BY KHIRTINI K KUMARAN

But thanks to the government ’ s Skim Peduli Kesihatan untuk Kumpulan B40 ( PeKa B40 ), this group can still enjoy access to healthcare . ProtectHealth Corporation Sdn Bhd , owned by the Ministry of Health ( MoH ), is the scheme administrator .

ProtectHealth CEO Dato ’ Dr Anas Alam Faizli talks to The Health on the effects of rising healthcare costs and how PeKa B40 has benefitted the poor .

How is the low-income group affected by rising healthcare costs ? A vital strength of the Malaysian health system is its success in providing broad and meaningful protection from the financial risks associated with the high cost of healthcare . This undoubtedly significant success is achieved through a geographically widespread public delivery system , which offers equitable and universal access to a wide range of services at minimal out-of-pocket cost .

With the increasing cost in healthcare , the most affected group is the low-income group or B40 . The presence of the Covid-19 pandemic has further added to the burden of the B40 group to obtain quality healthcare . For example , with an ageing population , the utilisation of healthcare services has increased . Ageing leads to higher vulnerability to diseases and higher incidences of co-morbidities ( more than one disease condition existing together ). Other issues associated with low socioeconomic status among older adults are related to malnutrition and inadequate diet .

How can we reduce healthcare costs ? One of the effective ways to reduce healthcare costs in Malaysia is via strategic purchasing , which aims to increase health system performance by effectively allocating financial resources to providers . A strategic purchaser allocates funds in a way that actively promotes improvements in service quality and efficiency and makes choices based on :

• the need for different health services ;

• the availability of effective medical interventions ;

• the relative cost-effectiveness of various interventions ;

• how people access these services , e . g . available only in urban areas ; and

• the quality and efficiency of services delivered by providers . A strategic purchaser may select certain health facilities / healthcare providers to contract with , eg ., those which offer a lower price and / or better quality . In PeKa B40 , ProtectHealth is the first in the country that has successfully purchased services from both public and private providers , with PeKa B40 benefits discharged through General

Practitioners ( GPs ), lab partners , Klinik Kesihatan ( KK ) and MoH Hospitals .

Additionally , ProtectHealth has managed to save the Government over RM10 million through price negotiation of the Drug Eluting Stent ( DES ), which is one of the Health Aid provided under PeKa B40 program .

Other efforts to reduce healthcare costs in Malaysia also include strengthening & enforcement of government policy on regulation for drug pricing and pooling of financing resources in a country using the Government ’ s initiative to purchase healthcare services / drugs / equipment through central negotiations ( higher purchasing power ).

What would an affordable healthcare financing scheme entail ? As we know , Malaysia is among the few nations globally that can provide its citizens affordable and even accessible medical care and has achieved excellent outcomes . However , Malaysia ’ s health system faces new challenges in the face of a rapidly evolving context — characterised by demographic and epidemiological transitions , a shifting socio-cultural environment , technological changes , and rising income levels . All these have contributed to a nutritional shift , increasing health risks , and new user expectations .

Changing the healthcare system is not an easy task . It requires in-depth scrutiny of every aspect , including political will , engagement , and feedback from all stakeholders .

The future healthcare financing scheme should entail :

• Solidarity in the rich subsidising the poor & healthy subsidising the sick

• Basic healthcare accessibility to all regardless of the social-economic background

• Contribution is based on socialeconomic status / income , such as progressive tax payment whereby the Government subsidises the poor .

• The healthcare benefit should cover those which are essential , practical , and cost-effective .

• The contribution of the financing

PeKa B40 informative billboards .

Dato ’ Dr . Anas

should be according to ability-to-pay - wealthier people contribute more

• Different segments of society are included in the same scheme to ensure a large financing pool .

• Single or few national / non-profit third-party payers to negotiate and mitigate increment of healthcare cost

To what extent have the objectives of the PeKa B40 scheme been met , and what are your plans ? The focus of PeKa B40 is to reduce the burden of NCDs through early screening and treatment to expand access to quality healthcare . This , in return , will reduce the cost of living and the wellbeing of the target population . At the same time , the PeKa B40 initiative aims to strengthen public-private partnerships while prioritising primary healthcare .

PeKa B40 has successfully met the objectives via all the benefits offered . Since PeKa B40 was implemented , the MoH has successfully detected non -communicable diseases ( NCDs ) among the B40 group , especially for newly diagnosed cases . As of 31 July 2021 , out of 519,454 recipients screened , a total of 34.8 per cent ( 181,149 ) recipients had been detected to have at least one of the non-communicable diseases , namely diabetes , high blood pressure , high cholesterol , anxiety , and depression .

The implementation of PeKa B40 reduced the financial cost burden on that group . They will not have to use their own financial resources ( out of pocket expenditure ) to purchase health screening and medical equipment .

Additionally , the Government save massive costs through early treatment by prevention of complications .

The MoH via ProtectHealth can negotiate the price of services and medical devices through more costeffective methods so that the scheme ’ s sustainability can also be emphasised . Moving forward , our plan consists of :

• Repeat screening for the high-risk group & educate on healthy lifestyle to maintain healthily

• Extend the package to include treatment to prevent loss to follow up as a result of lack of continuity of care after being screened in the private sector

• To further revise the work process and future expansion plan , revise and formalise the performance or quality indicators

and their standards , and propose a methodology for measuring outcome

• To double the efforts in promoting PeKa B40 and explore the best method of reaching the target population .

• To enhance the effort and resume outreach programmes in the more underserved areas once the MCO has lifted .

• To increase promotion via multiple platforms , including social media such as Facebook , Twitter , and Instagram

• To widen and strengthen partnerships , especially with agencies related to the B40 group .

• To do risk profiling of all the screened beneficiaries . This will identify the high-risk group for future repeat screening and establish the Wellness Module to manage high-risk beneficiaries to prevent their health from deteriorating .

What are the critical challenges faced by ProtectHealth in coordinating PeKa B40 during the pandemic ? The main key challenge is the decreasing number of health screenings . The number of beneficiaries screened increased exponentially since its launch , with a peak in December 2019 . However , it dropped dramatically after the enforcement of the Movement Control Order ( MCO ) on March 18 , 2020 , and until now . These are basically associated with the recipient ’ s concern over Covid-19 infection , total movement control orders , money constraints to pay transport fares due to loss of income , and more priority on purchasing necessities such as food rather than seeking healthcare .

What are the efforts being taken to promote the PeKa B40 initiatives further ? Various activities were carried out to promote PeKa B40 to the target group via multiple platforms . This includes media launch , print and electronic media , social media , outdoor advertisements , on-ground activities , exhibitions , interpersonal communication , publications , distribution of promotional materials , and sharing information through the PeKa B40 website .

Aside from that , briefings and talks about PeKa B40 were done almost weekly on various occasions , like community programs organised by the Government , private agencies , and NGOs .

Various messages and information were shared through this platform , such as recipients ’ eligibility , PeKa B40 benefits , the importance of health screening , the latest data analysis associated with NCDs , healthy lifestyle practices , Covid-19 , and many more . — The Health