The Political Economy Influence on Health Policy Reform in Malaysia: The Policy Analysis and Evaluation of '1Care for 1Malaysia'
Main Article Content
Abstract
Health systems worldwide face challenges in implementing intentional reforms due to intricate political economies shaping healthcare policies. Malaysia's dual system of tax-funded public care and out-of-pocket private financing reflects these complexities. Despite numerous attempts over the past three decades, Malaysian policymakers have struggled to transition to a unified insurance-based system. The "1Care for 1Malaysia (1C1M)" initiative in 2010 aimed to overhaul Malaysia's healthcare policy but faced challenges such as inadequate political will, financial constraints, stakeholder opposition, and policy ambiguity. This review employs the policy analysis triangle and the policy cycle framework to analyse 1C1M comprehensively. Despite its goals of achieving universal health coverage (UHC) and enhancing efficiency and equity, the initiative was hampered by political prioritisation issues, public skepticism, and management instability. Lessons from international experiences highlight the importance of sustained political commitment, transparent communication, and stakeholder engagement in driving successful reforms. Future efforts in Malaysia must prioritize these elements to achieve sustainable healthcare improvements.
Downloads
Article Details
References
Sparkes SP, Bump JB, Özçelik EA, Kutzin J, Reich MR. Political economy analysis for health financing reform. Health Syst Reform. 2019;5(3):183–94. https://doi.org/10.1080/23288604.2019.1633874
Kuhlmann E, Allsop J, Saks M. Professional governance and public control: a comparison of healthcare in the United Kingdom and Germany. Current Sociology. 2009;57(4):511-28. https://doi.org/10.1177/0011392109104352
Blank R, Burau V, Kuhlmann E. Comparative health policy: Macmillan International Higher Education: Red Globe Press; 2017 October 27, 2017.
Tsebelis G. Veto players: How political institutions work: Princeton University Press; 2002.
Croke K, Mohd Yusoff MB, Abdullah Z, Mohd Hanafiah AN, Mokhtaruddin K, Ramli ES, et al. The political economy of health financing reform in Malaysia. Health Policy and Planning. 2019;34(10):732-9. https://doi.org/10.1093/heapol/czz089
Walt G, Gilson L. Reforming the health sector in developing countries: the central role of policy analysis. Health Policy Plan. 1994;9(4):353-70. https://doi.org/10.1093/heapol/9.4.353
Buse K, Mays N, Colombini M, Fraser A, Khan M, Walls H. Making Health Policy, 3e: McGraw Hill; 2023.
Roberts M, Hsiao W, Berman P, Reich M. Getting Health Reform Right: A Guide to Improving Performance and Equity: Oxford University Press; 2008 01 Sep 2009.
Reich MR, Campos PA. A guide to applied political analysis for health reform. 2020.
Rasiah R. Malaysia's route to middle income status. Malaysia's socio-economic transformation: ideas for the enxt decade. 2014:57-91. https://doi.org/10.1355/9789814459686-007
Yorulmaz M, Mohamed NN, editors. Malaysia health system review: Overviews and opinions. International Journal of Health Administration and Education Congress (Sanitas Magisterium); 2019: Ayşegül KAPTANOĞLU.
Loh FKW, editor Malaysia (The Federation of Malaysia) A Centralized Federation with Challenges from the States. The Forum of Federations Handbook of Federal Countries 2020; 2020: Springer International Publishing.
Partap U, Young EH, Allotey P, Soyiri IN, Jahan N, Komahan K, et al. HDSS profile: the South East Asia community observatory health and demographic surveillance system (SEACO HDSS). International Journal of Epidemiology. 2017;46(5):1370-1g. https://doi.org/10.1093/ije/dyx113
Heng MS. A study of nation building in Malaysia. East Asia. 2017;34:217-47. https://doi.org/10.1007/s12140-017-9275-0
Saw S-H. The population of Malaysia: Institute of Southeast Asian Studies; 2007.
Jarrah ZM. A Political Analysis of Health Care Reform in Malaysia: Harvard University; 2018.
