)48

6 51

5 54

9 58

1 65

6 68

1 70

0 69

8 83

6 83

4 95

0 91

0 89

9

MS

9R

est o

f the

wor

ld0

0 0

5 0

0 0

0 0

0 1

1 4

Tota

l8,

045

8,75

1 9,

711

11,6

35

13,1

82

14,5

88

18,3

99

19,9

12

20,1

31

24,2

27

26,3

89

30,6

01

33,6

91


TAB

LE 5

.2c

: To

tal H

ealt

h E

xpen

dit

ure

by

So

urce

s o

f Fi

nanc

ing

, 199

7 -

2009

(Per

cen

t, %

)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Min

istr

y of

Hea

lth (M

OH

)46

.08

46.0

8 45

.82

46.1

3 47

.42

45.7

2 48

.99

44.7

8 40

.04

44.7

4 42

.60

42.6

0 43

.67

MS

1.1.

1.2

Min

istr

y of

Hig

her

Edu

catio

n (M

OH

E)

6.53

5.

91

6.30

6.

07

6.76

6.

98

6.16

6.

17

6.46

5.

90

6.37

6.

47

6.91

MS

1.1.

1.3

Min

istr

y of

Def

ence

(MO

D)

0.19

0.

08

0.10

0.

10

0.17

0.

25

0.11

0.

12

0.12

0.

11

0.22

0.

35

0.17

MS

1.1.

1.9

Oth

er fe

dera

l age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)2.

50

2.47

2.

42

2.26

2.

64

2.76

2.

60

3.44

3.

01

2.71

3.

06

3.46

2.

76

MS

1.1.

2.1

(Gen

eral

) Sta

te G

over

nmen

t0.

39

0.41

0.

32

0.28

0.

28

0.28

0.

24

0.25

0.

28

0.27

0.

31

0.28

0.

25

MS

1.1.

2.2

Oth

er s

tate

age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)0.

06

0.06

0.

10

0.08

0.

08

0.08

0.

06

0.06

0.

07

0.06

0.

06

0.06

0.

08

MS

1.1.

3Lo

cal A

utho

ritie

s0.

45

0.42

0.

41

0.39

0.

38

0.45

0.

41

0.39

0.

41

0.37

0.

39

0.38

0.

39

MS

1.2.

1E

mpl

oyee

Pro

vide

nt F

unds

(EP

F)0.

09

0.17

0.

21

0.20

0.

24

0.25

0.

23

0.28

0.

30

0.19

0.

20

0.16

0.

12

MS

1.2.

2S

ocia

l Sec

urity

Org

aniz

atio

n (S

OC

SO

)0.

15

0.15

0.

16

0.17

0.

21

0.21

0.

21

0.20

0.

10

0.20

0.

22

0.25

0.

28

MS

2.2

Priv

ate

insu

ranc

e en

terp

rises

(oth

er th

an s

ocia

l ins

uran

ce)

3.66

4.

17

4.33

4.

43

4.54

4.

92

5.24

5.

65

5.39

5.

14

5.35

5.

58

5.84

MS

2.3

Priv

ate

MC

Os

and

othe

r si

mila

r en

titie

s0.

60

0.57

0.

54

0.47

0.

44

0.42

0.

35

0.36

0.

40

0.38

0.

30

0.22

0.

20

MS

2.4

Priv

ate

hous

ehol

d ou

t-of

-poc

ket e

xpen

ditu

res

(OO

P)

32.0

2 32

.39

32.4

9 33

.21

30.7

7 31

.91

30.5

9 33

.74

38.0

9 35

.42

36.2

0 36

.11

35.5

8

MS

2.5

Non

-pro

fit o

rgan

izat

ions

ser

ving

hou

seho

lds

(NG

O)

1.24

1.

23

1.14

1.

17

1.10

1.

12

1.01

1.

04

1.17

1.

07

1.11

1.

11

1.09

MS

2.6

All

Cor

pora

tions

(oth

er th

an h

ealth

insu

ranc

e)6.

05

5.88

5.

65

4.99

4.

97

4.67

3.

81

3.51

4.

15

3.44

3.

60

2.98

2.

67

MS

9R

est o

f the

wor

ld0.

00

0.00

0.

00

0.04

0.

00

0.00

0.

00

0.00

0.

00

0.00

0.

00

0.00

0.

01

Tota

l10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00


Public Sector Sources of Financing

In 2009, analysis of the public sector sources of financing shows that the MOH spent RM14,713 million (80 per cent), making it the largest financier in this sector. This is followed by MOHE RM2,328 million (13 per cent), other federal agencies (including statutory bodies) RM929 million (5 per cent), Local Authorities RM131 million (1 per cent), and other public sector agencies with each agency spending less than RM100 million but in total amounting to RM301 million (1 per cent) (Figure 5.3 and Table 5.3a).

The public sector time series expenditure data shows a similar trend throughout the 1997-2008 period with MOH spending progressively increasing from RM3,707 million in 1997 to RM13,036 million in 2008 (Table 5.3b). This amounts to between 79 to 83 per cent share of public spending (Table 5.3c). MOH expenditure was followed by MOHE starting at RM525 million in 1997 and dropping slightly to RM517 million in 1998 and from then on progressively increasing to RM1,979 million in 2008, occupying a share of 10 to 13 per cent of public sector spending. After MOH and MOHE, other federal agencies including the federal statutory bodies expenditure started at RM201 million in 1997 and increased to RM1,059 million in 2008 occupying a share of 4 to 6 per cent of public sector expenditure. The remaining public sector agencies inclusive of MOD, state government, state agencies including state statutory bodies, LA, EPF and SOCSO each spent less than RM100 million per year (except for MOD spending RM108 million in 2008 and LA spending more than RM100 million for the last 3 years). These sources of financing contributed to a share of less than 1 per cent of the total public sector expenditure per agency per year.


TABLE 5.3a: Total Health Expenditure by Public Sector Sources of Funding, 2009

MNHA code Sources of Financing, 2009 RM Million Per cent




MS1.1.3 Local authorities 131 0.71






Total 18,401 100.00

FIGURE 5.3: Total Health Expenditure by Public Sector Sources of Financing, 2009

MOH MOHE LAOther Federal agencies

All Other agencies

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

1%1%5%

13%

80%

Per

cen

t of

Pub

lic S

ecto

r


TAB

LE 5

.3b

: To

tal H

ealt

h E

xpen

dit

ure

by

Pub

lic S

ecto

r S

our

ces

of

Fina

ncin

g, 1

997

- 20

09 (R

M M

illio

n)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Min

istr

y of

Hea

lth (M

OH

)3,

707

4,03

3 4,

450

5,36

7 6,

251

6,67

0 9,

013

8,91

7 8,

060

10,8

38

11,2

43

13,0

36

14,7

13

MS

1.1.

1.2

Min

istr

y of

Hig

her

Edu

catio

n (M

OH

E)

525

517

612

706

890

1,01

8 1,

133

1,22

9 1,

301

1,43

0 1,

681

1,97

9 2,

328

MS

1.1.

1.3

Min

istr

y of

Def

ence

(MO

D)

15

7 10

12

22

36

20

24

25

26

58

10

8 57

MS

1.1.

1.9

Oth

er fe

dera

l age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)20

1 21

6 23

5 26

2 34

8 40

2 47

9 68

5 60

6 65

7 80

8 1,

059

929

MS

1.1.

2.1

(Gen

eral

) Sta

te G

over

nmen

t32

36

31

33

37

41

44

50

57

65

81

85

84

MS

1.1.

2.2

Oth

er s

tate

age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)5

5 10

9

10

11

11

13

15

15

16

17

26

MS

1.1.

3Lo

cal A

utho

ritie

s36

37

40

46

50

65

75

77

82

89

10

2 11

5 13

1

MS

1.2.

1E

mpl

oyee

Pro

vide

nt F

unds

(EP

F)7

15

20

24

32

36

43

56

61

46

52

49

40

MS

1.2.

2S

ocia

l Sec

urity

Org

aniz

atio

n (S

OC

SO

)12

13

15

20

28

30

39

39

20

48

57

76

93

Tota

l4,

540

4,87

9 5,

424

6,47

9 7,

669

8,31

0 10

,856

11

,092

10

,227

13

,216

14

,098

16

,524

18

,401


TAB

LE 5

.3c

: To

tal H

ealt

h E

xpen

dit

ure

by

Pub

lic S

ecto

r S

our

ces

of

Fina

ncin

g, 1

997

- 20

09 (P

er c

ent,

%)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Min

istr

y of

Hea

lth (M

OH

)81

.65

82.6

6 82

.05

82.8

3 81

.50

80.2

6 83

.02

80.4

0 78

.81

82.0

1 79

.75

78.8

9 79

.96

MS

1.1.

1.2

Min

istr

y of

Hig

her

Edu

catio

n (M

OH

E)

11.5

7 10

.60

11.2

8 10

.90

11.6

1 12

.25

10.4

4 11

.08

12.7

2 10

.82

11.9

3 11

.98

12.6

5

MS

1.1.

1.3

Min

istr

y of

Def

ence

(MO

D)

0.34

0.

15

0.18

0.

19

0.29

0.

44

0.18

0.

22

0.25

0.

20

0.41

0.

65

0.31

MS

1.1.

1.9

Oth

er fe

dera

l age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)4.

44

4.42

4.

33

4.05

4.

54

4.84

4.

41

6.18

5.

92

4.97

5.

73

6.41

5.

05

MS

1.1.

2.1

(Gen

eral

) Sta

te G

over

nmen

t0.

70

0.73

0.

58

0.50

0.

48

0.49

0.

40

0.45

0.

56

0.49

0.

57

0.51

0.

45

MS

1.1.

2.2

Oth

er s

tate

age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)0.

10

0.11

0.

18

0.14

0.

14

0.14

0.

10

0.12

0.

14

0.12

0.

12

0.10

0.

14

MS

1.1.

3Lo

cal A

utho

ritie

s0.

79

0.76

0.

74

0.71

0.

65

0.79

0.

69

0.70

0.

80

0.68

0.

72

0.70

0.

71

MS

1.2.

1E

mpl

oyee

Pro

vide

nt F

unds

(EP

F)0.

15

0.31

0.

37

0.36

0.

42

0.44

0.

39

0.51

0.

60

0.35

0.

37

0.30

0.

22

MS

1.2.

2S

ocia

l Sec

urity

Org

aniz

atio

n (S

OC

SO

)0.

27

0.26

0.

28

0.31

0.

37

0.36

0.

36

0.35

0.

20

0.37

0.

40

0.46

0.

51

Tota

l10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00


Public Sector Sources by Providers Cross-tabulations

Cross-tabulations of public sector sources of funding and providers of health care services and products respond to the question as to where this public source of fund is spent or who provides the services and products with the money.

In 2009, hospitals consumed RM10,513 million or 57 per cent, followed by general health administration and insurance at RM3,522 million or 19 per cent, providers of ambulatory care at RM2,015 million or 11 per cent, provision and administration of public health programmes at RM1,177 million or 6 per cent and the remaining providers at RM1,175 million or 6 per cent (Figure 5.4 and Table 5.4a).

The 1997 to 2009 time series data shows a similar pattern in the share of the various providers in the public sector with all providers showing a steady rise over the time period (Table 5.4b and Table5.4c). However, over the last five years (2005-2009) the rate of increase in the expenditure at hospitals, providers of general health administration and insurance, and the providers of ambulatory care were much higher when compared to other providers. Also the rate of increase in expenditure of these 3 providers individually was higher in the last five years compared to their respective increase over the previous years. Over the time period although the expenditure for provision and administration of public health programmes in the public sector shows an increase in nominal amounts, the share of this expenditure compared to all other providers has been on a downward trend decreasing from 9.7 per cent in 1997 to 6.4 per cent in 2009.


FIGURE 5.4: Public Sector Expenditure by Providers of Health Services, 2009

Hospitals

Ambulatory health care Providers

All other Providers

Provision & Admin of Public Health ProgramGeneral Health Administration & Insurance

57%

6%7%

11%

19%

Private sectorexpenditure:55% of TEH

(RM18,401 million)

TABLE 5.4a : Public Sector Expenditure by Providers of Health Services, 2009

MNHA code Public Sector Providers RM Million Per cent

MP1 Hospitals 10,513 57.13

MP6 General health administration and insurance 3,522 19.14

MP3 Providers of ambulatory health care 2,015 10.95

MP5 Provision and administration of public health programmes 1,177 6.39

MP8 Institutions providing health related services 1,030 5.60

MP4 Retail sale and other providers of medical goods 130 0.71

MP2 Nursing and residential care facilities 13 0.07

MP9 Rest of the world 1 0.00

Total 18,401 100.00


TAB

LE 5

.4b

: P

ublic

Sec

tor

Exp

end

itur

e b

y P

rovi

der

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (R

M M

illio

n)

MN

HA

co

de

Pub

lic S

ecto

r P

rovi

der

s19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

2,86

7 2,

974

3,27

6 3,

662

4,27

8 4,

552

5,36

8 5,

938

6,16

6 7,

944

8,58

4 9,

969

10,5

13

MP

2N

ursi

ng a

nd re

side

ntia

l car

e fa

cilit

ies

5 5

6 6

7 8

8 9

9 10

11

12

13

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e32

1 33

3 38

6 45

9 57

3 68

4 93

3 1,

057

1,11

1 1,

544

1,58

9 1,

902

2,01

5

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds26

26

30

31

47

53

52

58

60

67

98

12

4 13

0

MP

5P

rovi

sion

and

adm

inis

trat

ion

of p

ublic

hea

lth p

rogr

amm

es44

1 42

0 45

5 49

6 59

1 70

1 66

8 67

7 66

7 84

8 89

5 99

9 1,

177

MP

6G

ener

al h

ealth

adm

inis

trat

ion

and

insu

ranc

e71

9 94

8 1,

056

1,57

5 1,

821

1,88

9 3,

319

2,80

3 1,

682

2,11

9 2,

144

2,49

8 3,

522

MP

7O

ther

indu

strie

s (re

st o

f the

Mal

aysi

an e

cono

my)

0 0

0 0

0 0

0 0

0 0

0 0

0

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

161

173

215

249

352

422

509

548

531

681

778

1,02

0 1,

030

MP

9R

est o

f the

wor

ld0

0 0

0 0

0 0

1 0

1 1

1 1

Tota

l4,

540

4,87

9 5,

424

6,47

9 7,

669

8,31

0 10

,856

11

,092

10

,227

13

,216

14

,098

16

,524

18

,401


TAB

LE 5

.4c

:Pub

lic S

ecto

r E

xpen

dit

ure

by

Pro

vid

er o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(Per

cen

t, %

)

MN

HA

co

de

Pub

lic S

ecto

r P

rovi

der

s19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

63.1

460

.95

60.3

956

.53

55.7

954

.78

49.4

453

.54

60.3

060

.11

60.8

860

.33

57.1

3

MP

2N

ursi

ng a

nd re

side

ntia

l car

e fa

cilit

ies

0.11

0.11

0.11

0.10

0.09

0.09

0.07

0.08

0.09

0.08

0.08

0.07

0.07

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e7.

076.

837.

127.

097.

478.

248.

599.

5310

.86

11.6

911

.27

11.5

110

.95

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds0.

580.

530.

560.

480.

610.

640.

480.

530.

590.

510.

690.

750.

71

MP

5P

rovi

sion

and

adm

inis

trat

ion

of p

ublic

hea

lth p

rogr

amm

es9.

728.

608.

387.

667.

708.

446.

156.

106.

526.

426.

346.

046.

39

MP

6G

ener

al h

ealth

adm

inis

trat

ion

and

insu

ranc

e15

.84

19.4

319

.48

24.3

023

.75

22.7

330

.57

25.2

716

.45

16.0

415

.21

15.1

219

.14

MP

7O

ther

indu

strie

s (re

st o

f the

Mal

aysi

an e

cono

my)

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

0.00

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

3.54

3.54

3.95

3.85

4.59

5.08

4.69

4.94

5.19

5.16

5.52

6.17

5.60

MP

9R

est o

f the

wor

ld0.

000.

000.

000.

000.

000.

010.

000.

010.

000.

010.

000.

010.

00

Tota

l10

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00


Public Sector Sources by Functions Cross-tabulations

Cross-tabulations of public sector sources of funding and functions of health care services and products respond to the question as to what is purchased or the type of services and products consumed with this source of financing.

