11Care for 1MalaysiaPrimary Health Care                      SJ /10Mar 2011
2Benefits 1CARE1.   Achieving enhanced universal coverage2.   Integrating public and private sectors3.   Ensuring an affor...
31.      Achieving enhanced universal coverage• Every member of the population is registered (looked after) by a     Prima...
43.       Ensuring an affordable and sustainable health         care system for Malaysians • No payment at point of care •...
55.    Developing effective safety nets for the risk      protection of vulnerable groups• All members of the population  ...
6                 Core component• Restructured health care   • New financing mechanism  delivery                   • NHFA ...
7                                                               SJ /10Mar 2011         Figure 1: Functions Within the Rest...
8                                                                                    SHI                                  ...
9                                                  SJ /10Mar 2011   Patient                     Additional services       ...
10                                                                                     SJ /10Mar 2011Specialized care     ...
11Primary Health Care Physician PHCP•   Doctors                          • Trained medical doctors from•   Solo or group  ...
12REGISTRATION OF PHCP                                                                                                   P...
13Distribution of primarycare doctors                                       WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRA      ...
14                                                                 KEDAH                                      Bilangan kli...
15                                                                       SARAWAK                                          ...
16Benefit package for PHC• Child health        • Diagnostic Services• Adolescent health • Radiological• Women‟s health • P...
17KKs will become Super PHCP Clinic                                    SJ /10Mar 2011
18Primary Health Care Physician“scope of practice”They are responsible for maintaining optimal health of their„registered ...
19Primary Health Care Physicians“operations”• Registers designated population• Receives reimbursement based on per capita ...
20FUNDING & INCENTIVES•Funding through capitation•Case-mix methodology will be employed• Additional Incentives will be pro...
21CO-PAYMENT ?• Co-payments will be nominal• To address abuse / moral hazard and to promote  responsible use of services• ...
22Benefits to the                 Benefits to the                      Benefits to theNation                          peop...
23Next agenda• Develop full blueprint within 2y  ▫ Building blocks     Mapping of population & providers     Professiona...
24TOR TWG PHC1. Study the existing service provision and   perform mapping of gaps2. Develop draft framework for PHC deliv...
25TOR TWG PHC Develop phases for implementation (cont’d) ▫ Health informatics   Registration of providers and population ...
26TOR TWG PHC4. Perform risk mitigation for each phase  ▫ Identify, characterize, and assess threats (political and resour...
271Care for 1Malaysiamandate:PHC :Equity, Universality, Solidarity                     SJ /10Mar 2011
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This is a March 2011 MOH presentation about the role of Primary Healthcare in the 1Care reforms.

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Dr.+safurah+ +health+sector+reform+of+primary+care+towards+1 care

  1. 1. 11Care for 1MalaysiaPrimary Health Care SJ /10Mar 2011
  2. 2. 2Benefits 1CARE1. Achieving enhanced universal coverage2. Integrating public and private sectors3. Ensuring an affordable and sustainable health care system for Malaysians4. Providing equitable (in terms of access and financing), efficient, and higher quality services; and better health outcomes for the Nation5. Developing effective safety nets for the risk protection of vulnerable groups6. Remodelling the health system to become more responsive to population needs7. Enhancing client satisfaction8. Promoting personalised and better managed care for the individual and family9. Reducing the brain-drain of skilled personnel both internally and internationally SJ /10Mar 2011
  3. 3. 31. Achieving enhanced universal coverage• Every member of the population is registered (looked after) by a Primary Health Care Physician• Urban and Rural• All members of the population2. Integrating public and private sectors • GPs and FMS will be integrated as one Primary Health Care Physician group • In KKs public sector 1000 vs 3000 post • 200 plus 7000 GPs SJ /10Mar 2011
  4. 4. 43. Ensuring an affordable and sustainable health care system for Malaysians • No payment at point of care • Capitation : promotes preventive services and wellness and early case management4. Providing equitable (in terms of access and financing), efficient, and higher quality services; and better health outcomes for the Nation • Capitation • Benefit package from womb to tomb • Pay for performance SJ /10Mar 2011
