P1 maimunah a.hamid_1care1aim

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A MOH presentation that shows the policy for 1Care has already been decided and accepted. The Technical Working Groups are not "consultations" on what new system to implement.

This is clear from slide 19, which states that the role of the TWGs are there to provide:

"Evidence to support the 1Care blueprint development."

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P1 maimunah a.hamid_1care1aim

  1. 1. Presentation Outline1CARE 1AIM: Evidence to Policy • Translating policy directions into value- added research Dato’ Dr. Maimunah Abdul Hamid • Evidence-based policy-making for 1Care Deputy Director-General of Health (Research & Technical Support) • 1Care Concept Ministry of Health, Malaysia • Evidence to support the 1Care blueprint 5th National Conference for Clinical Research development (NCCR 2011) • Evidence needs to ensure evidence-based policies & tracking 1Care targets 23 June 2011 The Sunway Convention Centre, Selangor • Institutional strengthening for research 1 2 “AMANAT” YAB PM in 2005 Malaysians must be prepared to………. pay more …. health and education…… a scheme ….. quality service. On a review of the health Translating Government care system, Najib and the Government was considering on a Policy Directions into Value- sustainable basis, amid increasing costs and demands. added Research for 1Care “The question now is whether we can continue with the present situation or have some sort of scheme.” Najib said “Gear up for less subsidy”, says adding that he would explain more Najib. (Sunday Star, 6 March ‘05) about the health care system review soon. 3 4 Discrepancy in Health Outcomes by Geographical Location % Health Indicators : Prevalence by geographical location Evidence-based Policy- Urban Rural making for transformation History of recent illness 22.4 25.5 Incidence of acute diarrhoea 4.7 5.5 Diabetes Mellitus 12.2 10.6 Hypertension 29.3 36.9 Smoking among adolescence 2.3 4.9 Source: National Health and Morbidity Survey (NHMS) III, 2006 5 6
  2. 2. Public & Private Sector Resources and Health expenditures per capita, 2009 prices Workload (2008) 2000 1800 In the future with no 1600 restructuring of the 11% 1400 Health clinics (with doctors) 802 6371 1200 health system….. 38% 1000 Outpatient visits (m) 38.4 62.65 800 41% In absence of health 600 No. of Hospitals 143 209 400 financing reform, health 78% Hospital Beds 11689 200 system likely to become 41249 74% 0 increasingly privatized… 09 10 11 12 13 14 15 16 17 18 19 Admissions 2199310 754378 both in funding and 20 20 20 20 20 20 20 20 20 20 20 55% Doctors (excl. Houseman) 12081 10006 GGHE pc PvtHE pc service delivery…… 45%Health Expenditure (RM billion) (2007) 13.54 16.68 2004 2009 2018 Public Private GGHE 50% 45% 35% 0% 20% 40% 60% 80% 100% 10 PvtHE 50% 55% 65% Source: Health Informatics Center (HIC),MOH -PvtOOP 40% 47% Source: Dr Christopher James, WHO 7 7 -PvtOther 15% 17% WPRO – Projections from MNHA data8 1Care Concept 1Care is the restructured integrated 1Care Concept health system that is responsive and provides choice of quality health care, ensuring universal coverage for the health care needs of the population based on solidarity and equity 9 1Care Concept Features of 1Care Streamlined MOH → focused on governance, stewardship & specific public health services, training & research MOH Additional services Patient (Out of pocket or private health insurance) Autonomous Malaysian Healthcare Delivery System MHDS (MHDS)- integrated public & private sector providers. Emphasis on primary health care. Gatekeeper to higher levels Hospital of care Regional Health PHCP Referred (Public or Authority Public Private Private) Publicly managed health fund - combination of general Receive Admit government revenue & social health insurance (SHI), & may treatment be tempered by minimal co-payments at point of seeking care PHCE PHCE Single payer system, the National Health Financing Authority PHCE Home (NHFA) – set-up on a not-for-profit basis under the MOH Government commits to higher levels of spending for healthcare 11 People commit to increased cost sharing through pooling of funds and cross-subsidy 12
