Transformation of Malaysian

Healthcare Systems
12
th
October 2011
Dr Hj. Nordin bin Saleh
Health Planning & Policy Unit
Planning and Development Division
Ministry of Health, Malaysia
1
Outline
1. The rationale
2. The proposed 1Care concept
2
The rationale
National agenda
Population health agenda
Health systems agenda
governance
delivery
healthcare financing
3
Economic
Transformation
Program
(ETP)
New Economic Model
a high income,
inclusive and
sustainable nation
March 2010
Government
Transformation
Programme
(GTP)
effective delivery of
government services
January 2010
Transforming the Nation towards
Developed Nation Status by 2020
1MALAYSIA
People First, Performance Now
10
th
MP + 11
th
MP
1Care for
1Malaysia
Transforming The Nation
6
Transforming The Nation
Why we need to transform
Population health agenda
Changing in disease & socio-
demography pattern
Discrepancy of health outcomes related
to accessibility & affordability
Greater expectation for quality services
7
Why we need to transform
Sustainability of the health system
Leakages of government subsidy
Catastrophic spending
Public concern on the high cost of health care
Private health insurance bubble
Mal-distribution of resources and lack of public-private
integration
Limited appraisal & reward systems for performance
Conflicts of interest (MOH as both provider, purchaser &
regulator)
8
9
.........1Care for 1Malaysia, a restructured health system that is
responsive in meeting the health care needs of the population,
provide choices of quality health care & ensuring universal
coverage based on solidarity & equity.
YAB Datuk Seri Najib Tun Razak at the 61
st
Session of the World
Health Organization Regional Committee for the Western Pacific,
October 11th, 2010
Building blocks of a health system
The proposed 1Care
Governance reform
Delivery systems reform
Healthcare financing reform
12
Conglomeration of many features based on
currently known global best practices, suitable
for the needs of Malaysia now & into the future
13
Governance Reform
Streamlined MOH functions
focused on stewardship and governance
Policy & Strategy formulation
Standards Setting & Regulation
Monitoring & Evaluation
Legislation & Enforcement activities
specific public health services
training and research
14
Governance Reform
Regulator-Purchaser-provider split
Autonomous National Health Financing Authority
Autonomous Public Healthcare Providers
POLICY
MAKING
-Patient Safety
- Services
- Research
- TCM
- Human Resources
Development
- Finance
- Infrastructure &
Equipment
-HTA
- Quality
- ICT
REGULATION &
ENFORCEMENT
Legislation
MOH
MONITORING &
EVALUATION
-HIC
- MNHA
- Surveillance
- H
2
0 Quality
- TCM
PUBLIC
HEALTH
-Disease
Control
TRAINING
Governance of Healthcare sector (current)
Professional
Bodies
-MMC
-MDC
-Pharmacy Board
- Others
Independent bodies
- Patience Safety Council
-- National Health Promotion
Board
-- Malaysian Health Travel
Council
-- Others
Enforcement
RESEARCH
PUBLIC SERVICE
DELIVERY
Primary Care
Hospital Care
Other services
PRIVATE SERVICE
DELIVERY
Primary Care
Hospital Care
Other services
POLICY
MAKING
-Patient Safety
- Services
- Research
- TCM
- Human Resources
Development
- Finance
- Infrastructure &
Equipment
-HTA
- Quality
- ICT
REGULATION &
ENFORCEMENT
Legislation
MOH
MONITORING &
EVALUATION
-HIC
- MNHA
- Surveillance
- H
2
0 Quality
- TCM
PUBLIC
HEALTH
-Disease
Control
TRAINING
Governance Reform
Professional
Bodies
-MMC
-MDC
-Pharmacy Board
- Others
Independent bodies
- Patience Safety Council
- National Health Promotion Board
- Malaysian Health Travel Council
-- Others
Enforcement
RESEARCH
AUTONOMOUS
PUBLIC SERVICE
DELIVERY
Primary Care
Hospital Care
Other services
NHFA
PRIVATE SERVICE
DELIVERY
Primary Care
Hospital Care
Other services
MHDS
Role of NHFA
Not-for-profit, autonomous body under MOH
Manages overall health care financing in close
collaboration with MOH and providers.
Main responsibilities include:
Collection, pooling and payment of the combined
health fund
Design Benefit Package with MOH & Providers
Monitor fiscal performance of the providers
Develop formularies for premiums, PPM, pay-for-
performance and unit costs/fees etc.
17
MOH
STATE HEALTH
DEPT
DISTRICT
HEALTH OFFICE
Autonomous
DISTRICT
HOSPITALS
Autonomous
STATE HOSPITALS
NHFA
G
R
O
U
P
PRIVATE
PHCP (GPs)
PRIVATE
HOSPITALS
Autonomous HKL
& Special
Institutions
Autonomous
PUBLIC CLINIC
Governance
Governance
Organisational reform
Organisational reform
Service delivery reform
Primary Health Care is the thrust of health care services
strong focus on promotive-preventive care & early intervention
Primary Health Care Providers (PHCP):
PHCP are independent contractors
Family doctor & gatekeeper referral system
Register entire population with PHCP
Dispensing of drugs by pharmacies where possible
- using standardised drug list and pricing
21
Service Delivery & Patient Flow
Receive
treatment
Home
Patient
PHCP
Public Private
Admit
Referred
Hospital
Public
Private
MOH
PUBLIC PRIVATE
MHDS
National Health Financing Authority
(NHFA)
Additional services
(Out of pocket or private health insurance)
22
Human Resource
Integration of public and private health care providers
Gaining of numbers, expertise & skills through
integration
Harmonise quality of service and remuneration
Pay for performance
- Incentives are being considered to promote performance
- Incentives for performance over the benchmark, people who
work in remote areas
Development of multidisciplinary team with allied health
personnel carrying out more functions, such as:
Preventive care by nurses
Triaging, basic treatment e.g. ANC, MCH, T&S, STO, etc by
nurses and AMOs.
Financing Reform
Combination of financing mechanisms
Social health insurance (SHI)
General government revenue (GGR)
minimal co-payments for a defined Benefits
Package
Pooled as single fund to promote social
solidarity and unity as per 1Malaysia concept
To be managed by NHFA
24
Financing Reform
Social Health Insurance (SHI) contribution
mandatory
premium community rated & calculated on
sliding scale as percentage of income
from employer, employee & government
Governments contribution covers
SHI premiums for registered poor, disabled,
elderly (60 years & above), governments role as
employer
PHC portion of SHI for whole population
Public health & other MOH activities
25
MOH
STATE HEALTH
DEPT
DISTRICT
HEALTH OFFICE
Autonomous
DISTRICT
HOSPITALS
Autonomous
STATE HOSPITALS
NHFA
G
R
O
U
P
PRIVATE
PHCP (GPs)
PRIVATE
HOSPITALS
Autonomous HKL
& Special
Institutions
Autonomous
PUBLIC CLINIC
Financial flow
Funding flow for personal care
(case-based and inventives)
Funding flow for personal care
(capitation and incentives
Targets of 1Care for 1Malaysia
Universal coverage
Integrated health care delivery system with the
thrust on PHC
Affordable & sustainable health care
Equitable (access & financing), efficient, higher
quality care & better health outcomes
Effective safety net
Streamlined MOH focused on governance,
stewardship & specific public health services,
training & research
28
Source : Health System Financing, WHO Report, 2010
Three Dimensions to Consider When Moving Forward
to Improve Universal Coverage & Financing of HC
29
Total Health Expenditures with &
without 1Care restructuring
30,000
40,000
50,000
60,000
70,000
80,000
90,000
2009 2010 2011 2012
2013
2014 2015 2016 2017 2018
C
o
n
s
t
a
n
t