In 2009, the public sector source of funds was spent the most for curative care consuming RM10,069 million or 55 per cent, followed by capital formation consuming RM2,754 million or 15 per cent and RM2,379 million or 13 per cent for health program administration and insurance. In the same year, RM1,577 million or under 9 per cent of this sector expenditure was spent for prevention and provision of public health services. The expenditure for all other functions of health care services and products was less than RM1,000 million each (Figure 5.5 and Table 5.5a).

The time series data shows a similar pattern with curative care, capital formation, and health administration and insurance occupying the three largest share of the public sector expenditure by function. However, the highest growth in the expenditure using public sector funding was in ancillary services to health care increasing from RM7 million in 1997 to RM250 million in 2009 but which remained to occupy less than 1 per cent share of the public sector spending. The expenditure for medical goods dispensed to out-patient and for research and development increased by nearly ten folds over the time period, but continued to occupy less than 5 per cent share of the public sector spending (Table 5.5b and Table 5.5c).


FIGURE 5.5: Public Sector Expenditure by Functions of Health Services, 2009

Curative Care

Admin HQ & Health Insurance

Prevention & Public Health

All Other FunctionsCapital Formation

55%

13%

9%

8%

15%


(RM18,401 million)

TABLE 5.5a: Public Sector Expenditure by Function of Health Services, 2009

MNHA code Function of Health services RM Million Per cent

MF1 Services of curative care 10,069 54.72

MR1 Capital formation of health care provider institutions 2,754 14.97

MF7 Health program administration and health insurance 2,379 12.93

MF6 Prevention and public health services 1,577 8.57

MR2 Education and training of health personnel 884 4.81

MF5 Medical goods dispensed to out-patients 419 2.28

MF4 Ancillary services to health care 250 1.36

MR3 Research & Development in Health 46 0.25

MF3 Services of long-term nursing care 13 0.07

MF2 Services of rehabilitative care 9 0.05

Total 18,401 100.00


TAB

LE 5

.5b

: Pub

lic S

ecto

r E

xpen

dit

ure

by

Func

tio

n o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(RM

Mill

ion)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

Ser

vice

s of

cur

ativ

e ca

re2,

828

2,89

6 3,

169

3,54

6 4,

093

4,44

8 5,

075

5,63

7 5,

794

7,44

6 8,

044

9,45

9 10

,069

MF2

Ser

vice

s of

reha

bilit

ativ

e ca

re3

2 3

2 3

2 9

9 11

12

10

5

9

MF3

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

5 5

6 6

7 8

8 9

9 10

11

12

13

MF4

Anc

illary

ser

vice

s to

hea

lth c

are

7 7

8 19

63

75

95

12

6 12

3 19

4 18

1 24

6 25

0

MF5

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

44

52

69

77

134

158

175

214

204

214

360

417

419

MF6

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s30

3 30

5 34

1 40

4 41

3 43

7 78

4 84

2 91

9 1,

559

1,36

1 1,

522

1,57

7

MF7

Hea

lth p

rogr

am a

dmin

istr

atio

n an

d he

alth

insu

ranc

e67

2 66

0 70

8 82

2 93

1 1,

134

1,40

8 1,

441

1,42

2 1,

836

1,91

3 2,

224

2,37

9

MR

1C

apita

l for

mat

ion

of h

ealth

car

e pr

ovid

er in

stitu

tions

519

782

912

1,35

6 1,

677

1,63

3 2,

809

2,32

4 1,

263

1,35

6 1,

533

1,72

3 2,

754

MR

2E

duca

tion

and

trai

ning

of h

ealth

per

sonn

el99

11

6 16

1 20

8 27

4 33

9 41

8 43

1 46

1 55

4 63

4 77

2 88

4

MR

3R

esea

rch

& D

evel

opm

ent i

n H

ealth

61

53

48

38

74

77

74

61

21

34

50

145

46

Tota

l4,

540

4,87

9 5,

424

6,47

9 7,

669

8,31

0 10

,856

11

,092

10

,227

13

,216

14

,098

16

,524

18

,401


TAB

LE 5

.5c:

Pub

lic S

ecto

r E

xpen

dit

ure

by

Func

tio

n o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(Per

cen

t, %

)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

Ser

vice

s of

cur

ativ

e ca

re62

.28

59.3

6 58

.43

54.7

2 53

.37

53.5

2 46

.75

50.8

2 56

.65

56.3

4 57

.05

57.2

4 54

.72

MF2

Ser

vice

s of

reha

bilit

ativ

e ca

re0.

06

0.04

0.

05

0.03

0.

04

0.03

0.

08

0.08

0.

10

0.09

0.

07

0.03

0.

05

MF3

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

0.11

0.

11

0.11

0.

10

0.09

0.

09

0.07

0.

08

0.09

0.

08

0.08

0.

07

0.07

MF4

Anc

illary

ser

vice

s to

hea

lth c

are

0.15

0.

14

0.14

0.

30

0.82

0.

90

0.87

1.

13

1.20

1.

47

1.29

1.

49

1.36

MF5

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

0.98

1.

07

1.27

1.

19

1.75

1.

91

1.61

1.

93

2.00

1.

62

2.56

2.

52

2.28

MF6

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s6.

67

6.25

6.

29

6.24

5.

39

5.25

7.

23

7.59

8.

99

11.8

0 9.

66

9.21

8.

57

MF7

Hea

lth p

rogr

am a

dmin

istr

atio

n an

d he

alth

insu

ranc

e14

.80

13.5

3 13

.04

12.6

9 12

.14

13.6

4 12

.97

12.9

9 13

.90

13.9

0 13

.57

13.4

6 12

.93

MR

1C

apita

l for

mat

ion

of h

ealth

car

e pr

ovid

er in

stitu

tions

11.4

4 16

.03

16.8

2 20

.93

21.8

6 19

.65

25.8

8 20

.95

12.3

5 10

.26

10.8

7 10

.43

14.9

7

MR

2E

duca

tion

and

trai

ning

of h

ealth

per

sonn

el2.

18

2.38

2.

97

3.22

3.

58

4.08

3.

85

3.88

4.

51

4.19

4.

50

4.67

4.

81

MR

3R

esea

rch

& D

evel

opm

ent i

n H

ealth

1.34

1.

09

0.88

0.

58

0.97

0.

93

0.68

0.

55

0.21

0.

26

0.36

0.

87

0.25

Tota

l10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00


Private Sector Sources of Financing

In 2009, analysis of the expenditure data shows that the highest source of financing in the private sector is household OOP spending amounting to RM11,986 million or 78 per cent of this sector expenditure (Figure 5.6 and Table 5.6a). The OOP spending excludes the purchases of individual health insurance. After OOP spending the next highest spending is by all private insurance agencies from personal, family or company insurance policies at RM1,968 million or 13 per cent of private sector spending. In the same year, corporations contributed to RM899 million or 6 per cent of private sector expenditure. This corporations expenditure is exclusive of group or company purchases of insurance which is reported under insurance agency expenditure. The other agencies under private sector which includes managed care organizations (MCO), non-profit organizations (NGO) serving households and rest of the world (ROW) or international agencies, in total contributed to RM437 million or below 3 per cent of the expenditure in this sector.

The private sector expenditure data for 1997-2009 time series shows that OOP expenditure throughout the time period remained the largest proportion and gradually increased from 73 to 79 per cent share of private spending (Table 5.6b and Table 5.6c). During this time period, private insurance enterprise expenditure also increased from 8 to 13 per cent share of private expenditure. However, corporation expenditure share of the private sector spending on health decreased from 14 to 6 per cent share of this sector.


FIGURE 5.6: Total Health Expenditure by Private Sector Sources of Financing, 2009

Private Household

OOP

Private Insurance

NGOAll Corporations

All Other agencies

90%

80%

70%

60%

50%

40%

30%

20%

10%

0%

1%2%6%

13%

78%

Priv

ate

Sec

tor

Sou

rces

of F

inan

cing

TABLE 5.6a: Total Health Expenditure by Private Sector Sources of Financing, 2009

MNHA code Source of financing RM Million Per cent

MS2.4 Private household out-of-pocket expenditures 11,986 78.39



MS2.5 Non-profit organisations serving households 367 2.40

MS2.3 Private MCOs and other similar entities 66 0.43

MS9 Rest of the world 4 0.02

Total 15,291 100.00


TAB

LE 5

.6b

: To

tal H

ealt

h E

xpen

dit

ure

by

Pri

vate

Sec

tor

So

urce

s o

f Fi

nanc

ing

, 199

7 -

2009

(RM

Mill

ion)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

2.2

Priv

ate

insu

ranc

e en

terp

rises

(oth

er th

an s

ocia

l ins

uran

ce)

295

365

421

516

599

718

964

1,12

4 1,

084

1,24

6 1,

413

1,70

9 1,

968

MS

2.3

Priv

ate

MC

Os

and

othe

r si

mila

r en

titie

s48

50

52

55

58

61

64

72

81

91

79

69

66

MS

2.4

Priv

ate

hous

ehol

d ou

t-of

-poc

ket e

xpen

ditu

res

2,57

6 2,

835

3,15

5 3,

864

4,05

6 4,

655

5,62

9 6,

719

7,66

7 8,

582

9,55

4 11

,050

11

,986

MS

2.5

Non

-pro

fit o

rgan

izat

ions

ser

ving

hou

seho

lds

(NG

O)

99

108

111

136

144

163

186

207

236

259

294

338

367

MS

2.6

All

Cor

pora

tions

(oth

er th

an h

ealth

insu

ranc

e)48

6 51

5 54

9 58

1 65

6 68

1 70

0 69

8 83

6 83

4 95

0 91

0 89

9

MS

9R

est o

f the

wor

ld (R

OW

)0

0 0

5 0

0 0

0 0

0 1

1 4

Tota

l3,

504

3,87

3 4,

288

5,15

6 5,

513

6,27

8 7,

543

8,82

0 9,

904

11,0

12

12,2

91

14,0

77

15,2

91

TAB

LE 5

.6c

: To

tal H

ealt

h E

xpen

dit

ure

by

Pri

vate

Sec

tor

So

urce

s o

f Fi

nanc

ing

, 199

7 -

2009

(Per

cen

t, %

)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

2.2

Priv

ate

insu

ranc

e en

terp

rises

(oth

er th

an s

ocia

l ins

uran

ce)

8.40

9.

42

9.82

10

.00

10.8

6 11

.44

12.7

8 12

.75

10.9

5 11

.31

11.5

0 12

.14

12.8

7

MS

2.3

Priv

ate

MC

Os

and

othe

r si

mila

r en

titie

s1.

38

1.29

1.

22

1.07

1.

05

0.97

0.

84

0.81

0.

82

0.83

0.

64

0.49

0.

43

MS

2.4

Priv

ate

hous

ehol

d ou

t-of

-poc

ket e

xpen

ditu

res

73.5

0 73

.21

73.5

8 74

.94

73.5

8 74

.15

74.6

2 76

.18

77.4

1 77

.93

77.7

3 78

.50

78.3

9

MS

2.5

Non

-pro

fit o

rgan

izat

ions

ser

ving

hou

seho

lds

2.84

2.

79

2.58

2.

63

2.62

2.

60

2.47

2.

35

2.38

2.

35

2.39

2.

40

2.40

MS

2.6

All

Cor

pora

tions

(oth

er th

an h

ealth

insu

ranc

e)13

.88

13.2

9 12

.80

11.2

7 11

.89

10.8

4 9.

28

7.91

8.

44

7.57

7.

73

6.47

5.

88

MS

9R

est o

f the

wor

ld0.

00

0.00

0.

00

0.09

0.

00

0.00

0.

00

0.00

0.

00

0.00

0.

01

0.01

0.

02

Tota

l10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00


Private Sector Sources by Providers Cross-tabulations

Just as in the public sector, the cross-tabulations of private sector sources of funding with providers of health care services & products, respond to the question as to where the private source of fund is spent or who provides the services & products with this money.

In 2009, hospitals consumed RM6,378 million or 42 per cent, followed by providers of ambulatory care at RM5,096 million or 33 per cent. The providers of retail sales & other providers of medical goods consumed RM2,251 million or 15 per cent whereas the providers of general administration and insurance consumed RM1,059 million or 7 per cent (Figure 5.7 and Table 5.7a). The remaining private source of funding amounting to a total of RM507 million or 3 per cent were spent at institutions providing health-related services, by providers & administrators of public health programmes, non-resident or ROW providers, and by providers of nursing & residential care facilities.

The 1997 to 2009 time series data shows that throughout this period, more than 70 per cent of the private source of financing has been at hospitals and providers of ambulatory care (Table 5.7b and Table 5.7c). Hospital expenditures increased from RM1,231 million in 1997 to RM6,378 million in 2009 whereas expenditures at ambulatory care providers increased from RM1,321 million in 1997 to RM5,096 million in 2009. The data also shows that although spending at institutions providing health-related services, which mainly comprises of the teaching & training institutions, has remained below 3 per cent of the spending, this expenditure at the expense of private source of funding has increased by nearly 8-fold from RM58 million in 1997 to RM459 million in 2009.


FIGURE 5.7: Private Sector Expenditure by Providers of Health Services, 2009

Hospitals

Retail sale & Medical goods Providers

General health admin & insurance

All Other ProvidersAmbulatory health care Providers

42%

15%

7%3%

33%


(RM15,291 million)

TABLE 5.7a: Private Sector Expenditure by Providers of Health Services, 2009

MNHA code Providers of Health Services RM Million Per cent



MP4 Retail sale and other providers of medical goods 2,251 14.72


MP8 Institutions providing health related services 459 3.00

MP5 Provision and administration of public health programmes 22 0.14

MP9 Rest of the world (ROW) 15 0.10


Total 15,291 100.00

*Private sector- include MS9


TAB

LE 5

.7b

: Pri

vate

Sec

tor

Exp

end

itur

e b

y P

rovi

der

s o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(RM

Mill

ion)

*

MN

HA

co

de

Pro

vid

ers

of

Hel

ath

Ser

vice

s19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

1,23

1 1,

404

1,59

9 1,

815

2,07

8 2,

401

2,94

4 3,

385

3,69

3 4,

241

4,80

6 5,

564

6,37

8

MP

2N

ursi

ng a

nd re

side

ntia

l car

e fa

cilit

ies

3 3

3 4

5 8

12

13

15

16

17

10

11

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e1,

321

1,41

3 1,

546

1,87

0 1,

974

2,21

1 2,

509

2,95

1 3,

552

3,87

8 4,

245

4,84

1 5,

096

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds50

3 54

2 59

4 81

8 78

8 92

6 1,

130

1,43

4 1,

588

1,72

9 1,

972

2,22

7 2,

251

MP

5P

rovi

sion

and

adm

inis

trat

ion

of p

ublic

hea

lth p

rogr

amm

es8

8 10

11

12

13

15

16

21

22

26

35

22

MP

6G

ener

al h

ealth

adm

inis

trat

ion

and

insu

ranc

e37

9 42

8 45

2 53

4 54

7 58

8 76

9 83

7 82

5 88

1 91

7 1,

008

1,05

9

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

58

73

82

101

105

127

158

177

203

236

298

379

459

MP

9R

est o

f the

wor

ld1

2 2

3 4

5 6

7 7

8 10

13

15

Tota

l3,

504

3,87

3 4,

288

5,15

6 5,

513

6,27

8 7,

543

8,82

0 9,

904

11,0

12

12,2

91

14,0

77

15,2

91

*Priv

ate

sect

or-

incl

ude

MS

9


TAB

LE 5

.7c:

Pri

vate

Sec

tor

Exp

end

itur

e b

y P

rovi

der

s o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(Per

cen

t, %

)*

MN

HA

co

de

Pro

vid

ers

of

Hea

lth

Ser

vice

s19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

35.1

4 36

.25

37.2

9 35

.20

37.7

0 38

.25

39.0

3 38

.38

37.2

9 38

.52

39.1

0 39

.53

41.7

1

MP

2N

ursi

ng a

nd re

side

ntia

l car

e fa

cilit

ies

0.07

0.

08

0.08

0.

09

0.08

0.

12

0.16

0.

15

0.15

0.

14

0.14

0.

07

0.07

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e37

.70

36.4

8 36

.07

36.2

6 35

.80

35.2

2 33

.27

33.4

5 35

.87

35.2

2 34

.54

34.3

9 33

.33

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds14

.36

14.0

0 13

.84

15.8

7 14

.30

14.7

4 14

.99

16.2

6 16

.03

15.7

0 16

.04

15.8

2 14

.72

MP

5P

rovi

sion

and

adm

inis

trat

ion

of p

ublic

hea

lth p

rogr

amm

es0.

