Health insurance in Malaysia

Healthcare in Malaysia is mainly under the responsibility of the government's Ministry of Health. Malaysia generally has an efficient and widespread system of health care, operating a two-tier health care system consisting of both a government-run universal healthcaresystem and a co-existing private healthcare system. Infant mortality rate – a standard in determining the overall efficiency of healthcare – in 2005 was 10, comparing favourably with the United States and western Europe. Life expectancy at birth in 2005 was 74 years.

History of Healthcare in Malaysia

Healthcare in Malaysia has under gone radical transformations. Earliest pre-colonial medical care was confined to traditional remedies current among local populations of Malays, Chinese, Indian and other ethnic groups. The advent of colonialism brought western medical practice into the country. Since the country's independence in August 1957, the system of medical care transferred from the British colonial rule has been transformed to meet the needs of emerging diseases, as well as national political requirements.

Healthcare today in Malaysia

Malaysia has a widespread system of health care. It implements a universal healthcare system, which co-exists with the private healthcare system.Infant mortality rate – a standard in determining the overall efficiency of healthcare – in 2005 was 10, comparing favourably with the United States and western Europe. Life expectancy at birth in 2005 was 74 years.Infant mortality fell from 75 per 1000 live births in 1957 to 7 in 2013.

Healthcare in Malaysia is divided into private and public sectors. Public provision is rather basic, especially in rural areas.^[5] The government produced a plan,1Care for 1Malaysia, in 2009, with the intention of reform based on the principle ‘use according to need, pay according to ability’, but little progress towards its implementation has been made.^[6] Malaysian society places importance on the expansion and development of healthcare, putting 5% of the government social sector development budget into public healthcare – an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of telehealth. Over the last couple of years they have increased their efforts to overhaul the systems and attract more foreign investment.

Government policy and action

The Malaysian government places importance on the expansion and development of health care, putting 5% of the government social sector development budget into public health care—an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of 

Government policy and action

The Malaysian government places importance on the expansion and development of health care, putting 5% of the government social sector development budget into public health care—an increase of more than 47% over the previous figure. This has meant an overall increase of more than RM 2 billion. With a rising and ageing population, the Government wishes to improve in many areas including the refurbishment of existing hospitals, building and equipping new hospitals, expansion of the number of polyclinics, and improvements in training and expansion of health. A major problem with the health care sector is the lack of medical centres for rural areas, which the government is trying to counter through the development of and expansion of a system called "tele-primary care". Another issue is the overperscription of drugs, though this has decreased in recent years.Over the last couple of years, the Malaysian Health Ministry has increased its efforts to overhaul the system and attract more foreign investment.

Influenza

The Malaysian government has developed a National Influenza Pandemic Preparedness Plan (NIPPP) which serves as a time bound guide for preparedness and response plan for influenza pandemic. It provides a policy and strategic framework for a multisectoral response and contains specific advice and actions to be undertaken by the Ministry of Health at the different levels, other governmental departments and agencies and non-governmental organisations to ensure that resources are mobilised and used most efficiently before, during and after a pandemic episode.^[13] Since the Nipah virus outbreak in 1999, the Malaysian Health Ministry have put in place processes to be better prepared to protect the Malaysian population from the threat of infectious diseases. Malaysia was fully prepared during the Severe Acute Respiratory Syndrome (SARS) situation (Malaysia was not a SARS affected country) and the episode of the H5N1 (bird flu) outbreak in 2004.

Medicine via Post

In January 2011 the Malaysia government launched a program to renew prescriptions via mail. Medicine via Post targets patients with chronic diseases. To be eligible to participate patients have to receive a certification from a pharmacist that their condition is stable and that they understand how to properly use their medication. Patients pay delivery costs which are RM3.5 in Putrajaya, RM5.0 for other locations in Peninsular Malaysia, and RM8.0 for Sabah and Sarawak. The program is based on a pilot-project conducted at Putrajaya Hospital started in October 2009.^[14]. A major problem with the health care sector is the lack of medical centres for rural areas, which the government is trying to counter through the development of and expansion of a system called "tele-primary care". Another issue is the overperscription of drugs, though this has decreased in recent years.Over the last couple of years, the Malaysian Health Ministry has increased its efforts to overhaul the system and attract more foreign investment.

