Page 60 - 20211214_OHKF_Health_Finance_Research_Report_E (1)

Malaysia: PeKa B40 Scheme
Malaysia’s dual-track healthcare system is very similar to the United Kingdom’s which offers
UHC to all citizens and access to comprehensive services within an extensive network of
Malaysian public health facilities. The public sector is the dominant provider of hospital-
based secondary and tertiary care and finances approximately 50% of PHC. Malaysia, like
many countries, has an aging population and thus is facing a gradual increase in total health
expenditure. In order to offset costs from the pressured public healthcare system while
maintaining high quality health service delivery for the population, Malaysia is actively
engaging in greater strategic purchasing practices. The PeKa B40 scheme is one such
example in recent times.

In April 2019, the Malaysian Ministry of Health (MOH) launched PeKa B40 as a national pilot
healthcare screening and protection scheme to combat the increasing rate of chronic
illnesses among those coming from the poorest 40% of households in Malaysia–known as
the B40 group (Ministry of Health of Malaysia, 2018; The Star, 2019). The scheme, with a total
government allocation of MYR 100 millions, entitles B40 individuals aged 50 and above to
four benefits: health screenings, medical devices, incentives to fulfill entire cancer treatments,
and transportation incentives. Recipients are eligible to receive up to MYR 20,000 for medical
devices, a maximum of MYR 1,000 in phases for cancer treatment based on the stage, and
up to MYR 1,000 in transportation incentives for each diagnosed disease and depending on
the distance required to travel to healthcare facilities.

For health screenings, recipients may receive screening for chronic illnesses such as
hypertension, diabetes, kidney-related diseases, cholesterol, and cancers at private or
government clinics who have registered as a participating PeKa B40 clinic. In order to
engage private clinics in PeKa B40, the MOH contracts directly with private GPs for their
participation. The MOH states that PeKa B40 prices are economical relative to the health
services offered, such as access to medical devices and lab tests, and that participating GPs
are monitored and evaluated for their quality through the scheme (ProtectHealth, 2020). By
June 2020, over 2,600 clinics (including 1,753 private and 887 government clinics) were
participating in PeKa B40, and over 350,000 individuals had been screened for chronic
illnesses, with nearly 43% of those screened having had at least one or more chronic
illnesses detected (ProtectHealth, 2020).

One year since the launch of PeKa B40, the scheme has not yet reached its screening target;
however, 40% of those screened were found to have one or more chronic illnesses, therefore
allowing for greater patient education and empowerment on their health status (ProtectHealth, 2020).
Although PeKa B40’s nascency does not allow for more in-depth monitoring and evaluation
reports as of yet, the scheme is a good start in the right direction for more active public-private
engagement in the healthcare system that could play a key role to in optimising healthcare
financing and service delivery in the long-run.

Singapore: Chronic Disease Management and the SingHealth DOT Programme
The Singaporean government funds nearly a quarter of all healthcare costs through taxes,
with mandatory individual medical saving, employer-based health insurance and OOP
comprising the rest of total health expenditure (Yeo et al, 2012). Singapore’s multipayer,
mixed healthcare financing system is buttressed by three national financing schemes, known
as the 3Ms: Medishield Life (mandatory universal basic health insurance funded primarily
from MediSave for all citizens and permanent residents to cover catastrophic expenses);
MediSave [mandatory (individual) national medical savings scheme whereby personal and
employer salary contributions among all working citizens and permanents residents are used
to pay for hospital and outpatient services]; and MediFund (safety net for low-income
individuals who cannot afford care through OOP, even with utilising MediSave)
(Commonwealth Fund, 2020b; Ministry of Health of Singapore, n.d.-c). Healthcare services

58