Table 4 Key characteristics of the Malaysian health system

The Malaysian health system comprises a mix of public and private funding and provision. The centrally organized public health sector provides 82 % of inpatient care and 35 % of ambulatory care, with the rest provided through the fast-growing private sector [31]. The public sector comprises a large network of primary care clinics, each typically serving a population of 20,000, staffed by a doctor (Medical Officer), pharmacist and nursing staff and overseeing a number of nurse-staffed community clinics providing maternal and child health. Doctors in public clinics are supported by Family Medicine Specialists (FMS), who visit regularly to advise on patients with more complex conditions. Secondary care is provided in five types of hospitals (defined in terms of size, specialization, and whether specialists are resident or visit). There is no gate-keeping system, with Ministry of Health having an “open door policy on outpatient services and hospital admissions” [31], allow patients to choose where they seek care. Public health services are administered centrally by the Ministry of Health (Ministry of Health), although the Ministry of Higher Education also runs university teaching hospitals, the Ministry of Defence has military health services, and, in some remote areas, the Ministry of Aboriginal Affairs provides services for indigenous populations.

As well as the formal medical system, there are also many traditional, complementary and alternative medicine (TCM) practitioners drawing on the beliefs of the three main communities: traditional Malay healers (bomohs), Traditional Chinese Medicine practitioners, and Ayurvedic practitioners serving the Tamil population.

Financing and insurance: Total health expenditure in 2011 was 4.26 % of GDP, equivalent to US$422 per capita [54], which is low compared with neighbouring SE Asian countries [55] and upper-middle income countries overall. In 2011, 45 % of total health expenditure was from Ministry of Health, with 37.7 % coming from out-of-pocket payments (OOP); OOP payments account for 78 % of private sector funding. Private insurance contributed only 7 % of Total Health Expenditure [54]; and Social Security Organisations account for only 0.68 %. Public clinics receive a fixed annual budget, linked to performance indicators and budget lines, with the rationale of providing equitable levels of care across the country [31]. Primary care is largely subsidized by Ministry of Health as part of their efforts towards universal health care coverage, brought in in the 1980s. Attendances at primary care clinics involve a small co-payment of RM1 (€0.25) for registration and regular consultation, and RM5 (€1.25) for specialist consultations. With the large subsidized public sector, there is no government social insurance scheme. The private sector has expanded rapidly in recent years, primarily in urban areas where investment in new public facilities has not kept pace with population growth and where disposable incomes are higher. There is a small private insurance market, primarily for expensive hospital treatment.