Malaysia Health System Performance

Malaysia has achieved rapid and large improvements in life expectancy and maternal and
child mortality. At the same time, Malaysia has performed less well compared to middle- and high-
income comparator countries in improving life expectancy of the adult population. This relatively
sluggish improvement in adult life expectancy reflects a high and growing burden of non-
communicable diseases (NCDs), which the health system has not been able to adequately manage
with its existing design and resources. Outcomes for once common communicable diseases, such
as malaria, have also improved considerably. Among middle-income countries, Malaysia performs
better than average on these measures.1
Malaysia has an equitable and broadly accessible government-run healthcare delivery
system that provides a comprehensive service package of primary, secondary, and tertiary care to
all Malaysians as well as to a large number of non-Malaysians residing or working in the country.
Government-provided services perform well in clinical quality assessments. The overall cost of
the system is relatively low as a share of GDP, indicating system efficiency, although costs are
rising. Malaysians enjoy a high degree of protection from unexpected high costs of health care,
and this protection is distributed in a pro-poor way, resulting in an equitably financed system.
Households express satisfaction overall with the health system, although stresses are emerging as
new demands place pressure on—and increase waiting times for—government services, causing
many who can afford to pay to opt for costly private alternatives. Malaysia’s overall health system
performance has been excellent, but it has declined in recent years on a number of fronts. A brief
summary of these challenges, described in more detail in Sections 2-4, includes: 1

A. System-level (macro) efficiency: overall health expenditures are rising faster than economic
growth, with significant potential for future upward cost pressures related to growth of private
healthcare services and private health insurance. 1

B. Health Outcomes: there are significant and growing gaps in progress on improving overall
health outcomes. These gaps are visible in slowing rates of improvement in indicators such as
child mortality, infant mortality, and maternal mortality, and are even more evident in the
limited gains in adult life expectancy beyond age 30 and 60, where data show slower rates of
change than in higher-income comparators. Given Malaysia’s younger population, one would
expect faster rates of improvement in life expectancy at age 30 and 60. These worsening trends
can be linked to significant gaps in screening and treatment for NCDs such as hypertension,
diabetes mellitus, and hypercholesterolemia, and in addressing rising rates of key risk factors
that can be expected to lead to future increases in NCDs. 1

C. Financial protection: Malaysia has relatively high out-of-pocket spending as a share of total
health expenditure. In future, high out-of-pocket expenditures may be associated with a
worsening trend in financial risk protection, and this problem may increase over time without
remedial action. 1

D. Responsiveness/satisfaction: dissatisfaction is evident with some key service-related aspects

of government service delivery such as long waiting times, privacy, and choice, while in the
private sector there is dissatisfaction due to high charges for services. 1
E. Access to services: there is limited access to more comprehensive primary care services in the
government delivery system, including effective treatment and management of NCDs. Higher
level public hospitals are crowded while lower level public hospitals have under-used capacity.
Private healthcare delivery is also distributed unevenly across Malaysia. 1

F. Quality of care: there is an emerging picture of weak performance in reaching adults for
screening and follow-up for major NCDs. Malaysian health system is not doing what is needed
on a population level to proactively improve overall health outcomes. This weak service
performance results in large numbers of people being undiagnosed for common NCDs as well
as those who are diagnosed receiving no treatment or sub-optimal treatment. 1

G. Service delivery (micro) efficiency: within the healthcare delivery system there is significant
allocative and technical inefficiency. Allocative inefficiency can be seen in the relatively
weaker performance addressing emerging NCDs and reducing avoidable mortality, as well as
the relatively high share of ambulatory care- sensitive conditions treated in hospitals. 1

Malaysia’s performance problems emerge from two broad types of causes. First, the Malaysian
health system has not evolved in line with the broader changes that Malaysia has experienced over
the past several decades. There are major changes that have taken place (and are continuing to take
place) in the context of health and the health system in Malaysia. Some of these, such as the rapid
demographic and epidemiological transitions, are the consequences of success—rising affluence,
increased life expectancy and ageing, better education, and rising expectations, among others.
Some of these are also consequences of government policies in non-health related aspects of
development—such as the encouragement of a mixed economy. Errors of omission or commission
in public policy affect government health care services but also affect the non-government side of
the health system and users’ response to the health care market that results. Second, the service
quality of government health services has not kept pace with the expectations of citizens, who
increasingly demand choice, personal attention, privacy, and rapid response to their needs.
Consequently, many patients turn to private sector services. 1

Figure 1. Life Expectancy at Birth (Years), by Ethnicity, among Malaysian Females, 1980–20151
Figure 2. Life Expectancy at Birth (Years), by Ethnicity, among Malaysian Males, 1980–20151

Figure 3. Infant Mortality Rate (per 1,000 Live Births), by Ethnicity in Malaysia, 1965–20131
Figure 4. Under 5 Mortality Rate (per 1,000 Live Births), by Ethnicity in Malaysia, 1966–20121

Figure 5. Rates of Transition of Infant Mortality Rate, Neonatal Mortality Rate, Perinatal
Mortality Rate, and Under-Five Mortality Rate, 1965-20131
Figure 6. Maternal Mortality Ratio, 1963-20111

Figure 7. Trends in the Prevalence of Diabetes Mellitus, Share of Adult Population, 1986–20151
Figure 8. Trends in the Prevalence of Hypertension, Share of Adult Population, 1986–20151

Figure 9. Trends in the Prevalence of Hypercholesterolemia, 2006–20151

Table 1. Incidence Rate and Mortality Rate of Communicable Diseases in 20162

Reference:
1. Ministry of Health Malaysia. Malaysia Health Systems Research Volume 1. Available from:
http://www.moh.gov.my/penerbitan/Laporan/Vol%201_MHSR%20Contextual%20Analysis_
2016.pdf [Cited 29 May 2018]
2. Ministry of Health Malaysia. Health Facts 2016. Available from:
http://www.moh.gov.my/images/gallery/publications/KKM%20HEALTH%20FACTS%2020
16.pdf [Cited 29 May 2018]