Malaysia Maps a Stakeholder-Driven Path to an Explicit National Health Benefit Package

Malaysia is edging closer to defining, in explicit terms, which health services its citizens are entitled to receive, according to a new participatory study published in BMC Health Services Research. The research, led by Khairil Idham Ismail and colleagues, brought together a wide range of Malaysian healthcare stakeholders to design the architecture, guiding principles and operational modalities of a National Health Benefit Package (NHBP), a central pillar of the country's ongoing health reform agenda. Universal Health Coverage (UHC), the global commitment to equitable access and financial protection, often relies on health benefit packages to spell out entitlements.

Yet moving from implicit prioritization, where decisions are made informally within the system, to an explicit, published package remains a formidable policy challenge, particularly for middle-income countries. The study notes that this transition is frequently hindered by political resistance and by technocratic processes that operate in isolation from the public they serve. Methodologically, the research took a deliberately participatory approach.

The team used a modified Policy Delphi framework inspired by Evidence-Informed Deliberative Processes (EDPs), executed in two phases. First, seven semi-structured key informant interviews were conducted to identify core system bottlenecks. Then a dual-arm Policy Delphi workshop with 84 participants combined baseline evidence briefs with deliberative foresight tools, including Problem Mapping, Futures Wheel exercises and Fishbowl discussions, to test ideas and surface disagreements.

Data were analysed through thematic triangulation to strengthen the inclusivity and robustness of the resulting framework. The triangulation produced a strikingly systemic picture. Rather than treating a benefit package as a simple list of services, stakeholders identified seven interdependent system domains that must be in place for an explicit NHBP to function: a robust governance model, a sustainable financing architecture, a central role for health technology assessment (HTA), a phased implementation pace, an equity-centred approach, a defined system scope, and a transparent framework anchored in law.

Financing emerged as a particularly consequential design element. The study's summary of what the research adds describes a hybrid financing model as part of the stakeholder-driven framework, alongside a phased statutory roadmap considered necessary for sustainable reform. Stakeholders emphasized that an explicit NHBP must transcend technocratic design, requiring both social legitimacy and statutory protection if it is to endure beyond political cycles.

Beyond the system domains, the participants converged on nine priority-setting criteria for deciding which services make it into the package: clinical effectiveness, cost-effectiveness, safety, budget impact, feasibility, strategic alignment, equity, burden of disease, and social acceptability. The authors characterize this as a multidimensional rubric for national resource allocation, one that deliberately balances technical efficiency with social equity and implementation feasibility rather than relying on cost-effectiveness alone. The role of HTA received particular attention in the deliberations.

While Health Technology Assessment supplies the technical evidence for benefit package design, the study's authors note that evidence alone is insufficient without a transparent, deliberative process to secure social and political legitimacy. Methodologically, the authors argue the study offers a replicable template for bridging the research-policy gap in complex health systems. By triangulating strategic foresight techniques such as the Futures Wheel, which maps cascading consequences of decisions, with dynamic deliberation formats like Fishbowl discussions, the team was able to build consensus on contentious design elements, including the authority of HTA bodies and the legal anchoring of the package.

This combination of methods, the researchers suggest, can pre-empt political opposition by making the trade-offs visible and negotiable from the outset. For Malaysian policy-makers, the study presents a concrete, evidence-informed roadmap for moving from fragmented prioritization to a centralized, transparent NHBP framework. The findings are framed as a stakeholder-driven alternative to traditional top-down policy design, aligning the country's UHC journey with its broader systemic reform priorities.

As with any qualitative study, the results reflect the perspectives of the participants involved, and the framework's real test will lie in whether Malaysia's government adopts its recommendations. The article was published open access on 28 August 2026 as a peer-reviewed, accepted version of record.

Subject of Research: Stakeholder perspectives on designing an explicit national health benefit package for Malaysia's universal health coverage reform

Article Title: Towards an explicit national health benefit package for Malaysia: a participatory multi-method study into stakeholder perspectives and evidence-informed policy design

Article References: Ismail, K. I., Romli, E. Z., Kamaruzaman, H. F., Ku Abd Rahim, K. N., Tengku Khalid, T. N. F., Sarimin, R., Kamarudin, S. P., Abdul Fatah, A. F., Mohd Rani, N. D., & Mohamed Ghazali, I. M. (2026). Towards an explicit national health benefit package for Malaysia: a participatory multi-method study into stakeholder perspectives and evidence-informed policy design. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15472-4

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15472-4

Keywords: Malaysia, Universal Health Coverage, health benefit package, health technology assessment, Policy Delphi, priority setting, health financing, health policy, deliberative processes, health system reform, Towards, explicit