Your SlideShare is downloading. ×
0
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Dr Abdul Rahim
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Dr Abdul Rahim

961

Published on

This MOH presentation proposes the wholesale reform and privatisation of the Malaysian healthcare system, instead of reforming and strengthening the present system.

This MOH presentation proposes the wholesale reform and privatisation of the Malaysian healthcare system, instead of reforming and strengthening the present system.

Published in: Health & Medicine, Business
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
961
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
25
Comments
0
Likes
1
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  1. FUTURE OF HEALTH CAREFINANCING IN MALAYSIA DR ABD RAHIM MOHAMAD PLANNING & DEVELOPMENT DIVISION MINISTRY OF HEALTH 18TH JANUARY 2009
  2. PRESENTATION OUTLINE Scope of Healthcare Financing Aim Objectives Problem Statements Current Issues Options Principles NHFA Benefit Packages Conclusion
  3. SCOPE OF HEALTHCAREFINANCING 1. Revenue Collection  Source of Financing  Structure  Collection mechanism 2. Pooling of Funds  Managed by an intermediary body 3. Purchasing – from health providers
  4. NATIONAL HEALTHCARE FINANCING MECHANISM THE SCOPE / SPECTRUM INTERMEDIARY PROVIDER HEALTHSOURCES CONTRIBUTION BODY PAYMENT CARE OF NHFA MECHANISM DELIVERYFINANCING SYSTEM GOVERNMENT BUDGET casemixe.g. NHI, Govt. GOVERNANCE global budget •CORPORATE ESSENTIALbudget, etc capitation •CLINICAL HEALTH fee-for- CARE BENEFITS services PACKAGES PATIENTS / CONSUMERS
  5. Aim of Healthcare Financing Provision of accessible healthcare and peace of mind Comprehensive healthcare protection Improve health through prevention More choice of service Right mix of financing option to deliver health care  Government will still be main player  Complemented by NHI
  6. NATIONAL HEALTHCARE FINANCING: OBJECTIVES NHFMMobilize Greater BetterResources Enhance integration in regulation“Risk efficiency Health: of healthsharing” & & quality 1 0 , 20 , 3 0 carepooling of Public / private providers Primary care as gatekeeperresources(Communityrated NHI Achieve greaterSystem) & equity & accessibilitymanage rateof healthspending Enhance national integration, social solidarity and caring society 6 NOT to change the present system if these goals are not met
  7. WHY DO WE NEED CHANGE
  8. PROBLEM STATEMENTS Issues raised concerning public medical services  Long waiting time  Postponed cases  Overworked staff in 3rd class wards – impersonal…..  Lack of choice  Inadequate amenities Issues raised concerning private sector  Exorbitant charges  Increasing private insurance premium  adverse selection vs cherry picking  Appropriateness of care vs. overservicing
  9. PROBLEM STATEMENTS 2 National Health Account Study 2006  Out-of-pocket (OOP) spending in Malaysia is high (40% of THE)  RM 9805 million  OOP spending in developed countries is low <20%  Health Expenditure trend in Malaysia Equity  High cost private healthcare– available only to those who can afford, insured or covered by employer  Fairness in financing – high OOP payment (inequitable financing and can lead to impoverishment due to catastrophic health expenditure) Economics  More efficient use of resources (especially HR)
  10. CURRENT ISSUES-11. Highly subsidised services & overdependence on government health facilities (also patronised by those who can afford)  Heavy workload  Long waiting time2. Inadequate integration in health, especially between public & private sectors  “Brain drain” to private sector – non-optimal resource use  Need for better regulation of private healthcare providers  Fragmented care and clinical record 10
  11. CURRENT ISSUES-2 3. Rising healthcare expenditure • rising demand and expectations • expensive high tech medicine 4. “Gaps” in present healthcare delivery system eg. Equity, efficiency, accessibility, quality of service. 5. Changing demographic & epidemiological patterns  Increase in the ageing population  Increase in chronic diseases11
