Journal of Contemporary Asia Volume 39, Issue 1, 2009, Jan 14, 2009
This article examines the hypothesis that interest groups are behind the increasing privatisation... more This article examines the hypothesis that interest groups are behind the increasing privatisation of healthcare services in Malaysia. The evidence supports the instrumentalist argument that powerful interest groups seeking profits, rather than real concerns for allocative efficiency, have been the prime drivers of healthcare privatisation in Malaysia . Not only have private healthcare expenditures risen more swiftly than government healthcare expenditure but, from 1982, public funds have also been used to purchase private services from public hospitals However, unlike simple class analyses, class contention manifesting through alliances between politicians, bureaucrats and capitalists has been a major force behind healthcare privatisation in Malaysia. The source of these developments can be traced to power wielded by the government to quicken the creation of a Bumiputera capitalist class that began to gain momentum from the late 1970s.
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Malaysia. It starts by reviewing the dominant arguments on ownership and
healthcare provision, viz., neoclassical, evolutionary and heterodox and
the politics of interest groups. Given the imperfections and asymmetries
associated with healthcare, as well as its properties as a social good that
should reach everyone, the paper adopts evolutionary and heterodox
arguments, and the views of political scientists on civil society. It then
explores out of pocket payment trends in the world. It is obvious that out
of pocket payments have increased dramatically in the developing countries
when government funding still dominates healthcare financing in most
developed countries. Malaysia has experienced a rapid shift from welfareoriented
healthcare
practices
until
the
1980s
to
privatization
thereafter
so
that
the
private
share
of
healthcare
reached
55.6
per
cent
in
2007.
A
combination
of
falling resources and brain drain confronting public hospitals, with an
expanding supply of private providers explains the increasing shift toward
private healthcare in Malaysia. The paper finishes with calls for increasing
government budget for healthcare, and using merit as the basis for promotion
in public hospitals, and the strengthening and enforcement of healthcare
legislations for all providers.
Cardiovascular disease (CVD) related deaths is not only the prime cause of mortality in the world, it has also continued to increase in the low and middle income countries. Hence, this study examines the relationship between CVD risk factors and socioeconomic variables in Malaysia, which is a rapidly growing middle income nation undergoing epidemiologic transition.
Methods
Using data from 11,959 adults aged 30 years and above, and living in urban and rural areas between 2007 and 2010, this study attempts to examine the prevalence of CVD risk factors, and the association between these factors, and socioeconomic and demographic variables in Malaysia. The socioeconomic and demographic, and anthropometric data was obtained with blood pressure and fasting venous blood for glucose and lipids through a community-based survey.
Results
The association between CVD risk factors, and education and income was mixed. There was a negative association between smoking and hypertension, and education and income. The association between diabetes, hypercholesterolemia and being overweight with education and income was not clear. More men than women smoked in all education and income groups. The remaining consistent results show that the relationship between smoking, and education and income was obvious and inverse among Malays, others, rural women, Western Peninsular Malaysia (WPM) and Eastern Peninsular Malaysia (EPM). Urban men showed higher prevalence of being overweight than rural men in all education and income categories. Except for those with no education more rural men smoked than urban men. Also, Malay men in all education and income categories showed the highest prevalence of smoking among the ethnic groups.
Conclusions
The association between CVD risk factors and socioeconomic variables should be considered when formulating programmes to reduce morbidity and mortality rates in low and middle income countries. While general awareness programmes should be targeted at all, specific ones should be focused on vulnerable groups, such as, men and rural inhabitants for smoking, Malays for hypertension and hypercholesterolemia, and Indians and Malays, and respondents from EPM for diabetes.
Keywords: Cardiovascular disease risk factors; Education; Income; Malaysia
Malaysia. It starts by reviewing the dominant arguments on ownership and
healthcare provision, viz., neoclassical, evolutionary and heterodox and
the politics of interest groups. Given the imperfections and asymmetries
associated with healthcare, as well as its properties as a social good that
should reach everyone, the paper adopts evolutionary and heterodox
arguments, and the views of political scientists on civil society. It then
explores out of pocket payment trends in the world. It is obvious that out
of pocket payments have increased dramatically in the developing countries
when government funding still dominates healthcare financing in most
developed countries. Malaysia has experienced a rapid shift from welfareoriented
healthcare
practices
until
the
1980s
to
privatization
thereafter
so
that
the
private
share
of
healthcare
reached
55.6
per
cent
in
2007.
A
combination
of
falling resources and brain drain confronting public hospitals, with an
expanding supply of private providers explains the increasing shift toward
private healthcare in Malaysia. The paper finishes with calls for increasing
government budget for healthcare, and using merit as the basis for promotion
in public hospitals, and the strengthening and enforcement of healthcare
legislations for all providers.
Cardiovascular disease (CVD) related deaths is not only the prime cause of mortality in the world, it has also continued to increase in the low and middle income countries. Hence, this study examines the relationship between CVD risk factors and socioeconomic variables in Malaysia, which is a rapidly growing middle income nation undergoing epidemiologic transition.
Methods
Using data from 11,959 adults aged 30 years and above, and living in urban and rural areas between 2007 and 2010, this study attempts to examine the prevalence of CVD risk factors, and the association between these factors, and socioeconomic and demographic variables in Malaysia. The socioeconomic and demographic, and anthropometric data was obtained with blood pressure and fasting venous blood for glucose and lipids through a community-based survey.
Results
The association between CVD risk factors, and education and income was mixed. There was a negative association between smoking and hypertension, and education and income. The association between diabetes, hypercholesterolemia and being overweight with education and income was not clear. More men than women smoked in all education and income groups. The remaining consistent results show that the relationship between smoking, and education and income was obvious and inverse among Malays, others, rural women, Western Peninsular Malaysia (WPM) and Eastern Peninsular Malaysia (EPM). Urban men showed higher prevalence of being overweight than rural men in all education and income categories. Except for those with no education more rural men smoked than urban men. Also, Malay men in all education and income categories showed the highest prevalence of smoking among the ethnic groups.
Conclusions
The association between CVD risk factors and socioeconomic variables should be considered when formulating programmes to reduce morbidity and mortality rates in low and middle income countries. While general awareness programmes should be targeted at all, specific ones should be focused on vulnerable groups, such as, men and rural inhabitants for smoking, Malays for hypertension and hypercholesterolemia, and Indians and Malays, and respondents from EPM for diabetes.
Keywords: Cardiovascular disease risk factors; Education; Income; Malaysia