Dr rozita halina tun hussein public private intergration in malaysia past and current


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This MOH presentation shows the extent of privatisation in Malaysian public healthcare. 1Care will completely privatise every other aspect of public healthcare. In effect, Malaysians will be living in a "no money, no health" system like America.

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  • RAHSIA RAHSIA 14/02/12 Semi Confidential Semi Confidential February 14, 2012
  • RAHSIA RAHSIA 14/02/12 Semi Confidential Semi Confidential February 14, 2012
  • Despite the dual health system MOH is still the biggest funder and provider of health care Semi Confidential Semi Confidential February 14, 2012
  • Semi Confidential Semi Confidential February 14, 2012
  • SULIT February 14, 2012 SULIT
  • Dr rozita halina tun hussein public private intergration in malaysia past and current

    1. 1. Public-Private Integration in Health Care Delivery - Past and Present Symposia on Public Private Integration Public Health Conference 12th July 2011 Dr Rozita Halina Tun Hussein Deputy Director Unit for National Health Financing Planning and Development Division Ministry of Health, Malaysia rozitahalina@moh.gov.my
    2. 2. Theoretical Framework
    3. 3. Integrated Health Services• DefinitionThe organisation and management of health services so that ... – people get the care they need, – when they need it, – in ways that are user-friendly, – achieve the desired results and – provide value for money (WHO Tech Brief No.1, May 2008)• Means to an end, not an end in itself
    4. 4. Integrated Health Services• User – health care that is seamless, smooth and easy to navigate continuity of care, health worker aware of patient’s health as a whole, not just 1 aspect• Provider – separate technical services and administrative support systems are provided, managed, financed and evaluated either together- Important with increasing specialization• Senior health managers and policy makers –decisions are not inappropriately compartmentalised,consider different technical programmes,taking into account the network of public, private and voluntary health providers, inter-sectoral opportunities
    5. 5. Role of the Private Sector in Malaysia • Malaysia has always had private health care – During colonial times prior to Independence – During economic boom – Now as engine of growth – Future – greater integration and synergism • Government health care delivery has been stronger than private health care sector, appreciate private sector growth • Idea of public-private integration is not new in Malaysia (Acknowledgment – Relevant MOH colleagues)
    6. 6. Past Efforts in Public- Private Integration
    7. 7. PAST: Reduction of Maternal MortalityWorking with Traditional Birth Attendants (TBA)• 1960s and 70s – strong political commitment to reduce MMR and ensure Maternal and Child safety at delivery– Recognise the time lag for government to train own skilled birth attendants (SBA) such as mid-wives– Recognise public’s preferences at that time• Registration of TBA• Training of TBA (Acknowledgment – Yadav, 1987 & Dato’ Dr Narimah Awin)
    8. 8. PAST: Reduction of Maternal Mortality• Monitoring and supervision of TBA after training – All mothers using TBAs screened at health centres – assessed for risk factors – Public health nurse kept records of all mothers and deliveries managed by TBAs – Sterile midwifery kits and medicines exchanged at the health centres for free – Monthly meetings between TBAs and public health nurses – Dual attendance of deliveries – government midwives cut umbilical cords• Improvement in mortality rates particularly MMR
    9. 9. PAST: Quality Improvement Initiatives • QA/QI – strong focus of MOH • Sensitisation and training of private hospitals • 1996/97 – voluntary national accreditation programme – MSQH – same standards for both public and private hospitals – Pioneered by MOH, Association of Private Hospitals Malaysia (APHM) and Malaysian Medical Association (MMA) – contributed funds to run programme – Good cross-fertilisation and learning – surveyors are from both public and private hospitals • Benchmarking of private hospitals – NPC, MOH • APHM annual conference – participation of government & MOH – QI, clinical governance, corporate governance
    10. 10. Facilitating Environment
    11. 11. Transforming the Nation towards Developed Nation Status by 2020 1MALAYSIA People First, Performance Now April 2009 Government EconomicTransformation Transformation Programme 1Care for Program (GTP) 1Malaysia (ETP)• effective delivery of • New Economic Modelgovernment services – a high income,•January 2010 inclusive and sustainable nation •March 2010 10th MP (June 2010) + 11th MP
    12. 12. Transforming The Nation