22

0.21

0.

23

0.21

0.

21

0.21

0.

20

0.18

0.

21

0.20

0.

21

0.25

0.

14

MP

6G

ener

al h

ealth

adm

inis

trat

ion

and

insu

ranc

e10

.81

11.0

4 10

.53

10.3

5 9.

93

9.36

10

.19

9.49

8.

33

8.00

7.

46

7.16

6.

92

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

1.66

1.

90

1.91

1.

96

1.91

2.

02

2.10

2.

01

2.05

2.

14

2.42

2.

69

3.00

MP

9R

est o

f the

wor

ld0.

04

0.04

0.

05

0.05

0.

07

0.07

0.

07

0.08

0.

07

0.08

0.

08

0.09

0.

10

Tota

l10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

*Priv

ate

sect

or-

incl

ude

MS

9


Private Sector Sources by Functions Cross-tabulations

Cross-tabulations of private sector sources of funding and functions of health care services and products respond to the question as to what is purchased or the type of services and products consumed with this source of financing.

In 2009, the public sector source of funds was spent the most for curative care consuming RM9,009 million or 59 per cent, followed by medical goods dispensed to out-patient at RM3,730 million or 24 per cent. In the same year, RM1,075 million or 7 per cent of this sector expenditure was spent for health program administration and health insurance (Figure 5.8 and Table 5.8a).

The time series data shows a similar pattern with expenditures for curative care and medical goods dispensed to out-patient totaling to 78 to 83 per cent of the sector spending (Table 5.8b and Table 5.8c). As noted in the earlier section, although education and training expenditure over this time period has remained below 3 percent share of this spending, it has increased by nearly 8-fold from RM55 million in 1997 to RM463 million in 2009.


FIGURE 5.8: Private Sector Expenditure By Functions of Health Services, 2009

Curative care

Health Program Admin & Health insurance

All Other functions

Ancillary ServicesMedical Goods

59%

7%

6% 4%

24%


(RM15,291 million)

TABLE 5.8a: Private Sector Expenditure by Function of Health Services, 2009



MF5 Medical goods dispensed to out-patients 3,730 24.39



MR2 Education and training of health personnel 463 3.03

MF6 Prevention and public health services 181 1.19




MR1 Capital formation of health care provider institutions 3 0.02

Total 15,291 100.00


TAB

LE 5

.8b

: Pri

vate

Sec

tor

Exp

end

itur

e b

y Fu

ncti

on

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (R

M M

illio

n)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

Ser

vice

s of

cur

ativ

e ca

re1,

764

1,98

8 2,

249

2,60

2 2,

912

3,33

8 3,

974

4,67

9 5,

369

6,06

8 6,

765

7,86

6 9,

009

MF2

Ser

vice

s of

reha

bilit

ativ

e ca

re15

17

20

22

25

28

36

39

45

52

61

62

75

MF3

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

27

31

35

40

45

53

67

103

89

101

111

115

133

MF4

Anc

illary

ser

vice

s to

hea

lth c

are

179

192

209

254

282

317

370

411

495

526

587

635

618

MF5

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

985

1,04

0 1,

129

1,48

3 1,

463

1,68

5 2,

019

2,42

0 2,

694

2,96

0 3,

340

3,79

0 3,

730

MF6

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s94

99

10

7 11

4 12

8 13

5 14

2 14

5 17

5 17

8 20

0 20

9 18

1

MF7

Hea

lth p

rogr

am a

dmin

istr

atio

n an

d he

alth

insu

ranc

e38

5 43

4 45

9 54

1 55

2 59

5 77

7 84

7 83

4 89

2 92

9 1,

021

1,07

5

MR

1C

apita

l for

mat

ion

of h

ealth

car

e pr

ovid

er in

stitu

tions

1 1

1 1

1 1

1 1

2 2

2 2

3

MR

2E

duca

tion

and

trai

ning

of h

ealth

per

sonn

el55

70

78

93

10

5 12

5 15

5 17

3 20

0 23

2 29

5 37

6 46

3

MR

3R

esea

rch

& D

evel

opm

ent i

n H

ealth

0 0

0 5

1 1

1 1

1 1

1 1

3

Tota

l3,

504

3,87

3 4,

288

5,15

6 5,

513

6,27

8 7,

543

8,82

0 9,

904

11,0

12

12,2

91

14,0

77

15,2

91


TAB

LE 5

.8c:

Pri

vate

Sec

tor

Exp

end

itur

e b

y Fu

ncti

ons

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (P

er c

ent,

%)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

Ser

vice

s of

cur

ativ

e ca

re50

.33

51.3

3 52

.45

50.4

7 52

.83

53.1

7 52

.69

53.0

5 54

.20

55.1

0 55

.04

55.8

8 58

.92

MF2

Ser

vice

s of

reha

bilit

ativ

e ca

re0.

43

0.45

0.

46

0.43

0.

45

0.45

0.

48

0.44

0.

46

0.48

0.

50

0.44

0.

49

MF3

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

0.77

0.

80

0.82

0.

79

0.81

0.

85

0.88

1.

17

0.90

0.

92

0.90

0.

82

0.87

MF4

Anc

illary

ser

vice

s to

hea

lth c

are

5.10

4.

97

4.88

4.

92

5.11

5.

05

4.91

4.

66

5.00

4.

77

4.78

4.

51

4.04

MF5

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

28.1

1 26

.85

26.3

4 28

.76

26.5

3 26

.85

26.7

7 27

.44

27.2

0 26

.88

27.1

7 26

.93

24.3

9

MF6

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s2.

68

2.57

2.

50

2.22

2.

32

2.14

1.

88

1.65

1.

77

1.62

1.

62

1.48

1.

19

MF7

Hea

lth p

rogr

am a

dmin

istr

atio

n an

d he

alth

insu

ranc

e10

.98

11.2

1 10

.70

10.4

9 10

.02

9.48

10

.30

9.60

8.

42

8.10

7.

56

7.25

7.

03

MR

1C

apita

l for

mat

ion

of h

ealth

car

e pr

ovid

er in

stitu

tions

0.02

0.

02

0.02

0.

02

0.02

0.

02

0.02

0.

02

0.02

0.

02

0.02

0.

02

0.02

MR

2E

duca

tion

and

trai

ning

of h

ealth

per

sonn

el1.

57

1.81

1.

83

1.80

1.

90

1.98

2.

05

1.96

2.

02

2.11

2.

40

2.67

3.

03

MR

3R

esea

rch

& D

evel

opm

ent i

n H

ealth

0.01

0.

01

0.01

0.

10

0.01

0.

01

0.01

0.

01

0.01

0.

01

0.01

0.

01

0.02

Tota

l10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00


OOP by Providers Cross-tabulations

In 2009, OOP expenditure by the top three providers of health services and products show a similar pattern to the total private sector expenditures by providers (refer Figure 5.7). In the same year, RM4,989 million or 42 per cent of OOP was spent at hospitals followed by RM4,446 million or 37 per cent at providers of ambulatory health care and RM2,194 million or 18 per cent at providers of retail sale and other providers of medical goods (Figure 5.9 and Table 5.9a).

The 1997-2009 time series data shows a similar pattern with expenditures at hospitals, providers of ambulatory care and providers of retail sale and other medical goods with each increasing progressively by more than 4-folds in absolute ringgit value over the time period (Table 5.9b and Table 5.9c). However, the individual share of the private expenditure of these three providers remained the same throughout the time period. Similarly OOP expenditure at institutions providing health related services increased by nearly 9-fold from RM40 million in 1997 to RM357 million in 2009.


FIGURE 5.9: Private Household OOP Expenditure By Providers of Health Services, 2009

Hospitals Retail sale & Other Medical Goods Providers

Institutions providing health related servicesAmbulatory Care Providers

42%

18%

3%

37%

OOP : 78%of Private Sector

Expenditure(RM11,986 million)

TABLE 5.9a: Private Household Out-of-Pocket Expenditure by Provider of Health Services, 2009

MNHA code Provider of Health services RM Million Per cent




MP8 Institutions providing health related services 357 2.98

Total 11,986 100.00


TAB

LE 5

.9b

: Pri

vate

Ho

useh

old

Out

-of-

Po

cket

Exp

end

itur

e b

y P

rovi

der

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (R

M M

illio

n)

MN

HA

co

de

Pro

vid

er o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

1,08

6 1,

227

1,38

1 1,

555

1,72

4 1,

955

2,42

2 2,

754

3,03

1 3,

452

3,85

6 4,

404

4,98

9

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e96

3 1,

036

1,14

7 1,

448

1,49

7 1,

715

1,99

6 2,

438

2,94

2 3,

268

3,56

0 4,

180

4,44

6

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds48

7 52

1 56

8 79

2 75

7 89

2 1,

093

1,39

5 1,

540

1,68

1 1,

909

2,17

1 2,

194

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

40

52

58

69

78

94

118

132

154

180

229

294

357

Tota

l2,

576

2,83

5 3,

155

3,86

4 4,

056

4,65

5 5,

629

6,71

9 7,

667

8,58

2 9,

554

11,0

50

11,9

86

TAB

LE 5

.9c:

Pri

vate

Ho

useh

old

Out

-of-

Po

cket

Exp

end

itur

e b

y P

rovi

der

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (P

er c

ent,

%)

MN

HA

co

de

Pro

vid

er o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

42.1

6 43

.27

43.7

9 40

.25

42.5

0 41

.99

43.0

2 40

.98

39.5

3 40

.23

40.3

6 39

.86

41.6

2

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e37

.37

36.5

4 36

.36

37.4

7 36

.92

36.8

3 35

.46

36.2

9 38

.38

38.0

8 37

.26

37.8

3 37

.10

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds18

.92

18.3

7 18

.01

20.4

9 18

.65

19.1

7 19

.41

20.7

6 20

.09

19.5

9 19

.98

19.6

5 18

.30

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

1.55

1.

82

1.84

1.

79

1.93

2.

01

2.10

1.

97

2.01

2.

09

2.39

2.

66

2.98

Tota

l10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00


Total Health Expenditure by Providers of Health Services

The providers of health care services & products include hospitals, nursing and residential care facility providers, ambulatory care providers, retail sale and medical goods providers and public health programme providers (Appendix Table A2.1b).

In 2009 analysis of providers of health services shows that the hospitals consumed RM16,891 million or 50 per cent of total health expenditure (Figure 6.1 and Table 6.1a). This was followed by providers of ambulatory health care at RM7,111 million or 21 per cent and general health administration at RM2,381 million or 7 per cent. All other remaining providers of health care services and products consumed RM2,728 million or 8 per cent of the total health expenditure.

The 1997 to 2009 time series data also shows a similar pattern with the same top four providers as in 2009 contributing to an average of 92 per cent share of total health expenditure per year (Table 6.1b and Table 6.1c). The expenditures of the same top four providers increased in absolute ringgit value of about 4-fold over the same time period.

CHAPTER 6


FIGURE 6.1: Total Health Expenditure on Health By Providers of Health Services, 2009

Hospitals Medical goods

All otherProviders

Ambulantoryhealth care

General Healthadmin &

insurance

60%

50%

40%

30%

20%

10%

0%

50%

21%

14%

7% 8%

Pro

vid

er o

f Hea

lth C

are

TABLE 6.1a: Total Expenditure by Providers of Health Services, 2009

MNHA code Providers of Health Services RM Million Per cent





MP8 Institutions providing health related services 1,490 4.42

MP5 Provision and administration of public health programmes 1,198 3.56


MP9 Rest of the world 15 0.05

MP7 Other industries (rest of the Malaysian economy) 0 0.00

Total 33,691 100.00


TAB

LE 6

.1b

: To

tal

Exp

end

itur

e b

y P

rovi

der

s o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(RM

Mill

ion)

MN

HA

co

de

Pro

vid

ers

of

Hea

lth

Ser

vice

s19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

4

,098

4,8

74

4

,874

5,4

77

6

,357

6,9

53

8

,311

9,3

24

9

,860

1

2,18

5 1

3,39

0 1

5,53

3 1

6,89

1

MP

2N

ursi

ng a

nd re

side

ntia

l car

e fa

cilit

ies

8

9

9

11

11

15

20

22

24

26

28

22

25

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e

1,6

42

1

,932

1,9

32

2

,329

2,5

46

2

,896

3,4

42

4

,008

4,6

63

5

,423

5,8

34

6

,743

7,1

11

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds

5

29

624

6

24

849

8

35

979

1,1

82

1

,493

1,6

48

1

,796

2,0

69

2

,351

2,3

81

MP

5P

rovi

sion

and

adm

inis

trat

ion

of p

ublic

hea

lth p

rogr

amm

es

4

49

465

4

65

507

6

03

715

6

83

692

6

88

870

9

20

1

,034

1,1

98

MP

6G

ener

al h

ealth

adm

inis

trat

ion

and

insu

ranc

e

1,0

98

1

,508

1,5

08

2

,108

2,3

69

2

,477

4,0

88

3

,640

2,5

06

3

,001

3,0

61

3

,507

4,5

80

MP

7O

ther

indu

strie

s (re

st o

f the

Mal

aysi

an e

cono

my)

0

0

0

0

0

0

0

0

0

0

0

0

0

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

219

2

97

297

3

50

458

5

49

667

7

26

734

9

17

1

,076

1,3

98

1

,490

MP

9R

est o

f the

wor

ld

2

2

2

3

4

5

6

8

7

9

11

13

15

Tota

l8,

045

9,71

19,

711

11,6

3513

,182

14,5

8818

,399

19,9

1220

,131

24,2

2726

,389

30,6

0133

,691


TAB

LE 6

.1c:

To

tal

Exp

end

itur

e b

y P

rovi

der

s o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(Per

cen

t, %

)

MN

HA

co

de

Pro

vid

ers

of

Hea

lth

Ser

vice

s19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MP

1H

ospi

tals

5

0.94

50.

19

5

0.19

47.

08

4

8.22

47.

66

4

5.17

46.

82

4

8.98

50.

30

5

0.74

50.

76

5

0.13

MP

2N

ursi

ng a

nd re

side

ntia

l car

e fa

cilit

ies

0.09

0.

10

0.10

0.

09

0.09

0.

10

0.11

0.

11

0.12

0.

11

0.11

0.

07

0.07

MP

3P

rovi

ders

of a

mbu

lato

ry h

ealth

car

e

20.

41

1

9.90

19.

90

2

0.02

19.

32

1

9.85

18.

71

2

0.13

23.

17

2

2.38

22.

11

2

2.03

21.

11

MP

4R

etai

l sal

e an

d ot

her

prov

ider

s of

med

ical

goo

ds

6.

58

6.43

6.

43

7.30

6.

33

6.71

6.

42

7.50

8.

19

7.41

7.

84

7.68

7.

07

MP

5P

rovi

sion

and

adm

inis

trat

ion

of p

ublic

hea

lth p

rogr

amm

es

5.

58

4.78

4.

78

4.36

4.

57

4.90

3.

71

3.48

3.

42

3.59

3.

49

3.38

3.

56

MP

6G

ener

al h

ealth

adm

inis

trat

ion

and

insu

ranc

e

13.

65

1

5.53

15.

53

1

8.12

17.

97

1

6.98

22.

22

1

8.28

12.

45

1

2.38

11.

60

1

1.46

13.

60

MP

7O

ther

indu

strie

s (re

st o

f the

Mal

aysi

an e

cono

my)

0.00

0.

00

0.00

0.

00

0.00

0.

00

0.00

0.

00

0.00

0.

00

0.00

0.

00

0.00

MP

8In

stitu

tions

pro

vidi

ng h

ealth

rela

ted

serv

ices

2.72

3.

05

3.05

3.

01

3.47

3.

76

3.62

3.

64

3.65

3.

79

4.08

4.

57

4.42

MP

9R

est o

f the

wor

ld

0.

02

0.02

0.

02

0.02

0.

03

0.04

0.

03

0.04

0.

04

0.04

0.

04

0.04

0.

05

Tota

l10

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00


Hospital by Sources of Financing Cross-tabulations

Further cross-tabulations of the two largest providers, hospitals and providers of ambulatory care services are noted further. The cross-tabulations of hospitals and sources of financing responds to the question as to who or which agencies finances health care services provided at all hospitals in the country.

In 2009 the highest spending for hospital services was incurred by the MOH at RM7,903 million or 47 per cent followed by private household OOP at RM4,989 million or 30 per cent, Ministry of Higher Education (MOHE) at RM1,774 million or 11 per cent and private insurance enterprises at RM1,220 million or 7 per cent (Figure 6.2 and Table 6.2a). The remaining hospital expenditure at RM 1,005 million or 6 per cent came from multiple other sources of financing each spending below RM1,000 million.