Influenza

The Malaysian government has developed a National Influenza Pandemic Preparedness Plan (NIPPP) which serves as a time bound guide for preparedness and response plan for influenza pandemic. It provides a policy and strategic framework for a multi-sectoral response and contains specific advice and actions to be undertaken by the Ministry of Health at the different levels, other governmental departments and agencies and non-governmental organisations to ensure that resources are mobilised and used most efficiently before, during and after a pandemic episode.^[Since the Nipah virus outbreak in 1999, the Malaysian Health Ministry have put in place processes to be better prepared to protect the Malaysian population from the threat of infectious diseases. Malaysia was fully prepared during the Severe Acute Respiratory Syndrome  situation (Malaysia was not a SARS affected country) and the episode of the H5N1outbreak in 2004.

Medicine via Post

In January 2011 the Malaysia government launched a program to renew prescriptions via mail. Medicine via Post targets patients with chronic diseases. To be eligible to participate patients have to receive a certification from a pharmacist that their condition is stable and that they understand how to properly use their medication. Patients pay delivery costs which are RM3.5 in Putrajaya, RM5.0 for other locations in Peninsular Malaysia, and RM8.0 for Sabah and Sarawak. The program is based on a pilot-project conducted at Putrajaya Hospital started in October 2009.^[14]

Health insurance in Brazil

Healthcare in Brazil is a Constitutional right.It is provided by both private and government institutions. The Health Minister administers national health policy. Primary healthcare remains the responsibility of the federal government, elements of which (such as the operation of hospitals) are overseen by individual states. Public healthcare is provided to all Brazilian permanent residents and foreigners in Brazilian territory through the National Healthcare System, known as Unified Health System - SUS. The SUS is universal and free for everyone.

Healthcare system

National health policies and plans: The national health policy is based on the Federal Constitution of 1988, which sets out the principles and directives for the delivery of healthcare in the country through the Unified Health System (SUS). Under the constitution, the activities of the federal government are to be based on multiyear plans approved by the national congress for four-year periods. The essential objectives for the health sector were improvement of the overall health situation, with emphasis on reduction of child mortality, and political-institutional reorganization of the sector, with a view to enhancing the operative capacity of the SUS. The plan for the next period (2000–2003) reinforces the previous objectives and prioritizes measures to ensure access at activities and services, improve care, and consolidate the decentralization of SUS management

Health sector reform

The current legal provisions governing the operation of the health system, instituted in 1996, seek to shift responsibility for administration of the SUS to municipal governments, with technical and financial cooperation from the federal government and states. Another regionalization initiative is the creation of health consortia, which pools the resources of several neighboring municipalities. A vital instrument of support for regionalization is the project for strengthening and reorganizing the SUS.

Regulatory actions

Procedures for the registration, control, and labelling of foods are established under federal legislation, which assigns specific responsibilities to the health and agriculture sectors. In the health sector, health inspection activities have been decentralized to the state and municipal governments. The environmental policy derives from specific legislation and from the Constitution of 1988.

Public healthcare services

The main strategy for strengthening primary healthcare is the Family Health Program, introduced by the municipal health secretariats in collaboration with the states and the Ministry of Public Health. The federal government supplies technical support and transfers funding through Piso de Atenção Básica. Disease prevention and control activities follow guidelines established by technical experts in the Ministry of Public Health. The National Epidemiology Center (CENEPI), an agency of the National Health Foundation (FUNASA) coordinates the national epidemiological surveillance system, which provides information about and analysis of the national health situation.