Leng OTS, Khan S, Vergara RG, Khan N. Policies and protections for ageing society in Malaysia. Journal of Southeast Asian Research. 2016;2016:1-8. https://doi.org/10.5171/2016.974366
Chung CF, Mansur K. A literature review on ageing population in selected Asian countries. Malaysian Journal of Business and Economics (MJBE). 2018;5(2):79-. https://doi.org/10.51200/mjbe.v0i0.1611
Abd Khalim MA, Sukeri S. Uptake and determinants of private health insurance enrollment in a country with heavily subsidised public healthcare: A cross-sectional survey in East Coast Malaysia. PLOS ONE. 2023;18(1):e0278404. https://doi.org/10.1371/journal.pone.0278404
Hassali MA, Tan CS, Wong ZY, Saleem F, Alrasheedy AA. Pharmaceutical pricing in Malaysia. Pharmaceutical prices in the 21st century. 2015:171-88. https://doi.org/10.1007/978-3-319-12169-7
Verma AK, Hassali MA, Saleem F. Health care financing in Malaysia: A way forward. Archives of Pharmacy Practice. 2015;6(4):93-6.
Iino H, Hashiguchi M, Hori S. Estimating the range of incremental cost-effectiveness thresholds for healthcare based on willingness to pay and GDP per capita: a systematic review. PloS one. 2022;17(4):e0266934. https://doi.org/10.1371/journal.pone.0266934
Ministry of Health Malaysia. Annual report 2022 [Internet]. Ministry of Health Malaysia; 2022.Available from: https://www.moh.gov.my/moh/resources/Penerbitan/Penerbitan%20Utama/2._MOH_Annual_Report_2022-compressed_.pdf
Logarajan RD, Nor NM, Sirag A, Said R, Ibrahim S. The Impact of Public, Private, and Out-of-Pocket Health Expenditures on Under-Five Mortality in Malaysia. Healthcare. 2022;10(3):589.
Chua H, Cheah J. Financing Universal Coverage in Malaysia: a case study. BMC public health. 2012;12 Suppl 1:S7. https://doi.org/10.1186/1471-2458-12-S1-S7
Atun R, Berman P, Hsiao W, Myers E, Wei A. Malaysia Health Systems Research Volume 1: Contextual Analysis of the Malaysian Health System. Putrajaya: Government of Malaysia, Ministry of Health Malaysia, Harvard TH Chan, School of Public Health [Internet]. 2016:[114-48 pp.]. Available from: https://www.moh.gov.my/moh/resources/Vol_1_MHSR_Contextual_Analysis_2016.pdf.
Yu CP, Whynes DK, Sach TH. Equity in health care financing: The case of Malaysia. International Journal for Equity in Health. 2008;7(1):15. 10.1186/1475-9276-7-15
Jaafar S, Mohamad Noh K, Abd Muttalib K, Othman N, Healy M. Health Systems in Transition: Malaysia Health System Review, Health Systems in Transition: Asia Pacific Observatory on Health Systems and Policies; 2013.
Lam J. 1 Care Plan for 1 Malaysia [Internet]. Scribd; 2024 [cited 2024 Nov 18]. Available from: https://www.scribd.com/document/148980713/1-Care-Plan-for-1-Malaysia.
Noh KM. Primary health care reform in 1CARE for 1 Malaysia. International Journal of Public Health Research Special. 2011(2011):50-6.
Ministry of Health, Malaysia. Country Health Plan. 10th Malaysia Plan 2011-2015. In: Ministry of Health M, editor.: Ministry of Health, Malaysia; 2010.
World Health Organization. Health systems financing: the path to universal coverage. 2010.
Guan YS. Post ‘Political Tsunami’. Taylor & Francis; 2010.
Ministry of Finance Malaysia. Strengthening economic resilience, accelerating transformation and fulfilling promises. In: Speech TPMMoFsB, editor. 2013.
Aw M. 1 Care for 1 Malaysia?: Indicators and Rationales for Health Care Reform in Malaysia - REFSA [Internet]. REFSA. 2015. Available from: https://refsa.org/institutional-reform-1-care-for-1-malaysia/
The 2014 Budget Ministry of Finance Malaysia :https://www.mof.gov.my/portal/arkib/budget/2014/bs14.pdf
Parti Sosialis Malaysia. Counter Proposal to 1Care [press release]. 2019.
