In response to the recent announcement of Budget 2022 as well as the related press statement by Minister of Health Khairy Jamaluddin, Malaysian Medics International (MMI) would like to express our gratitude for the 1.5% increase in budgetary allocation to RM32.41 billion to the Ministry of Health, while highlighting several other pertinent issues in relation to the announcements that require further consideration.

MMI acknowledges and supports the many health-positive inclusions in Budget 2022, including the allocation of RM2 billion allocated to the National COVID-19 Immunization Program (PICK) to secure its continuity; the commitment of RM2 billion towards improving the capacity of health facilities; the additional personal income tax exemptions on medical expenses incurred when consulting or receiving treatment from psychiatrists, clinical psychologists, and registered counselors; the two- to four-year contract extension for over 10,000 medical officers, pharmacists and dentists; the expansion of sugar tax to include premixed beverages; and the introduction of excise duties on all e-cigarette and vape products.^{1, 2}

MMI hopes that these increased allocations and new policies would be robustly implemented in the near future to safeguard the health and well-being of the rakyat.

In the interim, we humbly call on the Ministry of Health, the Ministry of Finance, other relevant stakeholders and distinguished policymakers to consider the following:

1. Commit to increasing spending on mental health

While MMI welcomes the RM70 million earmarked for the betterment of mental health² as well as the RM320 million allocated to psychiatry and mental health spending³, Malaysia’s spending on mental health continues to fall short of World Health Organization recommendations, which implores that 2% of national health budgets are allocated to mental health⁴. This is despite the COVID-19 pandemic exacerbating mental ill-health issues due to increased poverty-related stressors, incidence of domestic violence and substance abuse rates, thus leading to projected increases in mental health service utilization.

It is hence imperative that our nation’s spending on mental health increases proportionally to meet these increased demands, with these funds being directed towards the expansion and improvement of primary (preventative), secondary (curative) and tertiary (advanced curative) mental health services, as well as towards the digitalization of mental health services in Malaysia.

2. Clarify key issues related to financial security and career prospects of healthcare workers

MMI welcomes the increased emolument allocation for healthcare workers. However, we also recognize that the overall emolument increase of 1.9% in Budget 2022 compared to the previous year³ calculated from estimates of overall emolument figures from 2021 and 2022, may not be sufficient to keep up with headline inflation rates of 2-3%, as estimated by Bank Negara Malaysia⁵, thus suggesting a potential decline in real wages for healthcare workers.

We would appreciate clarification on whether additional financial schemes such as tax relief or one-off support payments for healthcare workers form part of the government’s plans to mitigate the disparity between wage growth rates and inflation.

Similarly, while MMI is enthusiastic over the RM100 million allocations towards specialty training for over 3,000 doctors and dentists, we would like to request further details on its anticipated distribution, including a breakdown by profession (medicine vs dentistry), specialty and specialization pathways (i.e. ratio of those specializing via local Masters programs vs those specializing through parallel pathways).

Lastly, while MMI recognizes the positive ramifications of the two to four-year contract extension on the career progression and financial security of existing healthcare workers, we would appreciate further clarification on the options available to healthcare workers at the end of their contract extension, including whether the government has plans to introduce further contract extensions after the initial extension, as proposed in our previous press statement⁶.

3. Redirect revenue from increased taxation towards future health and social services allocations

MMI strongly supports both the sugar tax expansion and the enhanced excise duties on all e-cigarette and vape products, in recognition of the well-established role of excise taxation in reducing the disease burden of non-communicable diseases (NCDs) such as hypertension, diabetes and obesity, by controlling the consumption of particular goods.

However, it is equally important to recognize that excise duties (or “sin taxes”) disproportionately affect lower-income populations who are less price-sensitive than higher-income populations, and at higher risk of poorer health outcomes due to their socioeconomic status⁷.

MMI recommends that the Ministry of Finance considers directing a significant proportion of the revenue raised from excise duties towards budgetary allocations for health and social services in the future.

These funds should be earmarked for national primary and secondary prevention programs aimed at NCD risk reduction in susceptible populations which are cost-effective interventions that mitigate the increasing burden of NCDs on the Malaysian health system.

Examples include smoking or vaping cessation clinics, national programs delivering nutrition education and community screening programs for the early detection of NCDs.

In summary, MMI recognizes and appreciates the increased attention paid by the government towards key issues in healthcare, as evidenced by the increased allocation to healthcare in Budget 2022.

Nevertheless, we believe that the aforementioned issues warrant further deliberation so as to ensure a more robust, responsive and equitable Malaysian health system.

References:

¹ Berita Harian. 2021. Teks Penuh Ucapan Budget 2022 | Berita Harian

² COVID-19 Malaysia. 2021. Kenyataan Media YB Menteri Kesihatan – 29 Okt 2021: Budget 2021 Tumpu Kesihatan Dan Kesejahteraan Rakyat.

³ Portal Rasmi Kementerian Kewangan Malaysia. 2021. Maksud Bekalan/Pembangunan 42. [pdf] Kementerian Kewangan Malaysia, pp.355-375.

⁴ World Health Organization. 2021. COVID-19 disrupting mental health services in most countries, WHO survey.

⁵ Bank Negara Malaysia 2021. Monetary Policy Statement, Bank Negara Malaysia.

⁶ A Call for Resolution on Issues Faced by House Officers, Malaysian Medics International.

⁷ The Use of Excise Taxes to Reduce Tobacco, Alcohol, and Sugary Beverage Consumption. Annual Reviews. 2021.

Malaysian Medics International (MMI)