Individual healthcare services

In 2014 there were 6,706 hospitals in Brazil. Over 50% of hospitals are found in 5 states: São Paulo, Minas Gerais, Bahia, Rio de Janeiro and Parana.
Throughout the country, 78% of hospitals practice general medicine while 16% are specialized and 6% provide outpatient care only.^[2] In 2012, 66% of the country's hospitals, 70% of its 485,000 hospital beds, and 87% of its 723 specialized hospitals belonged to the private sector. In the area of diagnostic support and therapy, 95% of the 7,318 establishments were also private. 73% of the 41,000 ambulatory care facilities were operated by the public.^[3]
The public hospital infrastructure required hospitals to be spread over a territory of 8.516 million square kilometres (3.288 million square miles). As such, the public hospital infrastructure relies on a vast network of small hospitals. Over 55% of public hospitals have less than 50 beds.
Hospital beds in the public sector were distributed as follows: surgery (21%), clinical medicine (30%), pediatrics (17%), obstetrics (14%),psychiatry (11%) and other areas (7%). In the same year, 43% of public hospital beds, and half the hospital admissions were in municipal establishments.
Since 1999, the Ministry of Public Health has been carrying out a health surveillance project in Amazonia that includes epidemiological and environmental health surveillance, indigenous health and disease control components. With US 600 million dollars from a World Bankloan, efforts are being made to improve the operational infrastructure, training of human resources and research studies. An estimated 25% of the population is covered by at least one form of health insurance; 75% of the insurance plans are offered by commercial operators and companies with self-managed plans.

Health insurance in the United Kingdom

Healthcare in the United Kingdom is a devolved matter, with England, Northern Ireland, Scotland and Wales each having their own systems of publicly funded healthcare, funded by and accountable to separate governments and parliaments, together with smaller private sector and voluntary provision. As a result of each country having different policies and priorities, a variety of differences now exist between these systems.

Despite there being separate health services for each country, the performance of the NHS across the UK can be measured for the purpose of making international comparisons. In a 2014 report ranking developed-country healthcare systems, the United Kingdom was ranked the best healthcare system in the world overall and in the following categories: Quality of Care Access to Care, Efficiency, and Equity.The UK's palliative care has also been ranked as the best in the world. On the other hand, in 2005-09 cancer survival rates lagged ten years behind the rest of Europe, although survival rates continue to increase.

In 2015, the UK was 14th (out of 35) in the annual Euro health consumer index. It was criticised for its poor accessibility and "an autocratic top-down management culture".The index has in turn been criticized by academics, however.

Common features

Each NHS system uses General Practitioners to provide primary healthcare and to make referrals to further services as necessary. Hospitals then provide more specialist services, including care for patients with psychiatric illnesses, as well as direct access to Accident and Emergency (A&E) departments. Community pharmacies are privately owned but have contracts with the relevant health service to supply prescription drugs.

The public healthcare system also provides free (at the point of service) ambulance services for emergencies, when patients need the specialist transport only available from ambulance crews or when patients are not fit to travel home by public transport. These services are generally supplemented when necessary by the voluntary ambulance services (British Red Cross, St Andrews Ambulance Association and St John Ambulance). In addition, patient transport services by air are provided by the Scottish Ambulance Service in Scotland and elsewhere by county or regional air ambulance trusts (sometimes operated jointly with local police helicopter services) throughout England and Wales.^[15] In specific emergencies, emergency air transport is also provided by naval, military and air force aircraft of whatever type might be appropriate or available on each occasion, and dentists can only charge NHS patients at the set rates for each country. Patients opting to be treated privately do not receive any NHS funding for the treatment. About half of the income of dentists in England comes from work sub-contracted from the NHS, however not all dentists choose to do NHS work.