2
0
0
9

p
r
i
c
e
s

(
m
i
l
l
i
o
n
s
)
No major changes 1Care
30
Health Expenditure
Projections
Current system
(2009)
No Change
(2018)
1Care
(2018)
PHI
7%
Steady State 1Care for 1Malaysia
1Care: Full reform funded through GGR & SHI
1Care: PHC reform funded through GGR
1Care: Public Facility autonomy funded through GGR
Phases of Health Sector Transformation
1Care: Strengthening of the current health system
Phase 1
Phase 2
Phase 3
Phase 4
31
32 32
1Care for 1Malaysia
Building a Stronger Health System & Drives Social
Justice in Health
Putting People First & Personalised Care
Benefits of Integration & Competition
Purchaser-Provider Split
Strengths of Primary Health Care & Gate-keeping
Provider payment mechanisms
Pay For Performance
Higher Health Expenditure for Better Health Outcomes
Public Financing, Social Health Insurance &
Government Stewardship
Stimulating the Health Sector in Malaysia
Status
Quo
Health System
Strengthening
Public
Sector
Autonomy
PHC
Reform
A journey of a
thousand miles begins
with a single step. Lao-tzu
Chinese Philosopher
(604 BC - 531 BC)
Full
1Care
33
Send your feedback to:
nordin.s@moh.gov.my