The 1997 to 2009 time series data also shows a similar pattern with the same top four sources of financing to hospital providers as in 2009 (Table 6.2b and Table 6.2c). However, the growth of expenditure in absolute value from 1997 to 2009 is seen highest in NGO followed by SOCSO and private insurance enterprise. In 1997, each of these sources contributed to less than 2 per cent of the expenditure to all hospitals for that year.


FIGURE 6.2: Hospital Expenditure By Sources of Financing, 2009

MOH

MOHE

Private insurance

All other sourcesHousehold OOP

59%

7%

6% 4%

24%

Hospitalexpenditure:50% of TEH

(RM16,891 million)

TABLE 6.2a : Hospital Expenditure by Sources of Financing, 2009

MNHA code Source of financing RM Million Per cent


MS2.4 Private household out-of-pocket expenditures (OOP) 4,989 29.54







MS2.5 Non-profit organisations serving households (NGO) 31 0.18


MS1.1.3 Local authorities 17 0.10



Total 16,891 100.00


TAB

LE 6

.2b

: H

osp

ital

Exp

end

itur

e b

y S

our

ces

of

Fina

ncin

g, 1

997

- 20

09 (R

M M

illio

n)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Min

istr

y of

Hea

lth (M

OH

)2,

248

2,36

1 2,

552

2,82

9 3,

216

3,32

3 3,

993

4,30

6 4,

542

6,18

4 6,

532

7,53

1 7,

903

MS

1.1.

1.2

Min

istr

y of

Hig

her

Edu

catio

n (M

OH

E)

462

435

520

597

766

870

947

1,02

2 1,

060

1,15

0 1,

326

1,52

2 1,

774

MS

1.1.

1.3

Min

istr

y of

Def

ence

(MO

D)

8 4

5 6

11

18

10

12

13

13

29

54

29

MS

1.1.

1.9

Oth

er fe

dera

l age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)13

6 15

3 17

2 19

6 23

9 28

9 35

5 52

1 47

5 50

8 60

4 76

1 70

0

MS

1.1.

2.1

(Gen

eral

) Sta

te G

over

nmen

t4

4 5

6 6

7 7

7 8

9 13

12

12

MS

1.1.

2.2

Oth

er s

tate

age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)1

1 2

2 2

2 2

3 3

3 3

4 4

MS

1.1.

3Lo

cal a

utho

ritie

s2

2 3

3 4

5 6

7 8

10

12

16

17

MS

1.2.

1E

mpl

oyee

Pro

vide

nt F

unds

(EP

F)6

13

16

19

26

30

30

45

54

41

42

40

33

MS

1.2.

2S

ocia

l Sec

urity

Org

aniz

atio

n (S

OC

SO

)1

1 2

4 7

9 17

16

2

25

21

29

42

MS

2.2

Priv

ate

insu

ranc

e en

terp

rises

(oth

er th

an s

ocia

l ins

uran

ce)

64

91

126

164

246

332

408

519

527

655

797

1,00

7 1,

220

MS

2.4

Priv

ate

hous

ehol

d ou

t-of

-poc

ket e

xpen

ditu

res

(OO

P)

1,08

6 1,

227

1,38

1 1,

555

1,72

4 1,

955

2,42

2 2,

754

3,03

1 3,

452

3,85

6 4,

404

4,98

9

MS

2.5

Non

-pro

fit o

rgan

izat

ions

ser

ving

hou

seho

lds

(NG

O)

1 1

1 1

1 3

1 1

1 1

2 11

31

MS

2.6

All

Cor

pora

tions

(oth

er th

an h

ealth

insu

ranc

e)81

85

90

95

10

8 11

1 11

3 11

2 13

5 13

3 15

1 14

1 13

7

To

tal

4,09

8 4,

378

4,87

4 5,

477

6,35

7 6,

953

8,31

1 9,

324

9,86

0 12

,185

13

,390

15

,533

16

,891


TAB

LE 6

.2c

: Ho

spit

al E

xpen

dit

ure

by

So

urce

s o

f Fi

nanc

ing

, 199

7 -

2009

(Per

cen

t, %

)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Min

istr

y of

Hea

lth (M

OH

)

54.8

4

53.9

3

52.3

5

51.6

6

50.6

0

47.7

9

48.0

4

46.1

8

46.0

7

50.7

5

48.7

9

48.4

8

46.7

9

MS

1.1.

1.2

Min

istr

y of

Hig

her

Edu

catio

n (M

OH

E)

11

.27

9

.94

10

.66

10

.89

12

.06

12

.51

11

.40

10

.96

10

.75

9

.44

9

.90

9

.80

10

.50

MS

1.1.

1.3

Min

istr

y of

Def

ence

(MO

D)

0

.19

0

.09

0

.10

0

.11

0

.18

0

.26

0

.12

0

.13

0

.13

0

.11

0

.22

0

.35

0

.17

MS

1.1.

1.9

Oth

er fe

dera

l age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)

3.3

1

3.4

8

3.5

2

3.5

8

3.7

6

4.1

5

4.2

8

5.5

9

4.8

2

4.1

7

4.5

1

4.9

0

4.1

5

MS

1.1.

2.1

(Gen

eral

) Sta

te G

over

nmen

t

0.1

0

0.1

0

0.1

0

0.1

0

0.0

9

0.0

9

0.0

8

0.0

8

0.0

8

0.0

8

0.1

0

0.0

8

0.0

7

MS

1.1.

2.2

Oth

er s

tate

age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)

0.0

3

0.0

3

0.0

3

0.0

3

0.0

3

0.0

3

0.0

3

0.0

3

0.0

3

0.0

2

0.0

2

0.0

2

0.0

2

MS

1.1.

3Lo

cal A

utho

ritie

s (L

A)

0

.05

0

.05

0

.06

0

.06

0

.06

0

.07

0

.07

0

.07

0

.09

0

.08

0

.09

0

.10

0

.10

MS

1.2.

1E

mpl

oyee

Pro

vide

nt F

unds

(EP

F)

0.1

4

0.2

9

0.3

4

0.3

6

0.4

1

0.4

3

0.3

6

0.4

8

0.5

5

0.3

4

0.3

2

0.2

6

0.1

9

MS

1.2.

2S

ocia

l Sec

urity

Org

aniz

atio

n (S

OC

SO

)

0.0

2

0.0

2

0.0

4

0.0

8

0.1

1

0.1

3

0.2

0

0.1

7

0.0

2

0.2

1

0.1

6

0.1

9

0.2

5

MS

2.2

Priv

ate

insu

ranc

e en

terp

rises

(oth

er th

an s

ocia

l ins

uran

ce)

1

.56

2

.09

2

.59

2

.99

3

.87

4

.77

4

.91

5

.56

5

.34

5

.37

5

.95

6

.48

7

.22

MS

2.4

Priv

ate

hous

ehol

d ou

t-of

-poc

ket e

xpen

ditu

res

(OO

P)

26

.50

28

.02

28

.34

28

.39

27

.12

28

.11

29

.14

29

.53

30

.74

28

.33

28

.80

28

.36

29

.54

MS

2.5

Non

-pro

fit o

rgan

izat

ions

ser

ving

hou

seho

lds

(NG

O)

0

.01

0

.01

0

.01

0

.01

0

.01

0

.05

0

.01

0

.01

0

.01

0

.01

0

.01

0

.07

0

.18

MS

2.6

All

Cor

pora

tions

(oth

er th

an h

ealth

insu

ranc

e)

1.9

8

1.9

5

1.8

5

1.7

4

1.6

9

1.6

0

1.3

6

1.2

0

1.3

7

1.0

9

1.1

3

0.9

1

0.8

1

To

tal

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00

100

.00


MOH Hospital by Curative care Cross-tabulations

MOH is the largest single financier of all the sources of financing for hospital services. Most of this expenditure is spent for curative care whereby curative care services provided by hospitals include inpatient, outpatient, day care services with minimal home care services. Under the MNHA framework, these types of services would be inclusive of both allopathic and traditional and complementary care services.

In 2009, RM7,781 million or 98 per cent of the RM7,903 million spent at MOH hospitals were for curative care services (Figure 6.3 and Table 6.3a). In the same year RM5,176 million or 67 per cent of the hospital curative care expenditure was for inpatient care services followed by RM2,450 million or 31 per cent for patient care services and RM154 million or 2 per cent for day care services.

The 1997 to 2009 time series data shows that in absolute ringgit value the MOH hospital inpatient and outpatient expenditure has increased by nearly 4-fold but remains at the same pattern as a share of the total curative care expenditure (Table 6.3b and Table 6.3c).


FIGURE 6.3: MOH Hospital Expenditure By Curative Care Functions of Health Services, 2009

In-patient Out-patient Day care

67%

2%

31%

Curative care:98% of total

Hospital Expenditure**(RM7,781 million)

TABLE 6.3a: MOH Hospital Expenditure by Curative Care Function of Health Services, 2009**


MF1.1 In-patient curative care 5,176 66.53

MF1.3* Out-patient curative care 2,450 31.49

MF1.2 Day cases of curative care 154 1.98

Total 7,781 100.00

Note: *Data includes home careNote: ** Excludes MOH development expenditure to hospitals

Note : ** Excludes MOH development expenditure to hospitals


TAB

LE 6

.3b

: MO

H H

osp

ital

Exp

end

itur

e b

y C

urat

ive

Car

e Fu

ncti

on

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (

RM

Mill

ion)

**

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

.1In

-pat

ient

cur

ativ

e ca

re

1,

470

1,53

2

1,

641

1,83

5

2,

048

2,16

0

2,

570

2,75

6

2,

852

3,99

4

4,

196

4,93

6

5,

176

MF1

.2D

ay c

ases

of c

urat

ive

care

46

48

51

57

63

66

79

84

87

12

0

125

14

7

154

MF1

.3*

Out

-pat

ient

cur

ativ

e ca

re

700

72

8

782

87

5

975

1,02

9

1,

224

1,31

0

1,

356

1,89

4

1,

997

2,34

4

2,

450

Tota

l

2,

215

2,30

8

2,

474

2,76

6

3,

086

3,25

5

3,

872

4,15

1

4,

295

6,00

8

6,

318

7,42

7

7,

781

TAB

LE 6

.3c:

MO

H H

osp

ital

Exp

end

itur

e b

y C

urat

ive

Car

e Fu

ncti

on

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (P

er c

ent,

%)*

*

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

.1In

-pat

ient

cur

ativ

e ca

re

66

.34

66

.37

66

.33

66

.34

66

.37

66

.36

66

.36

66

.40

66

.40

66

.47

66

.41

66

.46

66

.53

MF1

.2D

ay c

ases

of c

urat

ive

care

2.

07

2.

08

2.

06

2.

04

2.

05

2.

03

2.

03

2.

03

2.

02

2.

00

1.

98

1.

97

1.

98

MF1

.3*

Out

-pat

ient

cur

ativ

e ca

re

31.5

9

31.5

5

31.6

1

31.6

1

31.5

8

31.6

0

31.6

1

31.5

6

31.5

7

31.5

2

31.6

0

31.5

7

31.4

9

Tota

l

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

Not

e:*

Dat

a in

clud

e ho

me

care

Not

e: *

* A

ll M

OH

dat

a ex

clud

es d

evel

opm

ent e

xpen

ditu

re


TAB

LE 6

.3c:

MO

H H

osp

ital

Exp

end

itur

e b

y C

urat

ive

Car

e Fu

ncti

on

of

Hea

lth

Ser

vice

s, 1

997

- 20

09 (P

er c

ent,

%)*

*

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

.1In

-pat

ient

cur

ativ

e ca

re

66

.34

66

.37

66

.33

66

.34

66

.37

66

.36

66

.36

66

.40

66

.40

66

.47

66

.41

66

.46

66

.53

MF1

.2D

ay c

ases

of c

urat

ive

care

2.

07

2.

08

2.

06

2.

04

2.

05

2.

03

2.

03

2.

03

2.

02

2.

00

1.

98

1.

97

1.

98

MF1

.3*

Out

-pat

ient

cur

ativ

e ca

re

31.5

9

31.5

5

31.6

1

31.6

1

31.5

8

31.6

0

31.6

1

31.5

6

31.5

7

31.5

2

31.6

0

31.5

7

31.4

9

Tota

l

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

10

0.00

Ambulatory Care providers by Sources of Financing Cross-tabulations

After hospitals the next largest provider of health care services are the providers of ambulatory care services. The MNHA framework adopts the SHA framework definition of providers of ambulatory care and includes providers of medical clinics, dental clinics, family planning centers, substance abuse centers, dialysis centers, medical and diagnostic centers, ambulance providers and many other outpatient providers who do provide inpatient services. The MNHA framework, unlike the SHA framework, includes providers of Traditional and Complementary medicines under this category.

In 2009, ambulatory care providers consumed RM7,111 million or 21 per cent of total health expenditure (Figure 6.4 and Table 6.4a). Of this amount, RM5,096 million or 72 per cent was funded by private sector source of financing and the remaining RM2,015 million or 28 per cent by public sector financing.

The 1997 to 2009 time series data shows that the expenditure for ambulatory care services has increased by 4-fold in absolute ringgit value (Table 6.4b and Table 6.4c). A higher rate of increase of the private source of financing compared to public source of funding is noted. However, over the same time period the trend of share of private to public source of financing shows a decreasing trend in the private source and an increasing trend in the public source of financing for ambulatory care services.


FIGURE 6.4: Expenditure At Ambulatory care Providers (non-hospital setting) by Sources of Financing, 2009

Private sector Public sector

72%

28%

Ambulatory Care :

21%of TEH(RM7,111 million)

TABLE 6.4a: Expenditure at Ambulatory Care Providers by source of financing, 2009


MS2 Private sector 5,096 72

MS1 Public Sector 2,015 28

Total 7,111 100


TAB

LE 6

.4b

: Exp

end

itur

e at

Am

bul

ato

ry C

are

Pro

vid

ers

by

sour

ce o

f fi

nanc

ing

, 19

97 -

200

9 (R

M M

illio

n)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

2P

rivat

e se

ctor

1,32

1

1,

413

1,54

6

1,

870

1,97

4

2,

211

2,50

9

2,

951

3,55

2

3,

878

4,24

5

4,

841

5,0

96

MS

1P

ublic

Sec

tor

32

1

333

38

6

459

57

3

684

93

3

1,

057

1,11

1

1,

544

1,58

9

1,

902

2,0

15

Tota

l

1,

642

1,74

6

1,

932

2,32

9

2,

546

2,89

6

3,

442

4,00

8

4,

663

5,42

3

5,

834

6,74

3 7

,111

TAB

LE 6

.4c:

Exp

end

itur

e at

Am

bul

ato

ry C

are

Pro

vid

ers

by

sour

ce o

f fi

nanc

ing

, 19

97 -

200

9 (P

er c

ent,

%)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

2P

rivat

e se

ctor

80.4

680

.92

80.0

280

.28

77.5

176

.36

72.9

173

.62

76.1

771

.52

72.7

771

.79

71.6

6

MS

1P

ublic

Sec

tor

19.5

419

.08

19.9

819

.72

22.4

923

.64

27.0

926

.38

23.8

328

.48

27.2

328

.21

28.3

4

Tota

l10

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00


Total Health Expenditure by Function of Health Services

This dimension of health expenditure responds to the question on the type of services purchased with the financial resources.

In 2009 the expenditure for curative care services amounted to RM19,079 million or 57 per cent of total health expenditure (Figure 7.1 and Table 7.1a). This was followed by expenditure of RM4,148 million or 12 per cent for medical goods dispensed to out-patient, RM3,454 million or 10 per cent for health programme and health insurance administration, RM2,757 million or 8 per cent for capital formation. The remaining RM4,253 million or 13 per cent of expenditure was spent on prevention and public health services, education and training, ancillary services and other functions.

The 1997 to 2009 time series data (Table 7.1b and Table 7.1c) shows similar pattern to 2009 with the highest expenditures for the same four functions with increase in absolute ringgit value over the time period. However as a share of the total expenditure, curative care expenditure trend shows a V-shaped pattern with 2003 expenditure as the lowest expenditure. Health programme and health insurance administration expenditure dropped by 3 per cent as a share of total expenditure over the time period.