  12. Trend of Total Expenditure on Health (TEH), 1997-2006 (RM, Nominal Value) 30 5.0 4.5 4.5 4.3 4.5 4.2 25 3.8 4.0 3.7 24 21 22 3.4 3.5 3.2 3.2 20 19 2.9 3.0 15 14 2.5 13 12 % G D P Y 2 2.0 ) (MBRYno1)(li 10 10 9 8 1.5 1.0 5 0.5 - - 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year TEH TEH as percentage of GDP Source : MNHA 12
  13. Proportion of Public vs Private SectorsExpenditures PUBLIC VS PRIVATE NHFS MNHA MNHA HEALTH (1984/85) (2002) (2006) EXPENDITURES PUBLIC 76 % 56% 45.2% PRIVATE 24% 44% 54.8%NHFS: National Health Financing StudyMNHA: Malaysian National Health Account
  14. Per Capita Spending on Health, 1997-2006 (RM, Nominal Value)1000 917 900 829 826 800 756 700 560 600 501 529 500 406 432MR 381 400 300 200 100 0 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Year Per Capita Spending on Health 14
  15. Operating and Development Expenditure, MOH 1990-2004 10,000.0 9,000.0 8,000.0 7,000.0 6,000.0 RM Million 5,000.0 Operating Development 4,000.0 Total 3,000.0 2,000.0 1,000.0 - 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 YearNote: Using Current PricesSource: Finance Division, MOH
  16. TOTAL HEALTH EXPENDITURE AS PERCENTAGE OF GDP IN SELECTED OECD COUNTIRES AND MALAYSIA, 2005Source: MNHA Study 2003-2006, Health At A Glance 2007- OECD Indicators 16
  17. CURRENT ISSUES-36. Increasing healthcare charges in private sector  Greater inequity & public outcry if not controlled  Increasing trend of private health expenditure (esp. Out-of-pocket expenditure – financial risk upon unexpected health events)  ‘Supplier-induced demand’  Equity in access to private sector Physical : Concentrated in urban areas Financial : Access to private services is mainly for those who can afford esp. inpatient care 17
  18. Private Health Expenditure (PHE) (MNHA 2006) Total PHE: RM 13,393 million OOP: RM 9,804 million (73%)OOP from 2003 to 2006: rising trend (quantum)
  19. CURRENT ISSUES-47. Challenges of globalization & liberalization:  Cross border flow (human, life-stock, etc)  Transmission of diseases  Cross border transactions and practice – ethics, credentials and quality  Foreign workers  Utilizing subsidised services  Health insurance coverage not mandated currently  Outsourcing / offshore activities  Health tourism – competing with local consumers for resources 19
  20. Health Expenditure Trends in Malaysia (MNHA 2006) Increasing Total Expenditure of Health (TEH) Plateauing TEH as % of GDP OOP rising Private Expenditure exceeded public expenditure since 2004
  21. WHERE DO WE GO FROMHERE?
  22. OPTIONS1. Change present system  Introduce NHI through community rating  Further integrate public-private health sectors AND / OR2. Strengthen present system  Improve efficiency and quality of public and private sectors  Further regulate private sector to improve quality and contain cost
  23. Financing Strategy Introduce a National Health Financing Mechanism & restructuring of MOH hospitals and clinics. Develop National Health Insurance with government intermediary body (National Health Financing Authority) as a single fund manager.
  24. PROPOSED PRINCIPLES OF HEALTH CARE FINANCING MECHANISMSuperior to existing systemSingle healthcare financing system / single fund manager (National Health Insurance fund/ Government Revenue)If contribution based (NHI)  Mandatory- those who can afford to pay must pay  Government assistance for disadvantaged group. NHFA Not-for-profit Government owned accountable to MOH & should not be privatised Greater equity, access, quality, efficiency & choice Greater integration in healthcare (public-private, primary-secondary) Viable & sustainable Improvement of health status of population In line with:  National solidarity & a caring society  Vision for Health & Vision 2020, etc.
