exposed deep fault lines in the under-resourced health care system and highlighted the impact of shortages of medical workers and resources in Malaysia after years of underfunding of the public healthcare system .

While health experts welcomed Budget 2021 ’ s overall focus on health expenditure , they felt there were several shortcomings that needed to be addressed . One main takeaway from the budget in terms of health spending was the entire Covid-19 support being too small eg the allocation for vaccines being only RM3 billion which may not cover the likely scenario of two vaccine doses and the logistics of a nationwide vaccination program .

Further , the RM17 billion Covid-19 Fund for wage support and social assistance is too small to sustain an entire year ’ s worth of job losses and under-employment , which will impact nutrition , mental health and health outcomes .

Secondly , whilst the Finance Minister Tengku Datuk Seri Zafrul Abdul Aziz has refuted allegations that the government has drastically reduced its public health allocation in Budget 2021 , it is only a 4.3 per cent increase year-on-year . This may reduce the Health Ministry ’ s ability to deliver the much needed Covid-19 and non-Covid-19 care , and reduces the ability to achieve universal health coverage and long-term health reforms .

However , the additional tax reliefs for medical related expenses are welcome . There were a series of decisions that reflected a greater willingness to embrace health insurance , providing tax breaks for some insurance purchases and the introduction of vouchers for the B40 segment . This is a positive trend that allows for more sustainable and diversified funding sources for healthcare in Malaysia .

Front-liners will appreciate the continuation of the special allowance of RM600 per month and a one-off payment of RM500 . Surprisingly however , there is no explicit mention about the creation of new posts or absorption of contract medical personnel into permanent posts , particularly involving doctors .

Lack of funds for health promotion and prevention

The Health Ministry had implemented the shift system in a few government health clinics to reduce congestion and to aid in adhering to the new Covid-19 norms . However , many medical groups

Front-liners will appreciate the continuation of the special allowance of RM600 per month and a oneoff payment of RM500 . Surprisingly however , there is no explicit mention about the creation of new posts or absorption of contract medical personnel into permanent posts , particularly involving doctors .”

were against the shift system and urged the ministry to first increase their manpower before implementing the shift system as it will lead to burnouts which eventually could risk the safety of the patients .

It is interesting to note the rapid rise in the number of patient visits to government hospitals and clinics over the years . Even before the Covid-19 pandemic hit our shores , government clinics and hospitals had 77 million patients visits in 2018 alone , compared to 10 years earlier when there were only 17 million visits .

The lack of allocation for infrastructure as compared to last year ’ s budget is understandable because resources were expected to be pumped into Covid-19 prevention and control programs . Intriguingly , there is no specific mention about improving information and communication technology / electronic medical records ( ICT / EMR ), compared to last year ’ s RM30 million allocation , especially as there would be a need to have increased reliance on ICT / EMR and virtual clinics .

The RM24 million carved out for mental health , prevention of violence and substance abuse was a good move as there has been an alarming rise in these issues .

However , health experts decried a lack of funds for health promotion and prevention campaigns for non-communicable diseases ( NCD ). Although the focus was more on treatment rather than prevention , NCDs are the leading cause of death in Malaysia and this required an additional allocation for treatment , early intervention and awareness campaigns .

Need to protect groups at risk of NCDs

Malaysia records RM8.91 billion in losses in productivity annually from NCDs such as cancer , diabetes , heart disease and hypertension . There is a real need to protect groups at risk of NCDs as there is a risk of a national health crisis following a surge in NCD cases when the pandemic is over . The pandemic has taken a toll on the

wellbeing of NCD patients with delayed appointments , infrequent hospital visits and disrupted treatments .

It is also hoped that the government will allocate a budget for patients waiting to get treatment in public hospitals to receive treatment at private hospitals , which allows for early intervention and treatment .

Meanwhile , the Malaysia Healthcare Travel Council has welcomed the RM35 million allocation under the Budget 2021 for the healthcare travel sector . It shows that this sector is recognised as a priority export service with potential for a strong rebound .

The budget would be utilized to boost the healthcare travel industry to aid the revitalisation of the Malaysian economy and improve the healthcare delivery services via digitalisation . Malaysian healthcare has the potential to contribute up to RM10 billion to the economy as the industry recovers .

In addition to the financial allocation to the travel healthcare sector , the government ’ s decision to extend the tax exemption imposed on private healthcare services export until the year 2022 is lauded .

It is understandable that Budget 2021 seeks to balance competing needs from citizens and businesses struggling with unemployment and drying revenue , while the global pandemic is expected to continue well into next year . It is important however for the Malaysia government to focus on health and allocate the resources towards the safety and lives of the people with measures that provide aid directly to the Rakyat being of utmost importance .

From this perspective , it is felt that some of the allocation of the limited funds to potential unnecessary spending needs to be redirected to areas such as healthcare which really need such funds . — The Health

Harvindar Singh is Managing Partner , Harvey & Associates and Tax Partner , SCS Global Consulting ( M ) Sdn Bhd