CHAPTER 7


FIGURE 7.1: Total Expenditure on Health by Function of Health Services, 2009

Curative care

Capitalformation

All otherfunctions

Medical Goods

Admin HealthProgram &insurance

60% 57%

12%10%

8%

13%

50%

40%

30%

20%

10%

0%

Func

tion

of H

ealth

Ser

vice

s

TABLE 7.1a: Total Expenditure On Health by Function of Health Services, 2009



MF5 Medical goods dispensed to out-patients 4,148 12.31


MR1 Capital formation of health care provider institutions 2,757 8.18

MF6 Prevention and public health services 1,758 5.22

MR2 Education and training of health personnel 1,347 4.00





Total 33,691 100.00


TAB

LE 7

.1b

: To

tal e

xpen

dit

ure

on

Hea

lth

by

Func

tio

n o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(RM

Mill

ion)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

Ser

vice

s of

cur

ativ

e ca

re4,

592

4,88

45,

418

6,14

87,

006

7,78

69,

050

10,3

1611

,162

13,5

1314

,809

17,3

2419

,079

MF2

Ser

vice

s of

reha

bilit

ativ

e ca

re18

1922

2428

3146

4856

6471

6784

MF3

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

3236

4147

5261

7511

298

111

122

127

147

MF4

Anc

illary

ser

vice

s to

hea

lth c

are

186

199

217

273

345

392

465

537

618

720

769

881

868

MF5

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

1,02

91,

092

1,19

81,

560

1,59

71,

844

2,19

42,

634

2,89

83,

174

3,70

04,

207

4,14

8

MF6

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s39

740

444

851

954

157

192

698

71,

094

1,73

71,

561

1,73

11,

758

MF7

Hea

lth p

rogr

am a

dmin

istr

atio

n an

d he

alth

insu

ranc

e1,

057

1,09

41,

166

1,36

31,

483

1,72

92,

185

2,28

82,

256

2,72

82,

842

3,24

53,

454

MR

1C

apita

l for

mat

ion

of h

ealth

car

e pr

ovid

er in

stitu

tions

520

783

913

1,35

71,

678

1,63

42,

811

2,32

61,

265

1,35

81,

535

1,72

52,

757

MR

2E

duca

tion

and

trai

ning

of h

ealth

per

sonn

el15

418

623

930

137

946

357

360

466

178

692

91,

148

1,34

7

MR

3R

esea

rch

& D

evel

opm

ent i

n H

ealth

6153

4843

7578

7462

2235

5114

650

Tota

l8,

045

8,75

19,

711

11,6

3513

,182

14,5

8818

,399

19,9

1220

,131

24,2

2726

,389

30,6

0133

,691


TAB

LE 7

.1c:

To

tal e

xpen

dit

ure

on

Hea

lth

by

Func

tio

n o

f H

ealt

h S

ervi

ces,

199

7 -

2009

(Per

cen

t,%

)

MN

HA

co

de

Func

tio

n o

f H

ealt

h se

rvic

es19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MF1

Ser

vice

s of

cur

ativ

e ca

re57

.08

55.8

155

.79

52.8

453

.14

53.3

749

.19

51.8

155

.45

55.7

856

.12

56.6

156

.63

MF2

Ser

vice

s of

reha

bilit

ativ

e ca

re0.

220.

220.

230.

210.

210.

210.

250.

240.

280.

260.

270.

220.

25

MF3

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

0.40

0.42

0.42

0.40

0.39

0.42

0.41

0.56

0.49

0.46

0.46

0.41

0.43

MF4

Anc

illary

ser

vice

s to

hea

lth c

are

2.31

2.28

2.23

2.35

2.62

2.68

2.53

2.69

3.07

2.97

2.91

2.88

2.58

MF5

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

12.8

012

.48

12.3

413

.41

12.1

112

.64

11.9

313

.23

14.4

013

.10

14.0

213

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12.3

1

MF6

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s4.

934.

624.

624.

464.

113.

925.

034.

965.

447.

175.

925.

665.

22

MF7

Hea

lth p

rogr

am a

dmin

istr

atio

n an

d he

alth

insu

ranc

e13

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12.5

012

.01

11.7

211

.25

11.8

511

.87

11.4

911

.21

11.2

610

.77

10.6

010

.25

MR

1C

apita

l for

mat

ion

of h

ealth

car

e pr

ovid

er in

stitu

tions

6.46

8.94

9.40

11.6

612

.73

11.2

015

.28

11.6

86.

285.

615.

825.

648.

18

MR

2E

duca

tion

and

trai

ning

of h

ealth

per

sonn

el1.

912.

132.

462.

592.

873.

183.

113.

033.

283.

243.

523.

754.

00

MR

3R

esea

rch

& D

evel

opm

ent i

n H

ealth

0.76

0.61

0.49

0.37

0.57

0.53

0.40

0.31

0.11

0.15

0.19

0.48

0.15

Tota

l10

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00


Curative care expenditure by Sources of Financing Cross-tabulation

Curative care services include medical, paramedical, and allied health services inclusive of dental services which could be either allopathic or TCM services. It could be rendered either in hospital or non-hospital settings. The non-hospital setting is inclusive of medical or dental clinics but excludes other services provided at standalone allied health or rehabilitative facilities, standalone pharmacies and radiological service facilities and many other non-hospital facilities.

In 2009 a total of RM19,079 million or 57 per cent of total health expenditure was for curative care services (Figure 7.2). The source of financing for curative care services was RM10,069 million or 53 per cent from the public sector and the remaining RM9,009 or 47 per cent from the private sector. In the public sector 92 per cent and in the private sector 61 per cent of the curative care expenditure was spent at hospitals and the remaining in both sectors were spent at non-hospital curative care providers.

The 1997 to 2009 time series data shows a similar pattern in absolute ringgit value (Table 7.2). However, as a share of public to private source of funding for curative care services, the public share shows a downward trend and the private share shows an upward trend with the public sector financing higher than the private sector source of financing.


SOURCE:G

OVERNMENT

53%

(RM

10,

069

Mill

ion)

HOSPIT

ALS

92%

NON-H

OSPIT

ALS

8%(R

M 8

35 M

illio

n)(R

M 9

,234

Mill

ion)

SOURCE:P

RIV

ATE

47%

(RM

9,00

9 M

illio

n)

HOSPIT

ALS

61%

(RM

5,4

61 M

illio

n)

NON-H

OSPIT

ALS

39%

(RM

3,5

48 M

illio

n)

CURATIV

E C

ARE E

XPENDIT

URE, 2009

57%

OF

TOTA

L H

EALT

H E

XPEN

DIT

URE

(RM

19,

079

MIL

LIO

N)

FIG

UR

E 7

.2: C

urat

ive

Car

e E

xpen

dit

ure

By

So

urce

of

Fina

ncin

g 2

009


TAB

LE 7

.2:

Cur

ativ

e C

are

Exp

end

itur

e B

y S

our

ces

of

Fina

ncin

g, 1

997-

2009

(RM

Mill

ion)

So

urce

Pro

vid

er19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

Pub

lic S

ecto

r

Hos

pita

l

2,60

32,

664

2,89

53,

266

3,70

63,

971

4,70

25,

184

5,34

57,

160

7,49

78,

732

9,23

4

Non

-Hos

pita

l22

423

227

428

038

747

737

345

344

928

654

772

783

5

Sub

-To

tal

2,82

82,

896

3,16

93,

546

4,09

34,

448

5,07

55,

637

5,79

47,

446

8,04

49,

459

10,0

69

Priv

ate

Sec

tor

Hos

pita

l

1,03

11,

176

1,34

01,

521

1,75

12,

028

2,46

62,

817

3,07

83,

542

4,03

94,

695

5,46

1

Non

-Hos

pita

l73

381

290

91,

081

1,16

21,

310

1,50

91,

862

2,29

12,

526

2,72

63,

170

3,54

8

Sub

-To

tal

1,76

41,

988

2,24

92,

602

2,91

23,

338

3,97

44,

679

5,36

96,

068

6,76

57,

866

9,00

9

To

tal

4,59

24,

884

5,41

86,

148

7,00

67,

786

9,05

010

,316

11,1

6213

,513

14,8

0917

,324

19,0

79


Preventive & Promotive expenditure by Sources of Financing

This refers to expenditure for services designed to enhance the health status of the population, usually in the form of structured public health services including preventive and promotive programmes, and excludes the expenditure of similar services delivered on individual basis which is captured as part of curative services.

In 2009 a total of RM1,758 million or 5 per cent of total health expenditure was spent on public health programmes including preventive and promotive services of which RM1,577 million or 90 per cent was by the public sector source of financing (Figure 7.3). In the public sector, MOH spent 87 per cent of this amount.

The 1997 to 2009 time series data also shows MOH as the largest source of financing for this function of health care services with a six-fold increase in absolute ringgit value over the time period (Table 7.3).

FIGURE 7.3: Preventive and Promotive Public Health Programme Expenditure by Sources of Financing, 2009

RM

Mill

ion

200


400

600

800

1,000

1,200

1,400

1,600RM 1,577 Million

RM 181 Million

Non-MOH13%

MOH87%

1,800


TAB

LE 7

.3 :

Pre

vent

ive

& P

rom

oti

ve P

ublic

Hea

lth

Exp

end

itur

e b

y S

our

ces

of

Fina

ncin

g, 1

997

- 20

09 (R

M M

illio

n)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Min

istr

y of

Hea

lth (M

OH

)22

722

425

931

531

732

366

170

777

51,

403

1,18

01,

331

1,36

8

MS

1.1.

1.2

Min

istr

y of

Edu

catio

n (M

OE

)0

00

-0

10

10

00

10

MS

1.1.

1.3

Min

istr

y of

Def

ence

(MO

D)

00

00

00

00

00

00

0

MS

1.1.

1.9

Oth

er fe

dera

l age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)24

2426

3030

3336

4145

4954

5862

MS

1.1.

2.1

(Gen

eral

) Sta

te G

over

nmen

t23

2722

2226

2830

3641

4759

6157

MS

1.1.

2.2

Oth

er s

tate

age

ncie

s (in

clud

ing

stat

utor

y bo

dies

)1

26

56

65

67

88

816

MS

1.1.

3Lo

cal a

utho

ritie

s25

2628

3132

4449

4949

5158

6372

MS

1.2.

2S

ocia

l Sec

urity

Org

aniz

atio

n (S

OC

SO

)2

22

22

22

22

11

12

MS

2.4

Priv

ate

hous

ehol

d ou

t-of

-poc

ket e

xpen

ditu

res

78

910

1113

1620

2326

2636

26

MS

2.5

Non

-pro

fit o

rgan

izat

ions

ser

ving

hou

seho

lds

88

89

910

1111

1514

1827

14

MS

2.6

All

Cor

pora

tions

(oth

er th

an h

ealth

insu

ranc

e)79

8390

9610

811

211

511

413

813

815

414

614

1

MS

9R

est o

f the

wor

ld-

--

--

--

--

-1

0-

Tota

l39

740

444

851

954

157

192

698

71,

094

1,73

71,

561

1,73

11,

758


FIGURE 7.4: Expenditure for Education and Training by Sources of Financing, 2009

RM

Mill

ion

100


200

300

400

500

600

700

800

900

1000

RM 884 Million

Non-MOH,63%

MOH,37%

RM 463 Million

Expenditure for Education and Training by Sources of Financing

This includes expenditure for all health and health-related education and training of personnel. Although MNHA framework includes this expenditure under the total health expenditure, the SHA framework excludes this because of the shortfall in the assumptions and difficulties in the capture of this expenditure. Furthermore, personnel who undergo health and health-related education and training may not continue to provide services in the health sector.

In 2009 a total of RM1,347 million or under 3 per cent of total health expenditure was spent on health related education and training. A total of RM884 million or 66 per cent of this amount was funded by public sector source of financing with MOH spending 37 per cent and non-MOH spending the balance (Figure 7.4).

The 1997 to 2009 time series data shows that although both the public and private source of financing shows an increasing trend in expenditure for this function of health care service,the public source spending remains almost twice that of private source in absolute ringgit value (Table 7.4a and Table 7.4b). Similarly, in the public source of financing, the non-MOH spending is about twice that of MOH expenditure for education and training.


TAB

LE 7

.4a

: Exp

end

itur

e fo

r E

duc

atio

n an

d H

ealt

h Tr

aini

ng b

y S

our

ces

of

Fina

ncin

g, 1

997

- 20

09 (R

M M

illio

n)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Pub

lic S

ecto

r (M

OH

)35

3368

9614

718

623

122

221

827

027

531

032

5

MS

1.1.

1.2

- M

S1.

1.1.

9P

ublic

Sec

tor

(Non

- M

OH

)64

8393

112

127

153

187

209

243

284

359

462

559

MS

2P

rivat

e se

ctor

*55

7078

9310

512

515

517

320

023

229

537

646

3

Tota

l15

418

623

930

137

946

357

360

466

178

692

91,

148

1,34

7

TAB

LE 7

.4b

: E

xpen

dit

ure

for

Ed

ucat

ion

and

Hea

lth

Trai

ning

Exp

end

itur

e b

y S

our

ce o

f Fi

nanc

ing

, 199

7 -

2009

(Per

cen

t)

MN

HA

co

de

So

urce

of

fina

ncin

g19

9719

9819

9920

0020

0120

0220

0320

0420

0520

0620

0720

0820

09

MS

1.1.

1.1

Pub

lic S

ecto

r (M

OH

)22

.66

17.7

628

.34

31.9

538

.83

40.1

240

.39

36.7

133

.01

34.3

929

.59

27.0

324

.12

MS

1.1.

1.2

- M

S1.

1.1.

9P

ublic

Sec

tor

(Non

- M

OH

)41

.67

44.6

038

.91

37.2

033

.52

33.0

032

.58

34.6

236

.72

36.1

038

.62

40.2

141

.53

MS

2P

rivat

e se

ctor

*35

.67

37.6

432

.75

30.8

527

.64

26.8

827

.03

28.6

830

.27

29.5

131

.85

32.7

634

.35

Tota

l10

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

100.

0010

0.00

Not

e: D

ata

incl

udes

exp

endi

ture

und

er R

est o

f the

Wor

ld


State Expenditure

The state disaggregation of health expenditure is reported for the first time under MNHA. The state allocation was carried out based on the facility where the source of financing was used to purchase the various types of health care services and products. This state allocation was done for the smallest possible disaggregated source of financing and then rolled up to produce the total state expenditure. Further improvements and refinements in the methodology are expected in the future. The arrangements of the state in the Figures and Tables below are based on the state population size in the year 2009 as the reference year.

There are a total of thirteen states and three additional Federal Territories, namely Kuala Lumpur, Labuan and Putrajaya. The expenditure for Putrajaya is included under the state of Selangor to follow the state population census as reported under the Department of Statistics Malaysia.

In 2009, Selangor had the highest population of 5,034 thousand people but WP Kuala Lumpur had the highest expenditure of RM5,468 million (Figure 8.1 and Table 8.1). There appears to be a wider gap between the per capita spending and population in the highest and lowest populated states except for WP Kuala Lumpur (Figure 8.2 and Table 8.2).

The comparisons of per capita spending by the public and private sector source of funding can be made for the time series state disaggregated data. In 2009 show that the median public sector source of spending in all states excluding WP Kuala Lumpur was RM479 per capita (Figure 8.3 & Table 8.3). The median private sector source of spending in all states excluding WP Kuala Lumpur, the East Coast states of Kelantan and Terengganu and West Malaysia states of Sabah, Sarawak and Labuan was RM382 per capita. A total of RM5,484 million or 16 per cent of the total expenditure was expenditure at federal level and was excluded in the state disaggregation.

