Mohd-Tahir Nurul-Ain, Paraidathathu Thomas, Li Shu-Chuen
Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences and Pharmacy, The University of Newcastle, Callaghan, NSW, Australia; Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
School of Pharmacy, Taylor's University, Subang Jaya, Malaysia.
SAGE Open Med. 2015 Jul 22;3:2050312115596864. doi: 10.1177/2050312115596864. eCollection 2015.
Malaysia inherits a highly subsidized tax-based public healthcare system complemented by a fee-for-service private sector. Population health in Malaysia has considerably improved since independence using a relatively small amount of gross domestic product (~4%). Brain drain of highly specialized personnel, growth in healthcare spending, demographic and disease pattern changes and increase in patients' demands and expectations towards better medical care are exerting pressure on the sustainability of the system to continuously provide efficient and effective services at relatively low cost. Malaysia has adopted and implemented some of the quality use of medicine concepts such as National Essential Medicine List, health technology assessment and promotion of generic medicines in their health policy, but so far the results may not be optimal. Activities to further promote these strategies are needed for successful implementation to achieve more positive and sustained beneficial outcomes. Better strategic planning, management and collaboration between various stakeholders, considering the needs and barriers of the strategies, are important to ensure effective implementation of the strategies. More emphasis should be placed upon more equitable and rational distribution of healthcare resources to cater for rapid urbanization. Additionally, a sustainable health financing structure that is more progressive and does not encourage moral hazard should be established. In conclusion, Malaysia has achieved good outcomes in population health with relatively low financial inputs since independence. However, changes in the overall environment have created issues which would threaten the long-term viability of the healthcare system if not tackled properly. The numbers of internationally trialled strategies could be used to deal with these challenges. In addition, coordinated implementation of these strategies and effective engagement and communication between various stakeholders are necessary to further strengthen the Malaysian healthcare system effectively.
马来西亚继承了一个以税收为基础、高度补贴的公共医疗体系，同时还有一个按服务收费的私营部门作为补充。自独立以来，马来西亚利用相对少量的国内生产总值（约4%），使人口健康状况有了显著改善。高技能专业人员的人才外流、医疗支出的增长、人口结构和疾病模式的变化，以及患者对更好医疗服务的需求和期望的增加，都给该体系的可持续性带来了压力，使其难以继续以相对较低的成本提供高效且有效的服务。马来西亚在其卫生政策中采用并实施了一些合理用药的理念，如国家基本药物清单、卫生技术评估和推广仿制药，但到目前为止，效果可能并不理想。需要开展更多活动来进一步推动这些策略，以实现成功实施并取得更积极和持续的有益成果。考虑到这些策略的需求和障碍，各利益相关方之间进行更好的战略规划、管理和协作，对于确保这些策略的有效实施至关重要。应更加重视更公平、合理地分配医疗资源，以应对快速的城市化进程。此外，应建立一个更具累进性且不鼓励道德风险的可持续卫生筹资结构。总之，自独立以来，马来西亚在相对较低的财政投入下，在人口健康方面取得了良好成果。然而，整体环境的变化带来了一些问题，如果处理不当，将威胁到医疗体系的长期生存能力。可以采用一些经过国际试验的策略来应对这些挑战。此外，协调实施这些策略以及各利益相关方之间进行有效的参与和沟通，对于进一步有效加强马来西亚的医疗体系是必要的。