  5. 5. 55. Developing effective safety nets for the risk protection of vulnerable groups• All members of the population ▫ Rich covers the poor ▫ Healthy covers the sick ▫ Young covers elderly6. Remodelling the health system to become more responsive to population needs• Health Package meeting needs of the population• Covers all member of the population close to their home• Providers of their choice• Autonomous• Risk sharing with providers SJ /10Mar 2011
  6. 6. 6 Core component• Restructured health care • New financing mechanism delivery • NHFA ▫ MHDS ▫ Capitation ▫ Autonomous ▫ SHI SJ /10Mar 2011
  7. 7. 7 SJ /10Mar 2011 Figure 1: Functions Within the Restructured 1Care Health System Independent bodies Professional Bodies-Drug Regulatory Authority (DRA) -MMC -MDC-Health Technology As s es s ment (HTA) -Pharm acy Board-Medical Res earch Council (MRC) - Others-Patience Safety Council-Medical Device Bureau-National Service Fram ework (NSF)(Quality)-National Health Prom otion Board NHFA- Food Safety Authority- Others MOH • GOVERNANCE & STEWARDSHIP • POLICY & STRATEGY FORMULATION • STANDARD SETTING MHDS • REGULATION & ENFORCEMENT SERVICE DELIVERY • MONITORING & EVALUATION •PRIMARY CARE • PUBLIC HEALTH • RESEARCH •HOSPITAL CARE • TRAINING •OTHER SERVICES
  8. 8. 8 SHI MOH NHFA PRIVATE HKL & Special PROVIDERS Institutions PRIVATE STATE STATE HEALTH HOSPITALS HOSPITALS DEPT State NHFA NETWORKPUBLIC PROVIDERS DISTRICT DISTRICT PRIVATE PHCP PHC Board HOSPITALS HEALTH OFFICE (GPs) HEALTH CLINICS Funding flow NHFA – part of MOH Governance
  9. 9. 9 SJ /10Mar 2011 Patient Additional services (Out of pocket or private health insurance) PHCP Refer PrivatePublic Private Hospital Public Admit Receive treatment Return to referring PHCP Home
  10. 10. 10 SJ /10Mar 2011Specialized care Community Emergency Hospital mental department TB health unit Maternity control centre Consultant Traffic support Referral for accident Placenta SurgeryDiabetes clinic multi-drug resistance praevia Referral for Hernia complicationsDiagnostic services Self-help Primary-care team: Diagnostic support group continuous, CT Training Training comprehensive,Scan support centre person-centred care Liaison Social Pap communityCytology smears services lab health worker Other Other Alcoholism Waste disposal Community Alcoholics Gender inspection violence anonymous Mammography Environmental health lab Women’s NGOs Cancer shelter screening Specialized centre prevention services
  11. 11. 11Primary Health Care Physician PHCP• Doctors • Trained medical doctors from• Solo or group accredited institutions• Independent contractors • Registered with the MMC and• Family doctor concept permitted to practice• Gatekeepers • As specialist-National• Every individual is registered Specialist Register to PHCP/ratio/special groups • Over time only Primary Health Care Physicians are allowed to open a PHCP practice. • Secondary care specialist -not be registered as PHCPs SJ /10Mar 2011
  12. 12. 12REGISTRATION OF PHCP Population : 90,600 Private Hosp. : 0, MOH Hosp. : 1• Data base of both PHCP and population : Population : 36,400 Private Hosp. : 0, MOH Hosp. : 1 Population : 96,600 Private Hosp. : 0, MOH Hosp. : 1 matching population density to supply ▫ Gatekeeper ▫ Training and accreditation mechanism ▫ Mechanism for payment, tracking and monitoring ▫ Mechanism for addressing disruption of services Population : 429,100 Population : 93,700  Relocation Private Hosp. : 0, MOH Hosp. : 1 Private Hosp. : 3, MOH Hosp. : 1 Population : 135,700  Vacation Population : 153,900 Private Hosp. : 0, MOH Hosp. : 1 Locum and substitute doctor Private Hosp. : 0, MOH Hosp. : 1  Population : 127,300 Private Hosp. : 0, MOH Hosp. : 1 ▫ Arrangements for with group practices Population : 116,800 Private Hosp. : 0, MOH Hosp. : 1  Features to encourage group practices• Patients Population : 95,700 ▫ reliable mechanism for registering without Population : 137,400 duplications Private Hosp. : 0, MOH Hosp. : 1 ▫ register according to residence, work place / school ▫ changing provider SJ /10Mar 2011
  13. 13. 13Distribution of primarycare doctors WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRA Bilangan klinik Daerah Klinik Kerajaan yang ada Pegawai Klinik Swasta PerubatanWilayah Persekutuan Kuala Lumpur 13 13 943Wilayah Persekutuan Putrajaya 1 1 8JUMLAH 14 14 951 SJ /10Mar 2011
  14. 14. 14 KEDAH Bilangan klinik yang ada Daerah Klinik Kerajaan Klinik Swasta Pegawai PerubatanKota Setar 10 8 80Kulim 9 6 38Baling 5 4 6Pendang 3 2 8Bandar Bahru 3 2 0Sik 2 1 3Padang Terap 3 3 0Yan 2 2 2Kuala Muda 6 4 1Kubang Pasu 8 5 1Langkawi 3 2 11JUMLAH 54 39 150 SJ /10Mar 2011