CHAPTER 8


FIGURE 8.1: Total Expenditure by State, 2009

4,972

2,908

1,6021,837

2,191

1,410

5,468

1,431

2,377

1,134

654918 930

230 146

(RM

Mill

ion)

1,000

2,000

3,000

4,000

5,000

6,000S

elan

gor

Joho

r

Sab

ah

Sar

awak

Per

ak

Ked

ah

WP

KL

Kel

anta

n

P.P

inan

g

Pah

ang

Tere

ngga

nu

N.S

emb

ilan

Mel

aka

Per

lis

WP

Lab

uan

TABLE 8.1: State Population and Health Expenditure, 2009

State Population (Thousand)** Expenditure (RM Million)

Selangor* 5,034 4,972

Johore 3,269 2,908

Sabah 3,184 1,602

Sarawak 2,471 1,837

Perak 2,428 2,191

Kedah 1,943 1,410

WP KL 1,703 5,468

Kelantan 1,639 1,431

P. Pinang 1,580 2,377

Pahang 1,517 1,134

Terengganu 1,036 654

N. Sembilan 1,000 918

Malacca 762 930

Perlis 237 230

WP Labuan 94 146

Federal 5,484

Total 27,895 33,691

Note: *This includes WP Putrajaya

** Source: Department of Statistics Malaysia


Percapita (RM) State Population (Thousand)

FIGURE 8.2: State Population and Per Capita Health Spending, 2009

Per

Cap

ita S

pend

ing

(RM

)

Pop

ulat

ion

(Tho

usan

d)

3500

3,000

2,500

2,000

1,500

1,000

1,000

2,000

3,000

4,000

5,000

6,000

500

0 0

Sel

ango

r

Joho

re

Sab

ah

Sar

awak

Per

ak

Ked

ah

WP

KL

Kel

anta

n

P.P

inan

g

Pah

ang

Tere

ngga

nu

N.S

emb

ilan

Mel

aka

Per

lis

WP

Lab

uan

TABLE 8.2: State Population and Per Capita Health Spending, 2009

State Per Capita (RM) State Population (Thousands)

Selangor 988 5,034

Johore 890 3,269

Sabah 503 3,184

Sarawak 743 2,471

Perak 902 2,428

Kedah 726 1,943

WP KL 3,211 1,703

Kelantan 873 1,639

P. Pinang 1,504 1,580

Pahang 748 1,517

Terengganu 631 1,036

N. Sembilan 918 1,000

Malacca 1,221 762

Perlis 970 237

WP Labuan 1,553 94

Total Population 27,895




FIGURE 8.3: State Per Capita Health Spending by Public and Private Sector, 2009P

er C

apita

Spe

ndin

g (R

M)

1,000

1,200

1,400

1,600

1,800

2,000

400

600

800

200

0

Sel

ango

r

Joho

re

Sab

ah

Sar

awak

Per

ak

Ked

ah

WP

KL

Kel

anta

n

P.P

inan

g

Pah

ang

Tere

ngga

nu

N.S

emb

ilan

Mel

aka

Per

lis

WP

Lab

uan

TABLE 8.3: State Per Capita Health Spending by Public and Private Sector, 2009 (Ringgit Malaysia, RM)

State Public Sector Private Sector

Selangor 406 582

Johore 376 513

Sabah 381 122

Sarawak 476 268

Perak 483 419

Kedah 404 322

WP KL 1,757 1,454

Kelantan 651 222

P. Pinang 524 980

Pahang 472 275

Terengganu 474 157

N. Sembilan 572 345

Malacca 516 705

Perlis 695 275

WP Labuan 487 1,067



International Comparison

In this section some health expenditure comparisons are made with 2008 base reference year as the latest internationally available NHA data reported by WHO. Selected developed and regional country health expenditure data are compared to the same year Malaysian data. There is some variation in the total health expenditure as a percentage of GDP varies reported under MNHA framework and SHA framework.

In 2008, the MNHA framework shows total health expenditure of 4.1 per cent whereas the SHA framework shows it to be 3.8 per cent of GDP (Figure 9.1). This higher reporting under the MNHA framework is due to the extended boundaries of total health expenditure in this framework. If the MNHA value of total health expenditure is used for international comparison, it is noted that the expenditure in Malaysia is similar to most regional countries like China, India, Sri Lanka, and Thailand that spend slightly above 4 percent GDP for health. In the same year, Malaysia spent higher than Bangladesh and Indonesia but lower than other more developed Asian countries such as Korea and Japan. In comparison with two OECD countries, Australia and UK, both spent more than 8 per cent GDP which was around the average annual OECD country expenditure.

The rest of the data comparison shows the same value under MNHA and SHA framework. The US Dollar (USD) per capita spending in Australia, UK and Japan was more than USD3,000 per country whereas Singapore and Korea per capita spending was above USD1,000 (Figure 9.2). All other countries spent less than USD500 per capita. Malaysia spent USD356 per capita which equates to about twice than spent in Thailand and China. Sri Lanka, Indonesia, India and Bangladesh all spend below 100USD per capita.

Comparison of public and private share of health spending show that the developed countries such as Australia, UK and Japan has a much higher public sector share compared to the less developed countries such as India, Sri Lanka and Bangladesh (Figure 9.3). Malaysia’s public expenditure share was 54 per cent similar to Korea and Indonesia. The countries with a smaller share of private sector spending such as Australia, UK and Japan have a larger OOP share of the private sector expenditure (Figure 9.4). The public private share and the OOP share of private spending in Thailand are similar to developed countries. The trend in Malaysia is near similar to Korea and Indonesia with a rather high private spending and high OOP share of private spending.

CHAPTER 9


FIGURE 9.1: International Comparison of Total Health Expenditure as Per cent GDP, 2008To

tal H

ealth

Exp

endi

ture

as

% G

DP

0

1

2

3

4

5

6

7

8

9 8.7 8.5 8.3

6.5

4.3 4.2 4.1 4.1 4.1 3.83.3 3.3

2.3

10U

nite

d K

ingd

om

Aus

tral

ia

Jap

an

Rep

ublic

of K

orea

Chi

na

Ind

ia

Sri

Lank

a

Thai

land

Mal

aysi

a*

Mal

aysi

a**

Ban

glad

esh

Sin

gap

ore

Ind

ones

ia

Note: *MNHA Framework International Source : World Health Statistics 2011

** SHA Framework

Note: *Both MNHA & SHA Framework International Source : World Health Statistics 2011

FIGURE 9.2: International Comparison Per Capita Health Expenditure, 2008

Uni

ted

Kin

gdom

Aus

tral

ia

Jap

an

Rep

ublic

of K

orea

Chi

na

Ind

ia

Sri

Lank

a

Thai

land

Mal

aysi

a*

Ban

glad

esh

Sin

gap

ore

Ind

ones

ia

4,180

3,771

3,190

1,4041,245

356164 146 83 51 45 17

US

D P

er C

apita

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500


FIGURE 9.3: International Comparison Public-Private Share of Total Health Expenditure, 2008

Public Share Private Share

Uni

ted

Kin

gdom

Aus

tral

ia

Jap

an

Rep

ublic

of K

orea

Chi

na

Ind

ia

Sri

Lank

a

Thai

land

Mal

aysi

a*

Ban

glad

esh

Sin

gap

ore

Ind

ones

ia

0

20 83

17

81

20

74

26

65

29

54

46

54

46

54

46

47

53

44

56

34

66

32

68

31

69

40

60

80

100

120

Per

Cen

t Sha

re



FIGURE 9.4: OOP as Share of Private Sector Spending Vs Private Share of TEH, 2008

OOP% TEHOOP % Private

Uni

ted

Kin

gdom

Aus

tral

ia

Jap

an

Rep

ublic

of K

orea

Chi

na

Ind

ia

Sri

Lank

a

Thai

land

Mal

aysi

a*

Ban

glad

esh

Sin

gap

ore

Ind

ones

ia

0

20 17 2026 29

46 46 4653 56

66 68 6964

81

6862

7079

8783

8794

74

97

40

60

80

100

120

Per

cen

t sha

re


TABLE A1: Sources of Data

Samples of data sources from public sector used for estimation of MNHA.

PUBLIC SECTOR

Main Agencies Specific Organization

MOH Ministry of Health

Other Ministries Ministry of Home Affairs

Ministry of Defence

Ministry of Higher Education

Ministry of Science Technology and Innovation

Government Departments Accountant-General’s Department

Department of Statistics (DOS)

Public Service Department

Civil Defence Department

Prison Department of Malaysia

Social Welfare Department

Occupational Safety And Health Department

National Anti-Drug Agency (AADK)

Pilgrims Fund Board

University Hospitals University Malaya Medical Centre (UMMC)

University Kebangsaan Malaysia Hospital

University of Science Malaysia Hospital

University/Colleges University Malaya Student Health Clinic

University Malaya Student Counseling

University Technology MARA

International Islamic University Malaysia

University Kebangsaan Malaysia

University Putra Malaysia

University Malaysia Sarawak

APPENDIX TABLES


PUBLIC SECTOR


Other Public Sector National Population and Family Development

Health Department City Hall Kuala Lumpur

Local Authorities

Aborigines Hospitals and Clinics

The Council of Trust For The Indigenous People

Central Bank of Malaysia

Employee Provident Fund

Social Security Organization

National Heart Institute

Statutory Bodies (Federal/State)

Public Water Supply Department

National Sports Institute of Malaysia

Zakat Collection Centre

Conducted By Surveys/Studies

MOH National Health Morbidity Survey I,II & III

DOSHousehold Expenditure Survey 1998/1999

(Department of Statistic)

DOSNational Household Health Expenditure Survey

(NHHES)

DOS National Income Accounts

DOS Professional & Non-Professional Industry Surveys

Note : This list is non-comprehensive


TABLE A1: Sources of Data (cont.)

Samples of data sources from private sector used for estimation of MNHA.

PRIVATE SECTOR


Associations Association of Private Hospitals of Malaysia (APHM)

Other private hospitals not members of APHM

Primary Care Doctor’s Organization Malaysia (PCDOM)

Insurance agencies Life Insurance Association of Malaysia (LIAM)

Private Insurance of Malaysia (PIAM)

National Insurance Association of Malaysia (NIAM)

Councils Malaysian Medical Council (MMC)

Malaysian Dental Council (MDC)

University/Colleges Private Medical & Nursing Schools

Other agencies Private Corporations Limited and Private Limited

No-Governmental Organization (NGO)

Intercontinental Medical Supply (IMS)

Managed Care Organization (MCO)

Foreign Medical Examination Monitoring Agencies (FOMEMA)

WHO, UNDP

Private Water Supply Department


TABLE A2: Comparison of MNHA to SHA Framework (OECD 2000) with SHA Tables

The data in this document is reported using the MNHA framework. However, the revised data analysis was produced under dual coding and a set of tables showing the comparison of MNHA codes mapped to ICHA codes are shown for reference (Table A2.1a to Table A2.1c).This is followed by five SHA Tables (Table A3 to Table A7).

TABLE A2.1a : Classification of Total Expenditure on Health by Source of Financing

MNHA code ICHA code Sources of Funding Description

MS1 HF.1 Public Sector Refers to MS1.1 to MS1.2

MS1.1 HF.1.1 Public sector excluding social security fundsRefer to Federal Government, state government &

Local Authorities

MS1.2 HF.1.2 Social security funds SOCSO & EPF

MS2 HF.2 Private sector Refers to MS2

MS2.1 HF.2.1 Private social insurance Currently does not exits in Malaysia

MS2.2 HF.2.2Private insurance enterprises (other than social

insurance)Private Health Insurance

MS2.3 HF.2.2 Private MCOs and other similar entitiesRegistered MCO other than Private Health

Insurance

MS2.4 HF.2.3 Private household out-of-pocket expenditures Individual OOP spending on Health

MS2.5 HF.2.4 Non-profit organizations serving households Health - related - NGOs

MS2.6 HF.2.5 All Corporations (other than health insurance) Private Employer

MS9 HF.3 Rest of the world Rest Of the World


TABLE A2.1b : Classification of Total Expenditure on Health by Providers of Health Services

MNHA code ICHA code Providers of Health Services Description

MP1 HP.1 Hospitals Public & private hospitals

MP2 HP.2 Nursing and residential care facilitiesNursing care facilities including psychiatric care

facilities, residential for mental health, etc

MP3 HP.3 Providers of ambulatory health care

Establishments providing ambulatory health care

services directly to non-hospital setting, e.g.

medical practitioner clinics, dental clinics, etc

MP4 HP.4 Retail sale and other providers of medical goodsPharmacies & retail sale/suppliers of vision

products, hearing aids, medical appliances

MP5 HP.5Provision and administration of public health

programmes

Health prevention & promotion services (public &

private)

MP6 HP.6 General health administration and insurance

Overall administration of health (public & private)

& health insurance administration. (note: For MOH

it includes administration of HQ exclude public

health programs) State Health Dept., admin. cost

for hospitals management

MP7 HP.7 Other industries (rest of the Malaysian economy) Private occupational health care & home care etc.

MP8 HP.7.9 Institutions providing health related services Health training institutions (public & private)

MP9 HP.9 Rest of the worldnon - resident providers providing health care for

the final use residents of Malaysia


TABLE A2.1c : Classification of Total Expenditure on health by Function of Health Services

MNHA code ICHA code Functions of Health Services Description

MF1 HC.1 Services of curative careCurative care provider at inpatient, outpatient,

daycare & homecare services

MF2 HC.2 Services of rehabilitative careRehabilitative care provider at inpatient, outpatient,

daycare & homecare services

MF3 HC.3 Services of long-term nursing careLong term nursing care provider at inpatient,

outpatient, daycare & homecare services

MF4 HC.4 Ancillary services to health careStand-alone laboratory, diagnostic imaging,

transport & emergency rescue, etc.

MF5 HC.5 Medical goods dispensed to out-patientsPharmaceuticals, appliances, western medicines,

TCM, etc

MF6 HC.6 Prevention and public health servicesHealth promotion, prevention, family planning,

school health services, etc

MF7 HC.7Health program administration and health

insurance

Administration at HQ, State health dept, local

authorities, SOCSO, EPF, private insurance, etc

MR1 HC.R.1Capital formation of health care provider

institutions

Administration at HQ, State health dept, local

authorities, SOCSO, EPF, private insurance, etc

MR2 HC.R.2 Education and training of health personnelGov & private provision of education and training

of health personnel, including admin, etc

MR3 HC.R.3 Research and development in health Research and development in health

MR9 HC.R.6 All other health-related expendituresCategory to capture all other expenditures that not

classified elsewhere in MNHA


TAB

LE A

3 ;-

Cur

rent

hea

lth

exp

end

itur

e b

y fu

ncti

on

of

care

, p

rovi

der

ind

ustr

y an

d S

our

ce o

f Fu

ndin

g, 2

009

(RM

Mill

ion)

Exp

endi

ture

cat

egor

y IC

HA

-HC

(Fun

ctio

n of

he

alth

car

e)

ICH

A-H

P (P

rovi

der

indu

stry

)

Total current expenditure on health

ICH

A -

HF

sour

ce o

f fun

ding

HF.

1 H

F.1.

1 H

F.1.

2 H

F.2

HF.

2.1

+ H

F.2.

2 H

F.2.

3 H

F.2.

4 H

F.2.

5 H

F.3

General government

General government (excl.social security )

Social security funds

Private sector

Private insurance

HF.

2.1

HF.

2.2

Private household out-of-pocket expenditure

Non-profit organizations serving households (Other than social insurance)

Corporation (other than health insurance)

Rest of the word

Private social insurance

Other private insurance

In-p

atie

nt c

are

incl

udin

g da

y ca

ses

A

ll in

dust

ries

Cur

ativ

e an

d re

habi

litat

ive

care

H

C.1

.1 ;

1.2

; 2.1

; 2.

2

10,

470

6

,738

6,63

9

98

3,73

3

1,18

7

1,1

87

2

,450

2

3

7

2

-

Gen

eral

hos

pita

ls

H

P.1.

1

9,7

79

6

,091

6,01

8

73

3,68

7

1,16

6

1,1

66

2

,450

0

71

Spe

cial

ity h

ospi

tals

HP.

1.2

+ 1

.3

539

5

35

535

4

4

4

Nur

sing

and

resi

dent

ial c

are

faci

litie

s

H

P.2

0

0

0

-

-

All

othe

r pr

ovid

ers

A

ll ot

her

152

1

12

86

2

6

41

17

1

7

23

1

Long

term

nur

sing

car

e H

C.3

.1 ;

3.2

All

indu

strie

s

1

18

13

0

1

3

105

1

1

104

0

-

-

Gen

eral

hos

pita

ls

H

P.1.

1

1

04

-

104

-

104

Spe

cial

ity h

ospi

tals

HP.

1.2

+ 1

.3

13

13

-

-

Nur

sing

and

resi

dent

ial c

are

faci

litie

s

H

P.2

14

13

0

13

1

1

1

0

All

othe

r pr

ovid

ers

A

ll ot

her

-

-

-

Out

-pat

ient

cur

ativ

e an

d re

habi

litat

ive

care

H

C.1

.3 ;

2.3

All

indu

strie

s

8,6

85

3

,341

3,33

5

6

5,

344

69

-

69

4

,918

4

3

315

-

Hos

pita

ls

H

P.1

4

,453

2,6

17

2,

615

2

1,83

6

5

0

50

1

,689

3

1

6

6

Offi

ces

of p

hysi

cian

s

HP.

