title: Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience.
abstract: Malaysia has made substantial progress in providing access to health care for its citizens and has been more successful than many other countries that are better known as models of universal health coverage. Malaysia's health care coverage and outcomes are now approaching levels achieved by member nations of the Organization for Economic Cooperation and Development. Malaysia's results are achieved through a mix of public services (funded by general revenues) and parallel private services (predominantly financed by out-of-pocket spending). We examined the distributional aspects of health financing and delivery and assessed financial protection in Malaysia's hybrid system. We found that this system has been effective for many decades in equalizing health care use and providing protection from financial risk, despite modest government spending. Our results also indicate that a high out-of-pocket share of total financing is not a consistent proxy for financial protection; greater attention is needed to the absolute level of out-of-pocket spending. Malaysia's hybrid health system presents continuing unresolved policy challenges, but the country's experience nonetheless provides lessons for other emerging economies that want to expand access to health care despite limited fiscal resources.
authors.affiliation: Ravindra P. Rannan-Eliya (raviofficelk@gmail.com) is executive director of the Institute for Health Policy, in Colombo, Sri Lanka.
authors.forename: Ravindra P
authors.initials: RP
authors.lastname: Rannan-Eliya
authors.affiliation: Chamara Anuranga is a research associate at the Institute for Health Policy.
authors.forename: Chamara
authors.initials: C
authors.lastname: Anuranga
authors.affiliation: Adilius Manual is a research officer at the Institute for Health Systems Research, National Institutes of Health (NIH), in Selangor, Malaysia.
authors.forename: Adilius
authors.initials: A
authors.lastname: Manual
authors.affiliation: Sondi Sararaks is a senior medical officer at the Institute for Health Systems Research, NIH, Malaysia.
authors.forename: Sondi
authors.initials: S
authors.lastname: Sararaks
authors.affiliation: Anis S. Jailani is a research officer at the Institute for Health Systems Research, NIH, Malaysia.
authors.forename: Anis S
authors.initials: AS
authors.lastname: Jailani
authors.affiliation: Abdul J. Hamid is a research officer at the Institute for Health Systems Research, NIH, Malaysia.
authors.forename: Abdul J
authors.initials: AJ
authors.lastname: Hamid
authors.affiliation: Izzanie M. Razif is a research officer in the National Health Financing Unit of the Ministry of Health, in Putrajaya, Malaysia.
authors.forename: Izzanie M
authors.initials: IM
authors.lastname: Razif
authors.affiliation: Ee H. Tan is senior principal assistant director of the Oral Health Division of the Ministry of Health, in Putrajaya.
authors.forename: Ee H
authors.initials: EH
authors.lastname: Tan
authors.affiliation: Ara Darzi is executive chair of the World Innovation Summit for Health, Qatar Foundation, and director of the Institute of Global Health Innovation, Imperial College London, in the United Kingdom.
authors.forename: Ara
authors.initials: A
authors.lastname: Darzi
mesh_terms: D003695:Delivery of Health Care / Q000458:organization & administration; D003906:Developing Countries; D005102:Health Expenditures / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D061889:Healthcare Financing; D006801:Humans; D007348:Insurance, Health / Q000191:economics*; D008296:Malaysia; D017149:Private Sector / Q000191:economics; D017150:Public Sector / Q000191:economics; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance / Q000191:economics*
keywords: Developing World < International/global health studies; Financing Health Care; Health Reform; Organization and Delivery of Care; UHC