  3. 3. Presentations to YAB PM & No Change and 1Care Reform: Total Expenditure on Health (TEH) Economic Council• 11 August 2009 - 1Care for 1Malaysia concept• Follow-up - 22 March 2010, MOH presented research information requested by the Prime Minister and EC: i. Financial projection of health spending - in collaboration with Dr Christopher James, Health Economist, WHO - projections by Bank Negara Malaysia for comparison ii. Focus Group Discussion with various stakeholders iii. Impact Assessment - in collaboration with Prof Soonman Kwon, Seoul National University - local consultant - Chang Yii Tan, PE research 13 2009 base year 14 Summary of Financial Projections Financial Reforms PHI, 9% Pvt Corp & Others Gen 8% Tax 1. No Change No Change 35% – Health system likely to be increasingly dichotomous Current system (2018) (2009) – Private health expenditure will rise faster than public expenditure PHI OOP 7% 48% – Private spending is mainly from out-of-pocket payment → Pvt Corp & greater inequity & financial risk to the people and further Others Socso & erosion of the public health system 7% EPF, 0.0 0% Gen Tax 2. 1Care Reform 44% Pvt. Spending Gen Tax Public – Can contain growth of total health expenditure based on public 11% Health & sector management and prudency OOP40 % others 17% – Savings are more in private spending Socso & – Shortfall in SHI contribution due to health expenditure growing EPF, faster than wages – Government portion of health expenditure will be higher 0.4% 1Care (2018) SHI SHI - Pvt Gen Tax contribution 37% 15 34% 16 Focus Group Discussions with Impact Analysis Stakeholders - FINDINGS A) Assessing impact on the Population • Overall ability to pay • General consensus among funders, • Willingness to pay C) Assessing impact on users & providers - concept and proposal • Un-insured population the Health System was favorable • • Informal sector Immigrant population • Health Care Utilisation • Quality of Care and Health Outcomes • Most stakeholders were in favour of the B) Assessing impact on the • Health Care Cost • Equity in Access to Health delivery concept Economy Services • Workforce mobility • Impact on Providers • Labour market • Consumption • Impact on Medical Tourism • Funders & users were concerned about • Government Finance • Cost of Institutional Change having to pay • Private Health Insurance 17 18
  4. 4. Blueprint Development : Technical Working Groups (TWGs) 1. Primary Health Care Secondary & Tertiary Care Evidence to support the 2. 3. Health Financing 1Care blueprint development 4. Governance & Stewardship 5. Legislation, Regulation & Enforcement 6. Human Resource •Technical Working Groups (TWGs) 7. ICT • Evidence & data 8. Public Health 9. Oral Health 10. Pharmaceutical Services 19 Additional group – Strategic Communication 20 On-going research to support blueprint development7 research areas identified since 2008 – only 1 pending, 1 done Evidence needs to ensure evidence- based policies1. Health Facility & Services Survey & Population profiling: Mapping health facilities & services against health care needs for strategic policy development & tracking 1Care targets:2. Health Care Demand Analysis: Utilisation & equity analysis, models & policy monitoring & evaluation simulation for 1Care3. Cost Analysis: unit costing for out-patient & ambulatory services in public hospitals4. Analysis of Financial Arrangements & Expenditures: in public & private sectors5. Community Perception: on health care delivery systems 21 22 Targets of 1Care for 1Malaysia Sources of data • Universal coverage Healthcare System level Patient or Population level (public and private) organisation • Integrated health care delivery system research Including M&E level research • Affordable & sustainable health care • Disease burden Resource Care Service • Individual : clinical outcome incidence & Inputs Processes Outputs 1. Intermediate (eg. BP prevalence • Equitable (access & financing), efficient, higher • Perception on • Financing • Diagnosis • Out-patients control) quality care & better health outcomes healthcare system • Manpower • Therapy • In-patients 2. Ultimate (eg Mortality, QOL, Rehabilitation) • Utilisation on • Effective safety net healthcare system (incl financial • Facilities • Clinical • Centre level arrangement) services performance • Drugs • Responsive health care system • Devices • Procedures 1. Effectiveness 2. Equity • Client satisfaction 3. Efficiency 4. Responsiveness • Personalised care Where are the data? NHMS= National Health Morbidity Surveys; BOD = burden of disease report; MNHA=Malaysian National Health Account; • Reduce brain-drain PR =Patient registries; HSI =Healthcare statistics initiatives (Drugs, Device/Med. Technology, Healthcare Workforce & Facilities surveys); HRMIS= Human Resource Management Information System, HIC =Health Informatics Center , CD 23 =Communicable disease, NCD =Non communicable diseases Modified from Lim TO, 2007