3.1

3

,061

56

52

4

3,00

5

1

7

17

2

,733

1

1

243

Offi

ces

of d

entis

t

HP.

3.2

386

52

52

334

0

0

328

-

6

Offi

ces

of o

ther

hea

lth p

ract

ition

ers

H

P.3.

3

1

67

-

167

-

-

-

167

-

-

-

Out

-pat

ient

car

e ce

nter

s

HP.

3.4

616

6

16

616

0

-

-

-

-

-

-

-

-

Med

ical

and

dia

gnos

tic la

bora

torie

s

HP.

3.5

-

-

-

-

-

-

-

-

-

-

-

-

Oth

er p

rovi

ders

of a

mbu

lato

ry h

ealth

car

e

HP.

3.9

1

-

-

-

1

-

-

-

-

1

-

-

All

othe

r pr

ovid

ers

A

ll ot

her

1

0

0

0

1

1

-

1

-

-

-

-

Hom

e he

alth

car

e H

C.1

.4 ;

2.4

; 3.3

A

ll in

dust

ries

36

0

0

3

6

-

-

-

26

10

-

-

Anc

illary

ser

vice

s to

hea

lth c

are

HC

.4

All

indu

strie

s

8

68

250

25

0

0

618

0

0

408

9

2

01

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

HC

.5

All

indu

strie

s

4,1

48

419

41

0

9

3,

730

0

-

0

3,6

72

43

15

-

Pha

rmac

eutic

als,

oth

er m

ed.n

on-d

urab

les

HC

.5.1

3

,155

3

71

371

0

2,78

4

0

-

0

2

,732

3

8

1

5

-

Pre

scrib

ed m

edic

ines

H

C.5

.1.1

1

,298

2

92

2

92

0

1,00

6

0

0

9

91

0

1

4

Ove

r th

e co

unte

r m

edic

ines

H

C.5

.1.2

1

,647

79

79

1,

569

-

1

,532

3

7

0

Oth

er m

edic

al n

on-d

urab

les

HC

.5.1

.3

2

10

0

0

-

20

9

-

2

09

Ther

apeu

tical

app

l.; o

ther

med

ical

dur

able

s H

C.5

.2

9

93

47

3

8

9

946

-

-

-

941

5

-

-

Gla

sses

and

oth

er v

isio

n pr

oduc

ts

HC

.5.2

.1

7

47

1

1

0

74

6

-

-

-

7

46

0

-

-

Ort

hope

dic

appl

ianc

es ;

othe

r pr

osth

etic

s H

C.5

.2.2

26

25

20

5

1

-

-

-

-

1

-

-

All

othe

r m

isc.

dura

ble

med

ical

goo

ds

HC

.5.2

.3 -

5.2

.9

2

20

21

1

7

4

199

-

-

-

195

5

-

-

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s H

C.6

A

ll in

dust

ries

1

,652

1,4

78

1,

476

2

17

4

-

-

26

1

4

134

-

Hea

lth a

dmin

istr

atio

ns a

nd h

ealth

insu

ranc

e H

C.7

A

ll in

dust

ries

3

,455

2,3

79

2,

374

5

1,07

5

77

7

7

77

8

22

3

6

7

0

Tota

l Cur

rent

exp

end

itur

e o

n H

ealt

h ca

re

HC

.1-H

C.7

A

ll in

dus

trie

s 2

9,43

2 1

4,61

7

1

4,48

4

134

1

4,81

5

2,03

4

-

2

,034

1

1,61

2

36

5

804

0


TAB

LE A

3 ;-

Cur

rent

hea

lth

exp

end

itur

e b

y fu

ncti

on

of

care

, p

rovi

der

ind

ustr

y an

d S

our

ce o

f Fu

ndin

g, 2

009

(RM

Mill

ion)

Exp

endi

ture

cat

egor

y IC

HA

-HC

(Fun

ctio

n of

he

alth

car

e)

ICH

A-H

P (P

rovi

der

indu

stry

)


ICH

A -

HF

sour

ce o

f fun

ding

HF.

1 H

F.1.

1 H

F.1.

2 H

F.2

HF.

2.1

+ H

F.2.

2 H

F.2.

3 H

F.2.

4 H

F.2.

5 H

F.3

General government

General government (excl.social security )


Private sector

Private insurance

HF.

2.1

HF.

2.2


Non-profit organizations serving households (Other than social insurance)


Rest of the word



In-p

atie

nt c

are

incl

udin

g da

y ca

ses

A

ll in

dust

ries

Cur

ativ

e an

d re

habi

litat

ive

care

H

C.1

.1 ;

1.2

; 2.1

; 2.

2

10,

470

6

,738

6,63

9

98

3,73

3

1,18

7

1,1

87

2

,450

2

3

7

2

-

Gen

eral

hos

pita

ls

H

P.1.

1

9,7

79

6

,091

6,01

8

73

3,68

7

1,16

6

1,1

66

2

,450

0

71

Spe

cial

ity h

ospi

tals

HP.

1.2

+ 1

.3

539

5

35

535

4

4

4

Nur

sing

and

resi

dent

ial c

are

faci

litie

s

H

P.2

0

0

0

-

-

All

othe

r pr

ovid

ers

A

ll ot

her

152

1

12

86

2

6

41

17

1

7

23

1

Long

term

nur

sing

car

e H

C.3

.1 ;

3.2

All

indu

strie

s

1

18

13

0

1

3

105

1

1

104

0

-

-

Gen

eral

hos

pita

ls

H

P.1.

1

1

04

-

104

-

104

Spe

cial

ity h

ospi

tals

HP.

1.2

+ 1

.3

13

13

-

-

Nur

sing

and

resi

dent

ial c

are

faci

litie

s

H

P.2

14

13

0

13

1

1

1

0

All

othe

r pr

ovid

ers

A

ll ot

her

-

-

-

Out

-pat

ient

cur

ativ

e an

d re

habi

litat

ive

care

H

C.1

.3 ;

2.3

All

indu

strie

s

8,6

85

3

,341

3,33

5

6

5,

344

69

-

69

4

,918

4

3

315

-

Hos

pita

ls

H

P.1

4

,453

2,6

17

2,

615

2

1,83

6

5

0

50

1

,689

3

1

6

6

Offi

ces

of p

hysi

cian

s

HP.

3.1

3

,061

56

52

4

3,00

5

1

7

17

2

,733

1

1

243

Offi

ces

of d

entis

t

HP.

3.2

386

52

52

334

0

0

328

-

6

Offi

ces

of o

ther

hea

lth p

ract

ition

ers

H

P.3.

3

1

67

-

167

-

-

-

167

-

-

-

Out

-pat

ient

car

e ce

nter

s

HP.

3.4

616

6

16

616

0

-

-

-

-

-

-

-

-

Med

ical

and

dia

gnos

tic la

bora

torie

s

HP.

3.5

-

-

-

-

-

-

-

-

-

-

-

-

Oth

er p

rovi

ders

of a

mbu

lato

ry h

ealth

car

e

HP.

3.9

1

-

-

-

1

-

-

-

-

1

-

-

All

othe

r pr

ovid

ers

A

ll ot

her

1

0

0

0

1

1

-

1

-

-

-

-

Hom

e he

alth

car

e H

C.1

.4 ;

2.4

; 3.3

A

ll in

dust

ries

36

0

0

3

6

-

-

-

26

10

-

-

Anc

illary

ser

vice

s to

hea

lth c

are

HC

.4

All

indu

strie

s

8

68

250

25

0

0

618

0

0

408

9

2

01

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

HC

.5

All

indu

strie

s

4,1

48

419

41

0

9

3,

730

0

-

0

3,6

72

43

15

-

Pha

rmac

eutic

als,

oth

er m

ed.n

on-d

urab

les

HC

.5.1

3

,155

3

71

371

0

2,78

4

0

-

0

2

,732

3

8

1

5

-

Pre

scrib

ed m

edic

ines

H

C.5

.1.1

1

,298

2

92

2

92

0

1,00

6

0

0

9

91

0

1

4

Ove

r th

e co

unte

r m

edic

ines

H

C.5

.1.2

1

,647

79

79

1,

569

-

1

,532

3

7

0

Oth

er m

edic

al n

on-d

urab

les

HC

.5.1

.3

2

10

0

0

-

20

9

-

2

09

Ther

apeu

tical

app

l.; o

ther

med

ical

dur

able

s H

C.5

.2

9

93

47

3

8

9

946

-

-

-

941

5

-

-

Gla

sses

and

oth

er v

isio

n pr

oduc

ts

HC

.5.2

.1

7

47

1

1

0

74

6

-

-

-

7

46

0

-

-

Ort

hope

dic

appl

ianc

es ;

othe

r pr

osth

etic

s H

C.5

.2.2

26

25

20

5

1

-

-

-

-

1

-

-

All

othe

r m

isc.

dura

ble

med

ical

goo

ds

HC

.5.2

.3 -

5.2

.9

2

20

21

1

7

4

199

-

-

-

195

5

-

-

Pre

vent

ion

and

publ

ic h

ealth

ser

vice

s H

C.6

A

ll in

dust

ries

1

,652

1,4

78

1,

476

2

17

4

-

-

26

1

4

134

-

Hea

lth a

dmin

istr

atio

ns a

nd h

ealth

insu

ranc

e H

C.7

A

ll in

dust

ries

3

,455

2,3

79

2,

374

5

1,07

5

77

7

7

77

8

22

3

6

7

0

Tota

l Cur

rent

exp

end

itur

e o

n H

ealt

h ca

re

HC

.1-H

C.7

A

ll in

dus

trie

s 2

9,43

2 1

4,61

7

1

4,48

4

134

1

4,81

5

2,03

4

-

2

,034

1

1,61

2

36

5

804

0

TAB

LE A

4: C

urre

nt e

xpen

dit

ure

on

Hea

lth

by

func

tio

n o

f ca

re a

nd p

rovi

der

ind

ustr

y, 2

009(

RM

Mill

ion

)

Hea

lth c

are

by fu

nctio

ns

ICHA - HC code

Total curent health expenditure

HP.1

HP.2

HP.3

HP.3.1

HP.3.2

HP.3.3

HP.3.4

HP.3.5

HP.3.6

HP.3.9

HP.4

HP.4.1

HP.4.2 - 4.9

HP.5

HP.6

HP.6.1

HP.6.2

HP.6.3

HP.6.4

HP.6.9

HP.7

HP.9

Hospitals

Nursing and residential care facilities

Providers of ambulatory health care

Offices of physicians

Offices of dentists

Offices of other health practitioners

out-patient care centres

Medical and dignostic laboratories

Providers of home health care services

Other providers of ambulatory health care

Retail and sale and other providers of medical goods

Dispensing chemist

All other sales of medical goods

Provision and administration of public health

General health administration and insurance

Government administration of health

Social security fund

Other social insurance

Other (private) insurance

All other providers of health administration

Other industries (Rest of the economy)

Rest of the world

In-P

atie

nt c

are

9

,838

9,

806

1

1

5

1

5

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

2

15

Cur

ativ

e an

d R

ehab

ilitat

ive

care

H

C.1

.1 ;

HC

.2.1

9

,740

9,

709

-

1

5

1

5

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

2

15

Lon

g-te

rm n

ursi

ng c

are

HC

.3.1

98

97

1

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Ser

vice

of d

ay-c

are

750

616

1

3

121

22

-

-

99

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e &

Reh

abilit

ativ

e ca

re

HC

.1.2

;2.2

730

609

0

12

1

2

2

-

-

9

9

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Lon

g-te

rm n

ursi

ng c

are

HC

.3.3

7

1

3

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Out

pat

ient

car

e

8,6

85

4,45

3

-

4,

231

3,

061

386

167

61

6

-

-

1

0

-

0

-

-

-

-

-

-

-

-

1

Cur

ativ

e an

d R

ehab

ilitat

ive

care

H

C.1

.3 :

2.3

36

3

5

-

1

-

-

-

-

-

-

1

-

-

-

-

-

-

-

-

-

-

-

Bas

ic m

edic

al a

nd d

iagn

osyi

c se

rvic

es

HC

.1.3

.1

5,0

08

1,33

5

-

3,

673

3,

057

-

-

616

-

-

-

-

-

-

-

-

-

-

-

-

-

-

1

Out

pat

ient

den

tal c

are

HC

.1.3

.2

4

01

1

4

38

7

1

386

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r dis

cipl

ine-

spec

ific

spec

ializ

ed c

urat

ive

care

H

C.1

.3.3

3

,051

3,

048

-

3

3

-

-

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

0

All

othe

r al

lied

heal

th o

utpa

tient

cur

ativ

e ca

re

HC

.1.3

.9 ;2

.3

1

89

2

2

16

7

-

-

167

-

-

-

-

0

-

0

-

-

-

-

-

-

-

-

-

Hom

e ca

re

36

26

1

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Cur

ativ

e an

d R

ehab

ilitat

ive

care

H

C.1

.4 ;

2.4

8

8

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Lon

g-te

rm n

ursi

ng c

are

HC

.3.3

29

18

1

0

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

-

Anc

illary

Ser

vice

s to

hea

lth c

are

868

315

-

48

3

4

6

0

134

-

1

99

-

10

4

-

-

-

-

-

-

-

-

-

-

7

0

-

Anc

illary

Ser

vice

s to

hea

lth c

are

HC

.4

3

15

483

46

0

1

34

199

10

4

-

-

-

-

-

-

-

-

-

-

7

0

Med

ical

goo

ds d

ispe

nsed

to o

utpa

tient

s

4,1

48

73

9

-

1,

067

-

0

1,0

64

2

-

-

0

2,3

43

1

,204

1,1

39

-

-

-

-

-

-

-

-

-

Pha

rmac

eutic

als

and

othe

r m

edic

al n

on-d

urab

les

HC

.5.1

5

,633

677

-

1,06

6

-

0

1

,064

1

-

-

-

1

,413

1,2

03

209

-

-

-

-

-

-

-

The

rape

utic

app

lianc

es a

nd o

ther

med

ical

dur

able

s H

C.5

.2

1,9

24

6

2

-

1

-

-

-

1

-

-

0

930

0

930

-

-

-

-

-

-

-

To

tal e

xpen

dit

ure

on

per

sona

l hea

lth

care

2

4,32

6

15,

955

2

5

5,

916

3,

143

386

1

,365

71

8

199

-

105

2

,343

1,2

04

1

,139

-

-

-

-

-

-

-

73

15

Pre

vent

ive

and

publ

ic h

ealth

ser

vice

sH

C.6

1,6

52

2

2

-

1,

184

138

247

-

79

8

-

-

0

-

-

-

445

1

-

-

-

-

1

0

-

Hea

lth a

dmin

istr

atio

n an

d he

alth

insu

ranc

eH

C.7

3,4

54

54

0

-

1

-

-

-

-

-

-

1

2

6

26

-

64

7

2,2

33

1

,169

5

-

7

11

347

8

-

To

tal c

urre

nt h

ealt

h ex

pen

dit

ure

29,

432

1

6,51

7

25

7,10

0

3,28

1

63

3

1,3

65

1,

516

1

99

-

10

5

2,3

68

1

,229

1,1

39

1,

092

2

,234

1,1

69

5

-

711

34

8

81

15


TAB

LE A

5:-

Tota

l hea

lth

exp

end

itur

e b

y p

rovi

der

ind

ustr

y an

d fi

nanc

ing

ag

ent,

200

9 (R

M M

illio

n)

H

F.1

HF.

1.1

HF.

1.2

HF.

2 H

F.2.

1 +

HF.

2.2

HF.

2.3

HF.

2.4

HF.

2.5

HF.

3

ICH

A C

ode

- H

P C

ode

Total current expenditure on

health

General government

General government excluding security

funds


Private Sector

Private insurance

HF.

2.1

HF.

2.2


Non-profit organizations serving

households (Other than social insurance)

Corporation (other than health

insurance)

Rest of the word

Priv

ate

soci

al

insu

ranc

e O

ther

priv

ate

insu

ranc

e

Hea

lth c

are

good

s an

d se

rvic

es b

y pr

ovid

er in

dust

ry

Hos

pita

ls

HP.

1

16,

517

1

0,15

6

10,

082

75

6,36

1 1

,220

-

1

,220

4,9

72

3

1

1

37

-

Nur

sing

and

resi

dent

ial c

are

faci

litie

s H

P.2

25

13

0

13

11

1

-

1

11

Pro

vide

rs o

f am

bula

tory

hea

lth c

are

HP.