Assessment of the UK as a whole

The OECD publication Health at a Glance 2015 enabled comparisons of the UK as a whole with other countries. It was reported that the UK had an “outstandingly poor” record of preventing ill health and that hospitals in the UK were now so short-staffed (needing 75,000 more doctors and nurses to match standards in similar countries) and under equipped that people were dying because of a chronic lack of investment since 2010. The UK survival rates were 21st out of 23 countries for cervical cancer, 20th out of 23 countries on breast and bowel cancer and 19th out of 31 countries for stroke.

Healthcare in England

Most healthcare in England is provided by the National Health Service (NHS), England's publicly funded healthcare system, which accounts for most of the Department of Health's budget (£110 billion in 2013-14 

In April 2013, under the terms of the Health and Social Care Act 2012, a reorganisation of the NHS took place regarding the administration of the NHS. Primary care trusts  and strategic health authorities ) were abolished, and replaced by clinical commissioning groups ). Cogs now commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services a population is likely to need, and ensuring that there is provision of these services. The Cogs are overseen by NHS England, formally known as the NHS Commissioning Board (NHS CB) which was established on 1 October 2012 as an executive non-departmental public body. NHS England also has the responsibility for commissioning primary care services - General Practitioners, opticians and NHS dentistry, as well as some specialised hospital services. Services commissioned include general practice physician services (most of whom are private businesses working under contract to the NHS), community nursing, local clinics and mental health services.

Provider trusts are NHS bodies delivering health care service. They are involved in agreeing major capital and other health care spending projects in their region.NHS trustsare care deliverers which spend money allocated to them by CCG's. Secondary care (sometimes termed acute health care) can be either elective care or emergency care and providers may be in the public or private sector.

Health insurance in Australia

Health care in Australia is provided by both private and government institutions. The federal Minister for Health, currently Susan Lee, administers national health policy, and state and territory governments administer elements of health care within their jurisdictions, such as the operation of hospitals.

Medicare, administered by the federal government, is the publicly funded universal health care system in Australia which was instituted in 1984. It coexists with a private health system. Medicare is funded partly by a 2% Medicare levy with exceptions for low-income earners), with the balance being provided by government from general revenue. An additional levy of 1% is imposed on high-income earners without private health insurance. As well as Medicare, there is a separate Pharmaceutical Benefits Scheme also funded by the federal government which considerably subsidises a range of prescription medications.

National health policy

Financial year	% of GDP	Current price ($ billions)
1981–82	6.3	10.8
1991–92	7.2	30.5
2001–02	8.4	63.1
2008–09	9.0	114.4
2009–10	9.4	121.7
2010–11	9.3	131.6
2011–12	9.5	142.0
2012–13	9.7	147.0
2013–14	9.8	154.6
Source: Australian Institute of Health and Welfare [6]

Australia has a universal health care structure, with the federal government paying a large part of the cost of health services, including those in public hospitals. The amount paid by the federal government includes:

1. patient health costs based on the Medicare benefits schedule. Typically, Medicare covers 75% of general practitioner, 85% of specialist and 100% of public in-hospital costs.
2. patients may be entitled to other concessions or benefits^[7]
3. patients may be entitled to further benefits once they have crossed a so-called safety net threshold, based on total health expenditure for the year.^[7]

Government expenditure on healthcare is about 67% of the total, below the COED average of 72%.

The remainder of health costs (called out of pocket costs or the co payment) are paid by the patient, unless the provider of the service chooses to use bulk billing, charging only the scheduled fee, leaving the patient with no out of pocket costs. Where a particular service is not covered, such as dentistry, optometry, and ambulance transport, patients must pay the full amount, unless they hold a Low Income Earner card, which may entitle them to subsidised access.

Individuals can take out private health insurance to cover out-of-pocket costs, with either a plan that covers just selected services, to a full coverage plan. In practice, a person with private insurance may still be left with out-of-pocket payments, as services in private hospitals often cost more than the insurance payment.

