This report was conducted against a background of a proposed major restructuring of health services under the policy document 1Care for 1Malaysia. The restructure will be implemented in four distinct phases and it is anticipated that public and private health care providers will be integrated within the restructured national health system funded through general taxation and Social Health Insurance (SHI). The key element of the restructure is the proposed contribution by individuals and companies into a SHI fund which will allow an injection of funds into the health system, including oral health. It should be noted at the outset is that the absence of a definitive timeline for each phase of the restructure is restrictive in terms of estimations and projections. The restructure takes place against a backdrop of significant population growth, expected economic growth and increased expectations.
Malaysia has a population of 28.3 million and it is projected to increase to 34.8 million (18.4%) by 2020. During the same period those of retirement age (currently those aged 58 and over), are estimated to increase by 50% from 2.7 million to almost 4.1 million, reflecting an aging of the population in line with international trends. The changing demographics will result in an increasing burden on the financing of pensions and healthcare (Woods et al., 2009). By 2020 11.6% of the Malaysian population will be of pensionable age, increasing from 8.9% in 2010. The economically active population, those aged 18 to 57, will increase by just 16% with its share of the population declining from 53.9% to 52.7%.
In 2009, Malaysia had a dentist to population ratio of 1: 7,850 and a nurse (dental therapist) to population ratio of 1: 11,396. With the population projected to increase to 34.9 million by 2020, between 73 and 81 additional dentists are required each year to just to maintain the current dentist to population ratio of 1:7,850 assuming that treatments needs of the Malaysian population does not increase or decrease. However, Malaysia has a goal of dentist to population ratio of 1:4,000 for 2020. The achievement of this goal will require 5,112 additional dentists (total 8,717) by 2020 (See dental manpower projections in Appendix 3)
This proposal is informed by a systematic review of global dental delivery systems and in recognition of an existing system that has delivered oral health outcomes that are comparable with international best practice. It is anticipated that Benefit Package 2 will integrate public and private oral health care providers within the restructured national health system, 1Care for 1Malaysia, and lead to greater competition between providers, higher quality, and greater efficiency. The proposed system is expected to correct any imbalance between public and private providers in terms of resources and workloads. The key element of Benefit Package 2 is the proposed contribution by individuals and companies into a Social Health Insurance (SHI) fund which will allow an injection of funds into the health system. The availability of public dental insurance, which is a feature of Western Europe, can ensure a more equitable distribution and helps to ensure that children¿s access to dental care is not restricted by their parents¿ financial situation.