3

7,

100

2,00

4

1

,974

31

5,

096

22

-

22

4

,446

43

584

-

Offi

ces

of p

hysi

cian

s H

P.3.

1

3,

281

87

67

20

3,19

4

2

1

-

2

1

2,7

38

1

2

4

23

-

Offi

ces

of d

entis

ts

HP.

3.2

6

33

29

9

299

334

0

-

0

3

28

-

6

-

Offi

ces

of o

ther

hea

lth p

ract

ition

ers

HP.

3.3

1,36

5

-

1,36

5

-

-

-

1,3

65

-

0

-

out-

patie

nt c

are

cent

res

HP.

3.4

1,51

6

1,

494

1,4

83

10

22

1

-

1

-

22

-

-

Med

ical

and

dig

nost

ic la

bora

torie

s H

P.3.

5

199

36

36

-

163

0

-

0

-

9

155

-

Pro

vide

rs o

f hom

e he

alth

car

e se

rvic

es

HP.

3.6

-

-

-

-

-

-

-

-

-

-

Oth

er p

rovi

ders

of a

mbu

lato

ry h

ealth

car

e H

P.3.

9

105

89

89

0

17

0

-

0

16

1

-

-

Ret

ail a

nd s

ale

and

othe

r pr

ovid

ers

of m

edic

al g

oods

H

P.4

2,36

8

118

1

10

8

2,25

1

0

-

0

2,1

94

4

3

14

-

Dis

pens

ing

chem

ist

HP.

4.1

1,22

9

92

92

0

1,

137

0

-

0

1

,085

38

14

-

All

othe

r sa

les

of m

edic

al g

oods

H

P.4.

2 -

4.9

1,13

9

25

18

8

1,

114

-

-

-

1

,109

5

-

-

Pro

visi

on a

nd a

dmin

istr

atio

n of

pub

lic h

ealth

H

P.5

1,09

2

1,

077

1,0

76

2

14

-

-

14

0

Gen

eral

hea

lth a

dmin

istr

atio

n an

d in

sura

nce

HP.

6

2,

234

1,17

5

1

,170

5

1,

059

7

77

-

777

-

215

67

-

Gov

ernm

ent (

Exc

.Soc

ial i

nsur

ance

) H

P.6.

1

1,

169

1,16

9

1

,169

0

-

-

-

-

-

-

-

Soc

ial s

ecur

ity fu

nd

HP.

6.2

5

5

-

5

-

-

-

-

-

-

-

Oth

er s

ocia

l ins

uran

ce

HP.

6.3

-

-

-

-

-

-

-

-

-

-

-

Oth

er P

rivat

e in

sura

nce

HP.

6.4

-

-

7

11

7

11

-

711

-

-

-

-

All

othe

r pr

ovid

ers

of h

ealth

adm

inis

trat

ion

HP.

6.9

3

48

1

1

3

47

66

-

66

-

215

67

-

Oth

er in

dust

ries

(Res

t of t

he e

cono

my)

H

P.7

81

73

73

-

8

-

-

-

-

8

-

-

Occ

upat

iona

l hea

lth c

are

HP.

7.1

-

-

-

-

-

-

-

-

-

-

-

-

Priv

ate

hous

ehol

ds

HP.

7.2

-

-

-

-

-

-

-

-

-

-

-

-

All

othe

r in

dust

ries

as s

econ

dary

pro

duce

rs o

f hea

lth

care

H

P.7.

9

81

73

73

-

8

-

-

-

-

8

-

-

Res

t of t

he w

orld

H

P.9

15

1

0

0

15

-

1

4

1

Tota

l he

alth

exp

endi

ture

2

9,43

2

14,

690

1

4,55

6

13

4 1

4,82

3 2

,020

-

2

,020

1

1,62

6

372

804

0


TAB

LE A

6:-

Cur

rent

hea

lth

exp

end

itur

e b

y p

rovi

der

ind

ustr

y an

d fi

nanc

ing

ag

ent,

200

8 (R

M M

illio

n)

IC

HA

Cod

e -

HP

Cod

e

Total current expenditure

on health

HF.

1 H

F.1.

1 H

F.1.

2 H

F.2

HF.

2.1

+ H

F.2.

2 H

F.2.

3 H

F.2.

4 H

F.2.

5 H

F.3

General government

General government excluding security

funds


Private Sector

Private insurance

HF.

2.1

HF.

2.2


Non-profit organizations serving

households (Other than social insurance)

Corporation (other

than health insurance)

Rest of the word



Cur

rent

exp

endi

ture

on

Hea

lth c

are

Per

sona

l hea

lth c

are

serv

ices

HC

.1 -

HC

.3

19

,310

10

,092

9

,974

1

18

9,2

18

1,25

7

-

1,25

7

7

,497

77

387

-

In-p

atie

nt s

ervi

ces

9,8

38

6,2

41

6,2

10

3

2

3

,597

1,

172

-

1,

172

2,3

52

0

72

-

Day

car

e- s

ervi

ces

7

50

5

10

4

29

8

0

241

15

-

15

2

02

2

3

1

-

Out

-pat

ient

ser

vice

s

8

,685

3

,341

3

,335

6

5,3

44

6

9

-

6

9

4

,917

43

315

-

Hom

e ca

re-s

ervi

ces

36

0

0

-

36

-

-

-

26

1

0

-

-

Anc

illary

ser

vice

s to

hea

lth c

are

HC

.4

868

250

250

0

6

18

0

-

0

408

9

201

-

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

HC

.5

4

,148

419

410

9

3,7

30

0

-

0

3

,672

43

1

5

-

Pha

rmac

eutic

als

and

othe

r med

ical

non

-dur

able

s H

C.5

.1

3

,155

371

371

0

2,7

84

0

-

0

2

,732

38

1

5

-

Ther

apeu

tic a

pplia

nces

and

oth

er m

edic

al

dura

bles

H

C.5

.2

993

47

38

9

946

-

-

-

9

41

5

-

-

Per

sona

l hea

lth c

are

serv

ices

and

goo

ds

HC

.1 -

HC

.5

24

,326

10

,760

10,

634

127

13

,565

1,

257

-

1,

257

11,5

78

128

6

03

-

Pre

vent

ive

and

publ

ic h

ealth

ser

vice

sH

C.6

1,6

52

1,4

78

1,4

76

2

174

-

-

-

26

1

4

1

34

-

Hea

lth a

dmin

istr

atio

n an

d he

alth

insu

ranc

eH

C.7

3,4

54

2,3

79

2,3

74

5

1

,075

777

-

7

77

8

223

67

0

Tota

l Cur

rent

Hea

lth

exp

end

itur

e

29

,432

14

,617

14,

484

134

14

,815

2,

034

-

2,

034

11,6

12

365

8

04

0


Tab

le A

7 :T

ota

l exp

end

itur

e o

n H

ealt

h, in

clud

ing

Hea

lth-

rela

ted

Fun

ctio

ns, 2

009

(RM

Mill

ion)

ICHA Code - HP Code


HF.

1H

F.1.

1H

F.1.

2H

F.2

HF.

2.1

+ H

F.2.

2H

F.2.

3H

F.2.

4H

F.2.

5H

F.3

General government

General government excluding security funds


Private Sector

Private insurance

HF.

2.1

HF.

2.2


Non-profit organizations serving households (Other than social

insurance)


Rest of the word



Hea

lth c

are

serv

ices

and

goo

ds b

y fu

nctio

n

Ser

vice

s of

cur

ativ

e an

d re

habi

litat

ive

care

HC

.1,H

C.2

19,1

6310

,078

9,97

410

49,

085

1,25

6-

1,25

67,

376

6638

7-

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

HC

.314

713

013

133

1-

112

211

--

Anc

illary

Ser

vice

s to

hea

lth c

are

HC

.486

825

025

00

618

0-

040

89

201

-

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

HC

.54,

148

419

410

93,

730

0-

03,

672

4315

-

Pha

rmac

eutic

als

and

othe

r med

ical

non

-dur

able

sH

C.5

.13,

155

371

371

02,

784

00

2,73

238

15-

Ther

apeu

tic a

pplia

nces

and

oth

er m

edic

al

dura

bles

HC

.5.2

993

4738

994

6-

--

941

5-

-

Per

sona

l med

ical

ser

vice

s an

d go

ods

HC

.1-H

C.5

24,3

2610

,760

10,6

3412

713

,565

1,25

7-

1,25

711

,578

128

603

-

Pre

vent

ive

and

publ

ic h

ealth

ser

vice

sH

C.6

1,65

21,

478

1,47

62

174

--

2614

134

-

Hea

lth a

dmin

istr

atio

n an

d he

alth

insu

ranc

eH

C.7

3,45

42,

379

2,37

45

1,07

577

777

78

223

670

Tota

l cur

ent e

xpen

ditu

re o

n he

alth

29,4

3214

,617

14,4

8413

414

,815

2,03

4-

2,03

411

,612

365

804

0

Gro

ss c

apita

l for

mat

ion

HC

.R.1

2,75

72,

754

2,75

4-

3-

--

3-

--

Tota

l exp

endi

ture

on

heal

th32

,189

17,3

7117

,237

134

14,8

182,

034

-2,

034

11,6

1536

580

40

Mem

oran

dum

item

s: F

urth

er h

ealth

rela

ted

func

tions

Edu

catio

n an

d tr

aini

ng o

f hea

lth p

erso

nnel

HC

.R.2

1,34

788

488

4-

463

--

-37

03

882

Res

earc

h an

d de

velo

pmen

t in

heal

thH

C.R

.350

4646

-3

--

-2

--

1

Food

, hyg

iene

and

drin

king

wat

er c

ontr

olH

C.R

.410

699

99-

7-

--

--

7-

Env

ironm

ent h

ealth

HC

.R.5

--

--

--

--

--

Adm

inis

trat

ion

and

prov

isio

n of

soc

ial s

ervi

ces

in

kind

to a

ssis

t liv

ing

with

dis

ease

HC

.R.6

--

--

--

--

--

--

Adm

inis

trat

ion

and

prov

isio

n of

hea

lth-r

elat

ed

cash

-ben

efits

HC

.R.7

--

--

--

--

--

--

Gra

nd to

tal

33,6

9218

,401

18,2

6713

415

,291

2,03

4-

2,03

411

,986

367

899

4


Tab

le A

7 :T

ota

l exp

end

itur

e o

n H

ealt

h, in

clud

ing

Hea

lth-

rela

ted

Fun

ctio

ns, 2

009

(RM

Mill

ion)

ICHA Code - HP Code


HF.

1H

F.1.

1H

F.1.

2H

F.2

HF.

2.1

+ H

F.2.

2H

F.2.

3H

F.2.

4H

F.2.

5H

F.3

General government

General government excluding security funds


Private Sector

Private insurance

HF.

2.1

HF.

2.2


Non-profit organizations serving households (Other than social

insurance)


Rest of the word



Hea

lth c

are

serv

ices

and

goo

ds b

y fu

nctio

n

Ser

vice

s of

cur

ativ

e an

d re

habi

litat

ive

care

HC

.1,H

C.2

19,1

6310

,078

9,97

410

49,

085

1,25

6-

1,25

67,

376

6638

7-

Ser

vice

s of

long

-ter

m n

ursi

ng c

are

HC

.314

713

013

133

1-

112

211

--

Anc

illary

Ser

vice

s to

hea

lth c

are

HC

.486

825

025

00

618

0-

040

89

201

-

Med

ical

goo

ds d

ispe

nsed

to o

ut-p

atie

nts

HC

.54,

148

419

410

93,

730

0-

03,

672

4315

-

Pha

rmac

eutic

als

and

othe

r med

ical

non

-dur

able

sH

C.5

.13,

155

371

371

02,

784

00

2,73

238

15-

Ther

apeu

tic a

pplia

nces

and

oth

er m

edic

al

dura

bles

HC

.5.2

993

4738

994

6-

--

941

5-

-

Per

sona

l med

ical

ser

vice

s an

d go

ods

HC

.1-H

C.5

24,3

2610

,760

10,6

3412

713

,565

1,25

7-

1,25

711

,578

128

603

-

Pre

vent

ive

and

publ

ic h

ealth

ser

vice

sH

C.6

1,65

21,

478

1,47

62

174

--

2614

134

-

Hea

lth a

dmin

istr

atio

n an

d he

alth

insu

ranc

eH

C.7

3,45

42,

379

2,37

45

1,07

577

777

78

223

670

Tota

l cur

ent e

xpen

ditu

re o

n he

alth

29,4

3214

,617

14,4

8413

414

,815

2,03

4-

2,03

411

,612

365

804

0

Gro

ss c

apita

l for

mat

ion

HC

.R.1

2,75

72,

754

2,75

4-

3-

--

3-

--

Tota

l exp

endi

ture

on

heal

th32

,189

17,3

7117

,237

134

14,8

182,

034

-2,

034

11,6

1536

580

40

Mem

oran

dum

item

s: F

urth

er h

ealth

rela

ted

func

tions

Edu

catio

n an

d tr

aini

ng o

f hea

lth p

erso

nnel

HC

.R.2

1,34

788

488

4-

463

--

-37

03

882

Res

earc

h an

d de

velo

pmen

t in

heal

thH

C.R

.350

4646

-3

--

-2

--

1

Food

, hyg

iene

and

drin

king

wat

er c

ontr

olH

C.R

.410

699

99-

7-

--

--

7-

Env

ironm

ent h

ealth

HC

.R.5

--

--

--

--

--

Adm

inis

trat

ion

and

prov

isio

n of

soc

ial s

ervi

ces

in

kind

to a

ssis

t liv

ing

with

dis

ease

HC

.R.6

--

--

--

--

--

--

Adm

inis

trat

ion

and

prov

isio

n of

hea

lth-r

elat

ed

cash

-ben

efits

HC

.R.7

--

--

--

--

--

--

Gra

nd to

tal

33,6

9218

,401

18,2

6713

415

,291

2,03

4-

2,03

411

,986

367

899

4

1 STEERING COMMITTEE

• Co-Chairman(i) Secretary General, Ministry of Health Malaysia(ii) Director General of Health Malaysia

• Secretariat

Malaysia National Health Accounts Unit, Planning & Development Division, Ministry of Health Malaysia

• Members

Ministry of HealthMinistry of FinanceCentral Bank of MalaysiaDepartment of StatisticsEconomic Planning Unit, Prime Minister’s DepartmentPublic Services Department of MalaysiaAccountant-General’s DepartmentMinistry of Home AffairsMinistry of Higher EducationMinistry of Human ResourcesMinistry of Housing and Local GovernmentMinistry of DefenceMinistry of Rural and Regional DevelopmentMinistry of Women, Family and Community DevelopmentDepartment of Occupational Safety and HealthHealth and Environment Department, Kuala Lumpur City HallEmployees Provident Fund Social Security OrganizationMalaysian Medical AssociationAssociation of Private Hospitals of MalaysiaPrimary Care Doctors’ Organization MalaysiaFederation of Private Medical Practitioners Association of MalaysiaMalaysian Employers Federation

2 MNHA SECRETARIAT

(Current staff – Technical and Support staff)Dr. Jameela Binti ZainuddinDr. Noryati Binti Yusof @ AtanPn. Kamsiah Binti Hj. NawiSister Ng Siew LuanPn. Rohaini Binti HasimPn. Salina Binti ShafiiEn. Hishamudden Bin AliasPn. Marina Binti TalibCik Hasinah Binti Abu Hasan

MNHA COMMITTEES AND MEMBERS


Pn. Noriza Binti Ab RahmanCik Wahidah Binti WahabCik Dolly AdamPn. Nor Aslinda Waty Binti Rozikin

• (Previous MNHA staff)Dr. Siti Aishah Binti AbdullahPn. Rosmaria Binti SallehCik Nurliyana Binti MohamadCik Nur Shazana Binti AzharCik Nur Aisyah Binti Abu BakarCik Nor Amirah Binti HamidCik Nazatul Afirah Binti SazaliPn. Za’ebah Binti IsmailCik Siti Mezatu Ekma Binti Mohd NoorPn. Siti Fatimah Binti AzahariEn. Zaifulnizam Bin Abd Karim

3 REPORT EDITORIAL COMMITTEE

Publication Editor: Dr. Jameela Binti Zainuddin

• Editorial Board Members:Dr. Noryati Binti Yusof @ AtanSister Ng Siew LuanPn. Salina Binti ShafiiEn. Hishamudden Bin AliasPn. Rohaini Binti HasimPn. Kamsiah Binti Hj. Nawi

• Secretariat:Pn. Marina Binti TalibCik Hasinah Binti Abu Hasan



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