  15. 15. 15 SARAWAK Bilangan klinik yang ada Daerah Klinik Kerajaan Klinik Swasta Pegawai PerubatanDaerah Betong / Betong 9 0 2Daerah Betong / Saratok 5 0 1Daerah Bintulu / Bintulu 5 0 24Daerah Bintulu / Tatau 4 0 -Daerah Kapit / Kapit 10 1 1Daerah Kapit / Belaga 6 0 -Daerah Kapit / Song 5 1 -Daerah Kuching / Kuching 13 3 136Daerah Kuching / Bau 2 0 2Daerah Kuching / Lundu 4 0 2Daerah Limbang / Limbang 4 0 3Daerah Limbang / Lawas 9 0 3Daerah Miri / Marudi 21 0 1Daerah Miri/Miri 8 3 42Daerah Mukah / Dalat 2 0 -Daerah Mukah/ Daro 8 0 -Daerah Mukah/Matu 6 0 -Daerah Mukah 9 0 3Daerah Samarahan / Samarahan 6 0 6Daerah Samarahan / Serian 8 0 3Daerah Samarahan / Simunjang 6 0 -Daerah Sarikei / Julau 6 1 8Daerah Sarikei / Meradong 6 1 -Daerah Sarikei / Pakan 4 0 -Daerah Sarikei 2 1 -Daerah Sibu / Kanawit 4 0 1Daerah Sibu / Selangau 4 0 -Daerah Sibu / Sibu 4 2 48Daerah Sri Aman / Lubuk Antu 6 2 -Daerah Sri Aman / Sri Aman 7 1 3JUMLAH 193 16 289 SJ /10Mar 2011
  16. 16. 16Benefit package for PHC• Child health • Diagnostic Services• Adolescent health • Radiological• Women‟s health • Pharmacy• Men‟s health • Pathology• Family planning• Antenatal care• Postnatal care• Elderly health• Prevention /promotive• Curative care SJ /10Mar 2011
  17. 17. 17KKs will become Super PHCP Clinic SJ /10Mar 2011
  18. 18. 18Primary Health Care Physician“scope of practice”They are responsible for maintaining optimal health of their„registered population‟ to provide “essential health package”through:• Screening and health assessment from of “womb to tomb”• Health promotion and counseling /patient education• Prevention activities (paps smear, immunization …)• Diagnosis / differential diagnosis• Intervention and treatment of common illness and medical conditions• Careplans , long-term care and follow-up• Referral• Data collection for patient and population analysis• Participate in CPDs / CMEs SJ /10Mar 2011
  19. 19. 19Primary Health Care Physicians“operations”• Registers designated population• Receives reimbursement based on per capita for the provision of essential services• Collects patients data and submit data and information as required• Compliance to all standards and guidelines as well as service targets• Commission secondary care from hospitals for patients where relevant (at what rate?)• Other services may include : ▫ Emergency services and Call Centres ▫ School health Services ▫ Rehab Services ▫ Flying Doctors Services SJ /10Mar 2011
  20. 20. 20FUNDING & INCENTIVES•Funding through capitation•Case-mix methodology will be employed• Additional Incentives will be provided for: • Specialist qualifications • House calls • Additional payments for exceeding stipulated performance of benchmarks • Funding training and topping up courses • Those working in rural or unpopular locations • Those who treat more chronic patients SJ /10Mar 2011
  21. 21. 21CO-PAYMENT ?• Co-payments will be nominal• To address abuse / moral hazard and to promote responsible use of services• Likely services are for medicine and dental services.• Need to identify range and scope of services like duration, type and entitlement• Very sensitive issue and require strong social advocacy• Mechanism for waiver for those who cannot afford and those with entitlement SJ /10Mar 2011
  22. 22. 22Benefits to the Benefits to the Benefits to theNation people Providers• Strengthen national unity • More access to providers • Bridge gaps remuneration and• Stimulate the health care • Care nearer to home workload market • No payment at point of • Optimize HR both sectors• Reduces unnecessary seeking care (during hardship) • Encourage serving in rural dependence on • Vulnerable group better areas protected government fund • Quality care • Appropriate level of• Financial safety nets for • Client satisfaction competency and standard of lower and middle income care groups • Greater health outcomes for community• Contain the rapid growth in health care cost and inflation SJ /10Mar 2011
  23. 23. 23Next agenda• Develop full blueprint within 2y ▫ Building blocks  Mapping of population & providers  Professional & care standards  Benefit packages  Monitoring & Evaluation• Phased implementation, evaluation and monitoring SJ /10Mar 2011
  24. 24. 24TOR TWG PHC1. Study the existing service provision and perform mapping of gaps2. Develop draft framework for PHC delivery3. Develop phases for implementation ▫ awareness and motivation / buy-ins ▫ essential universal package ▫ standards, accreditation, credentialing and privileging SJ /10Mar 2011
  25. 25. 25TOR TWG PHC Develop phases for implementation (cont’d) ▫ Health informatics  Registration of providers and population ▫ Registration list of Primary Care Providers to the Population ▫ Propose Organisational and Management Structure of the various levels ▫ Develop clear roles and relationship of Primary Care related NGOs & other Organizational Support Systems ▫ Develop indicators to monitor risks or impact SJ /10Mar 2011
  26. 26. 26TOR TWG PHC4. Perform risk mitigation for each phase ▫ Identify, characterize, and assess threats (political and resources) ▫ Assess the vulnerability of critical implications to specific threats (scope too big or too small, cost too high etc) ▫ Determine the risk (i.e. The expected consequences of specific types of attacks on specific assets) ▫ Identify ways to reduce those risks ▫ Prioritize risk reduction measures based on a strategy SJ /10Mar 2011
  27. 27. 271Care for 1Malaysiamandate:PHC :Equity, Universality, Solidarity SJ /10Mar 2011

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