  5. 5. DR FOSTER INTELLIGENCE, Imperial CollegeUsing Research Evidence to Improve Health System Performance – E.g. from NHS, UK 25 Dr Foster Report Card Dr Foster Report Card 30Developing Evidence-based Clinical Regional Comparative Analysis : Access to Doctor or Nurse When Sick or Needed Care Practice Guideline Same- or next-day Waited six days Percent* appointment or more 100 93 78 72 70 75 65 66 62 57 57 50 45 45 33 28 25 25 17 16 19 14 5 5 8 2 0 NZ N R TH R NZ FR UK N R TH R S IZ FR UK E US S E US IZ SW SW GE AU CA GE NO AU CA NO SW SW NE NE * Base: Answered question. Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries. 30
  6. 6. Regional Comparative Analysis : Wait Time in Emergency Room Before Being Treated Less than 30 minutes Four hours or morePercent75 52 Institutional strengthening for 4650 44 research 33 34 33 33 34 31 29 2625 20 20 16 17 12 11 13 4 6 4 3 0 Z N R TH R N R TH R NZ FR S S IZ IZ UK FR UK E E US US N E E W W AU CA AU A O O SW SW E NE G G C N N S S NBase: Used ER in past two years. 31 32Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries. Why health research system needs to transform? 6 NIH (National Institutes of Health Research) • To contribute towards the achievement for Malaysia to be a high income nation • To better support MOH’s new role in 1Care • Breakdown walls to – enhance function & roles of research institutions – improve efficiency & reducing duplication of research activities 33 34 Research Excellence - the Vision What shall we do? 1. Improving governance • Leaders in niche research areas – Strengthening research governance - Tract record in publications 2. Improving capacity & capability of human resource - Opinion leaders – Leadership - Attract external funding – Attracting & retaining quality researchers - Attract internal collaboration – Defined career structure (entry as trainee, researcher & • Improvements in policy & practice senior researcher) – patients care 3. Realigning & consolidating current roles – patients outcome – More focused • Recognition – Avoid duplication & improve efficiency – Earn major awards – Better synergy – Fellowships of prestigious academies & collages 35 36
  7. 7. What shall we do? our dream: 1NIH MOH Scientific Committee for MOH 4. Optimising the use of scarce research expertise & other Medical Research resources Office of Research Ethics and Policy Office of Program Coordination and Strategic Scientific Advisory Committee – Sharing of physical & human resources Initiatives Office of Research Management, Evaluation & Technology Transfer & commercialization Office of Administrative 5. Improving funding Management: Office of Communications and Public Liaison General Administration Office of the NIH Director Human Resource – Generating funds Finance & Procurement Facility Management Office of International Collaboration Office of Research & Technical Services 6. Adopting newer roles – Broker (searching for external funds & outsourcing of research) IHM CRC IMR IKU IHSR IHBR – Marketing of services & products 7. Application of advance technology Centre for Information Technology Data Warehouse Centre for Biostatistics 37 (incl clinical support system) 38 our dream The Proposed 1NIH must be BETTER than current model our dream: 1NIH Complex Artist’s impression • Strengths of current system will be preserved • Stronger supportive role • Separation of administrative & technical functions • Better integration of research activities • More responsive to MOH needs & expectations through increased autonomy 39 40 our AIM: Evidence to Policy & Practice WE CAN make better contribution to health • Better interventions • Informing decision & policy makingJulio Frenk • Internalisation by individuals -Former Mexican Minister of Health changing behaviours & empowering people THANK YOU 41

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