The government encourages individuals with income above a set level to privately insure. This is done by charging these (higher income) individuals a surcharge of 1% to 1.5% of income if they do not take out private health insurance, and a means-tested rebate. This is to encourage individuals who are perceived as able to afford private insurance not to resort to the public health system,^[10] even though people with valid private health insurance may still elect to use the public system if they wish.

Insurance

Private health insurance funds private health and is provided by a number of private health insurance organisations, called health funds. The largest health fund with a 30% market share is Median. Median was set up to provide competition to private "for-profit" health funds. Although government owned, the fund has operated as a government business enterprise since 2009, operating as a fully commercialised business paying tax and dividends under the same regulatory regime as do all other registered private health funds. Highly regulated regarding the premiums it can set, the fund was designed to put pressure on other health funds to keep premiums at a reasonable level.The Coalition Howard Government had announced that Median would be sold in a public float if it won the 2007 election, however they were defeated by the Australian Lab or Party under Kevin Rudd which had already pledged that it would remain in government ownership. The Coalition under Tony Abbott made the same pledge to privatise Median if it won the 2010 election but was again defeated by Labour. Privatisation was again a Coalition policy for the 2013 election, which the Coalition won. However, public perception that privatisation would lead to reduced services and increased costs makes privatising Median a "political hard sell."

Some private health insurers are "for profit" enterprises, and some are non-profit organisations such as CFC Health Insurance and CBS Health Fund. Some have membership restricted to particular groups, some focus on specific regions – like BF which centres on Western Australia, but the majority have open membership as set out in the PHIAL annual report. Membership to most of these funds is also accessible using a comparison websites or the decision assistance sites. These sites operate on a commission-basis by agreement with their participating health funds and allow consumers to compare policies before joining on-line.

Most aspects of private health insurance in Australia are regulated by the Private Health Insurance Act 2007. Complaints and reporting of the private health industry is carried out by an independent government agency, the Private Health Insurance Ombudsman.The ombudsman publishes an annual report that outlines the number and nature of complaints per health fund compared to their market share.

There are a number of other matters about which funds are not permitted to discriminate between members in terms of premiums, benefits or membership – these include racial origin, religion, sex, sexual orientation, nature of employment, and leisure activities. Premiums for a fund's product that is sold in more than one state can vary from state to state, but not within the same state.

The Australian government has introduced a number of incentives to encourage adults to take out private hospital insurance. These include:

• Lifetime Health Cover: If a person has not taken out private hospital cover by 1 July after their 31 Th birthday, then when (and if) they do so after this time, their premiums must include a loading of 2% per annum. Thus, a person taking out private cover for the first time at age 40 will pay a 20 per cent loading. The loading continues for 10 years. The loading applies only to premiums for hospital cover, not to ancillary (extras) cover.
• Medicare Levy Surcharge: People whose taxable income is greater than a specified amount (in the 2011/12 financial year $80,000 for singles and $168,000 for couples and who do not have an adequate level of private hospital cover must pay a 1% surcharge on top of the standard 1.5% Medicare Levy. The rationale is that if the people in this income group are forced to pay more money one way or another, most would choose to purchase hospital insurance with it, with the possibility of a benefit in the event that they need private hospital treatment – rather than pay it in the form of extra tax as well as having to meet their own private hospital costs.
  • The Australian government announced in May 2008 that it proposes to increase the thresholds, to $100,000 for singles and $150,000 for families. These changes require legislative approval. A bill to change the law has been introduced but was not passed by the Senate. A changed version was passed on 16 October 2008. There have been criticisms that the changes will cause many people to drop their private health insurance, causing a further burden on the public hospital system, and a rise in premiums for those who stay with the private system. Other commentators believe the effect will be minimal.
• Private Health Insurance Rebate: The government subsidises the premiums for all private health insurance cover, including hospital and ancillary (extras), by 10%, 20% or 30%. In May 2009, The Lab or Government under Kevin Rudd announced that as of June 2010, the Rebate would become means-tested and offered on a sliding scale.