Pan American Health O. Road Map for the Plan of Action on Health in All Policies. 2016.
Bayat M, Kashkalani T, Khodadost M, Shokri A, Fattahi H, Ghasemi Seproo F, et al. Factors Associated With Failure of Health System Reform: A Systematic Review and Meta-synthesis. J Prev Med Public Health. 2023;56(2):128-44. https://doi.org/10.3961/jpmph.22.394
Ssengooba F, Rahman SA, Hongoro C, Rutebemberwa E, Mustafa A, Kielmann T, et al. Health sector reforms and human resources for health in Uganda and Bangladesh: mechanisms of effect. Human resources for health. 2007;5:1-13. https://doi.org/10.1186/1478-4491-5-3
Wong J. Healthy Democracies: Welfare Politics in Taiwan and South Korea: Cornell University Press; 2004.
Homedes N, Ugalde A. Why neoliberal health reforms have failed in Latin America. Health policy. 2005;71(1):83-96. https://doi.org/10.1016/j.healthpol.2004.01.011
Aviram U, Guy D, Sykes I. Risk avoidance and missed opportunities in mental health reform: The case of Israel. International Journal of Law and Psychiatry. 2007;30(3):163-81. https://doi.org/10.1016/j.ijlp.2007.03.001
Hacker JS. Learning from defeat? Political analysis and the failure of health care reform in the United States: Cambridge University Press; 2001. 61-94 p.
Ritchie BK. Politics and economic reform in Malaysia. Available at SSRN 509682. 2004 Feb.
Kevin Croke, Mariana Binti Mohd Yusoff, Zalilah Abdullah, Ainul Nadziha Mohd Hanafiah, Khairiah Mokhtaruddin, Emira Soleha Ramli, Nor Filzatun Borhan, Yadira Almodovar-Diaz, Rifat Atun, Amrit Kaur Virk, The political economy of health financing reform in Malaysia, Health Policy and Planning, Volume 34, Issue 10, December 2019, Pages 732–739, https://doi.org/10.1093/heapol/czz089
World Health Organization. The Abuja declaration: ten years on. 2010. 1.
Mcintyre D, Meheus F, Røttingen J-A. What level of domestic government health expenditure should we aspire to for universal health coverage? Health Economics, Policy and Law. 2017;12(2):125-37. https://doi.org/10.1017/S1744133116000414
Ministry of Health Malaysia. Malaysia National Health Accounts: Health Expenditure Report 1997-2019. Putrajaya: MOH; 2021.
Whibley A. Finland's failure to deliver key healthcare reforms provides valuable lessons for other countries. Acta Paediatrica. 2019;108(7):1187-9. https://doi.org/10.1111/apa.14817
Wendt C. Social health Insurance in Europe: basic concepts and new principles. Journal of Health Politics, Policy and Law. 2019;44(4):665-77. https://doi.org/10.1215/03616878-7530837
Weiss ML. What a Little Democracy Can Do: Comparing Trajectories of Reform in Malaysia and Indonesia. Democratisation. 2007;14(1):26-43. https://doi.org/10.1080/13510340601024280
Adinolfi P. Barriers to reforming healthcare: The Italian case. Health Care Analysis. 2014;22:36-58. https://doi.org/10.1007/s10728-012-0209-0
Hurley C, Baum F, Van Eyk H. ‘Designing Better Health Care in the South’: A Case Study of Unsuccessful Transformational Change in Public Sector Health Service Reform. Australian Journal of Public Administration. 2004;63(2):31-41. https://doi.org/10.1111/j.1467-8500.2004.00376.x
Kay A, Boxall AM. Success and failure in public policy: Twin imposters or avenues for reform? Selected evidence from 40 years of health-care reform in Australia. Australian Journal of Public Administration. 2015;74(1):33-41. https://doi.org/10.1111/1467-8500.12135
Ashton T. The rocky road to health reform: some lessons from New Zealand. Australian Health Review. 2001;24(1):151-6. https://doi.org/10.1071/ah010151
Vittal Katikireddi S, McKee M, Craig P, Stuckler D. The NHS reforms in England: four challenges to evaluating success and failure. J R Soc Med. 2014;107(10):387-92. https://doi.org/10.1177/0141076814550358 4.