A Political Analysis of Health Care Reform in Malaysia

Abstract

This thesis explores the political economy of health care reform in Malaysia by examining two policies in depth: first, transformation from National Health Service towards social health insurance, known as 1Care; and second, an incremental step in the form of non-profit, socially-oriented voluntary health insurance (VHI). The Analytical Platform proposes the following problem statement: there is an insufficient understanding of the institutional and political barriers to health care reform in Malaysia. The chapter presents a literature review to provide the conceptual and scientific foundation of knowledge for the thesis. Next, the chapter describes Malaysia’s political environment and health system in detail, including previous attempts at reform. Results Statement Part I presents a retrospective political analysis of Malaysia’s 1Care reform, which investigates the fundamental causes of the reform’s failure. This is achieved by conducting a stakeholder analysis using Reich’s PolicyMaker tool and methodology, to elucidate interest groups’ power and position on the reform; then by applying Kingdon’s multiple streams framework to provide context for the reform’s failure within the agenda-setting process. The overarching conclusion of this analysis is that, although opposition groups made considerable efforts to derail 1Care, the underlying cause of the reform’s failure was the lack of continuous and demonstrable political support by the Prime Minister and ruling coalition. Results Statement Part II seeks to provide relevance to the current policy environment by extracting lessons learned from 1Care that can be applied to the ongoing non-profit VHI scheme. Where comprehensive reforms failed, this chapter examines whether a relatively small-scale, incremental step such as VHI can be leveraged towards achieving longer-term goals. The findings from this analysis highlight the inherently political nature of health care reform and reinforce the crucial need to conduct political economy analysis to develop reforms that are both technically optimal and politically feasible.