    13. 13. Public Sector Transformation1. Create a citizen-centred public service2. Reduce size of government – lean government, reduce overlapping roles and functions3. Improve skills of the workforce4. Focus more on results oriented spending, look into areas of cost-savings and efficiency of resource use5. Strengthen govt’s facilitative role - collaborate with the private sector and support private sector growth6. Expand private delivery of public services – allow competitive access to public funding e.g. in health care, technology support7. Enhance public agencies to drive growth 13
    14. 14. Economic Transformation Programme• Specialising the economy - high value-added, innovation- based, strong growth potential, GTP → enabling environment → internally-competitive, appropriate soft & hard infrastructure knowledge economy• Improving the skills of the workforce – specialised & skilled labour moving up the value-chain, increase productivity, social and private returns to education & skills upgrading• Making growth more inclusive – Strong inclusiveness policies, equity, improved social protection → helping household cope with poverty through health care• Bolstering public finances – broaden thecountry’s narrow revenue base, lessen subsidies,reduce the crowding-out of private initiatives,shift expenditure to areas of specialisation,skills & inclusiveness 14
    15. 15. National Key Economic Areas (NKEAS)NKEAs - drivers of economic activity that has the potential to directly and materially contribute a quantifiable amount of economic growth to the Malaysian economy
    16. 16. Current Efforts in Public- Private Integration
    17. 17. PRESENT – Govt or MOH Investments• Medical tourism - MHTC– 1-stop centre on hc travel – Private hospitals - at least national level accreditation – Government incentives – tax exemptions on private capital investments for medical tourism• Outsourcing with Contractual agreements (SLA) - e.g.- – 5 hospital support services and catering of food – Pharmaceuticals with Hospital Pharmacy Information System (drug inventory programme for MOH hospitals) – Health care services • when machine breakdowns • when services are not available e.g radiotherapy, urology • when public services are inadequate – dialysis – ICT system development and support – HMIS, THIS• Buying available private hospitals – Sabah and Sarawak
    18. 18. PRESENT – Private Sector FundsPrivate Financing Initiatives (PFI)– Research arrangements with industry • Randomised Control Trials (RCTs) - CRC • Transgenic mosquitoes for Dengue control – IMR– Development of new facilities – MOH RFPs • Private sector build & maintain - MOH rent first then transfer ownership to government – Women and Child Hospital • Land swap – old MOH institutions on prized commercial land – private sector build new complexes on private or MOH land – 1NIH research complex, Pharmacy complex– Entry Point Projects (EPP) of NKEA Healthcare and ICT • Hospital Information System, Teleprimary Care and Oral Health Information System for MOH facilities • Private health insurance for foreign workers • Training schools – John Hopkins with Perdana University
    19. 19. PRESENT – Enhancing Service DeliveryTraining of medical students/nurses/allied health• from private colleges in public facilitiesMethadone programme• authorised GPs and later community pharmacists• govt provides methadone FOC• patients pay GPs consultation feesRepeat medicine delivery via courier services• Pos Malaysia Sdn Bhd – RM5• patient’s choice and payment, CSR – 5% profits goes to fund cancer drugs for those in need
    20. 20. PRESENT – Enhancing Service DeliveryPatient’s purchase of implants and prosthesis• Public providers facilitate – introduce patients to sales reps for patient’s ease , having specific shops in hospitals• Extending financial support for eligible low-income households to purchase artificial limbs and prosthetics.• Improve access to prosthetics by setting up at least one prosthetics centre per state.Locum arrangements• public doctors in private facilitiesContracting of private providers in public facilities• in PHC clinics and hospital on sessional basis• traditional and complementary care (TCM)
    21. 21. Current Challenges
    22. 22. Overview of the Malaysian Health System 22
    23. 23. Public & Private Sector Resources and Workload (2008) 11%Health clinics (with doctors) 802 6371 38% Outpatient visits (m) 38.4 62.65 41% No. of Hospitals 143 209 78% Hospital Beds 41249 11689 74% Admissions 2199310 754378 55% Doctors (excl. Houseman) 12081 10006PUBLIC PRIVATESeries1 Series2 0% 20% 40% 60% 80% 100% Source: Health Informatics Center (HIC),MOH 23
    24. 24. Challenges in Quantity and SeverityManpower constraints 2009 doctor: population ratio - 1:1,255 (excluding houseman) (i) Absolute numbers New doctors registered with MMC • - 1,451 • - 2,413 • - 3,172 Target for Malaysia – 1:600 (ii) Mal-distribution - between public-private - within the public sector MOH primary health care providers treated more chronic illnesses compared to private GPs – treat the ‘healthy ill’ (Source: PHC ACG study with Johns Hopkins, 2007) About 70% of patients managed by public sector specialists were complex cases compared with 25% of similar cases by private sector specialists. Recently - backlash of Health 24
    25. 25. THANK YOUDr Rozita Halina Tun Hussein rozitahalina@moh.gov.my