  25. PROPOSAL:NATIONAL HEALTH FINANCING AUTHORITY (NHFA) THE GOVERNANCE OF THE NATIONAL HEALTH FUND Government owned Proposed Functions: Accountable to MOH 2. Policy, research & corporate health planning Statutory Body 4. Health benefit packages 5. Assessment of healthcareNHFA Not-for-profit 6. ICT planning & applications 7. Utilisation data 8. Health financing data Not to be privatised 9. Fund collection/disbursement 8. Strategic human resource planning & training Single fund manager 9. Provider payment/negotiation
  26. PROPOSAL:ESSENTIAL HEALTHCARE PACKAGES (EHP) ESSENTIAL HEALTHCARE PACKAGES (EHP) SOURCE: - In line with wellness paradigm NATIONAL - Covers selected preventive, promotive, HEALTH curative & rehabilitative services INSURANCE - Available from public & private sectors NON-ESSENTIAL/ OTHER OPTIONAL HEALTHCARE PACKAGES SOURCES - Voluntary/ means testede.g. PHI, Employer, - For optional coverage not covered OOP, etc. in the essential health care packages - Available from public & private sectors Taiwan – Wide benefit coverage (includes traditional medicine) Korea – Narrow benefit coverage NOTE: Need to consider affordability and sustainability in developing EHP
  27. PROPOSAL:- PREMIUM LEVEL & INCENTIVES AFFORDABLE & ACCEPTABLE PREMIUM  According to ability to pay (Progressive) GOVERNMENT ASSISTANCE  For the disadvantaged group.
  28. NATIONAL HEALTHCARE FINANCING MECHANISM THE SCOPE / SPECTRUM Ministry of Health F Monitoring, Evaluation, Regulation & Enforcement U T U R E PROVIDERSOURCES MANDATORY HEALTH CONTRIBUTION PAYMENT H OF NATIONAL MECHANISM CARE EFINANCING HEALTH DELIVERY A LEVEL & SYSTEM CEILING OF FUND casemix Le.g. National global budget CONTRIBUTION ESSENTIAL THealth & capitation GOVERNANCE HEALTH HInsurance, CO-PAYMENT, fee-for-services MEANS TEST i.e INTER- CARE BENEFITSgovt.budget PACKAGES MEDIARY S BODY Y (NHFA) PATIENTS / S CONSUMERS T E M
  29. PROPOSED HEALTHCARE SYSTEM Government Consolidated Revenue MOH New role of MOH M R A N E ESSENTIAL RESTRUCTU- D D A Premium National HEALTH RED MOH U Employee T O Health BENEFIT PACKAGES HOSPITALS & CLINICS C Employer, Self-employed, R Y Fund E Foreign- NHFA workers V O(Those who can L Savings, EXTRA PRIVATE G COVERAGE / SECTOR afford) U Out-of-pocket, ADDED A N Private T Insurance VALUE P A R PACKAGES S Y
  30. ROLL-OUT OF NHFMRecommendations of previous consultants  Adopt incremental approach o E.g. Population coverage (formal vs. Informal sector) o Service coverage (outpatient vs. inpatient) o Accessibility (public vs. private)  Path dependent – while adopting good practices of other countries  Implement certain activities during 9MP o Case-mix  Accuracy of Diagnosis o Unit costing o Social Advocacy (meeting with stakeholders)
  31. Assurance Government will still be main source of healthcare fund Government will subsidise the disadvantaged. MOH will monitor the following:  Access  Utilization  Quality and safety
  32. Press comments on ProposedPrivatisation of IJN by IJN staff “Hospital staff deny demand for higher pay linked to proposal. Medical consultants at the National Heart Institute (IJN) have reiterated their commitment to serve IJN in its current form” “However, the perception that the privatisation proposal is in response to demands for higher remunerations by its medical staff is misconceived and must be corrected accordingly to safeguard and preserve the trust placed upon us by our patients” The Star, 20th December 2008
  33. Press comments by IJN pioneersurgeon “It (IJN) was never meant to be commercial institute. It was meant to be a centre of research, a premier academic institute.” “Therefore, I am rather suspicious of the privatisation idea. It is not as if the hospital is not doing well. Ideally, a health institution such as IJN should be physician-led” Tan Sri Dr. Yahya Awang The Star, 21st December 2008
  34. CONCLUSION Implementation of the NHFM should be:  Incremental  Path Dependent  Most appropriate for the country (Creative and Innovative)“Innovative thinking in developing the most appropriate financing mechanism (choice and design) best suited for the country” Diane McIntyre
  35. If you would like to give input and comments, please visit:http://malaysianhealthcaresystem.blogspot.com/

×