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1CARE healthcare transformation

1CARE healthcare transformation

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  • What is Tioman population and hospital facilities ???
  • Derived from O’Donnell, van Doorslaer et al (2007) World Bank Economic Review . With the exception of Hong Kong, Malaysia, Sri Lanka and Thailand, the poor get much less that their population share of the public health subsidy. But in most countries the poor get a greater share of the subsidy than they have of income.
  • 16/05/11 16/05/11
  • The fact is that this proposal brings together many features based on the currently accepted global best practices which are suitable for the needs of Malaysia now and into the future. All these strengths and best practices, the substantiating evidence, are elaborated in the submitted document that is the basis this highly distilled presentation. SULIT SULIT 16/05/11
  • New slide added 16/05/11 16/05/11
  • Every individual is registered with a PHCP. primary health care services will be the foundation of the health services with strong focus on promotive-preventive care and early intervention. Primary health care providers (PHCP) will function as family doctors and dentists and act as gatekeepers to secondary and tertiary care. Public hospitals will be coordinated on regional networks and funded through a global budget based on case adjustments using DRG. Private hospitals services will be paid through case-based payments. Payment for service is by capitation with case-mix adjustments and additional incentives for achieving performance targets and as inducement for working in less desirable areas. The benefit package of services will be developed. Other payment mechanisms apply for dental and pharmaceutical prescriptions where patients will make some co-payments when receiving service. But identified population groups will be exempted from these co-payments. Except for emergencies, PHCPs as gatekeepers will refer patients to higher levels of care when necessary. Public hospitals will be coordinated on regional networks and funded through a global budget based on case adjustments using DRG. Private hospitals services will be paid through case-based payments.
  • 16/05/11 16/05/11

Transcript

  • 1. PHC Financing for 1Care Dr Rozita Halina Tun Hussein Unit for National Health Financing Ministry of Health Malaysia 15 May 2011
  • 2. Source : Health System Financing, WHO Report, 2010 Three Dimensions to Consider When Improving Universal Coverage and Financing HC
  • 3. Providing Universal Coverage Changing ‘Money follows the facility’ to ‘following the patient’ Population: 138,900 MOH Hosp: 1 , Private Hosp: 0 Population: 445,900 MOH Hosp: 1 , Private Hosp: 0 Population: 140,200 MOH Hosp: 1 , Private Hosp: 0 Population: 96,600 MOH Hosp: 1 , Private Hosp: 0 Population: 385,400 MOH Hosp: 1 , Private Hosp: 0 Population: 34,700 MOH Hosp: 1 , Private Hosp: 0 Population: 56,000 MOH Hosp: 1 , Private Hosp: 0 Population: 84,600 MOH Hosp: 1 , Private Hosp: 0 Population: 72,500 MOH Hosp: 1 , Private Hosp: 0 Population: 90,000 MOH Hosp: 1 , Private Hosp: 0 Population: 97,900 MOH Hosp: 1 , Private Hosp: 0 Population: 447,200 MOH Hosp: 3 , Private Hosp: 4 Population: 162,800 MOH Hosp: 0 , Private Hosp: 0 Population: 109,900 MOH Hosp: 1 , Private Hosp: 0 Population: 74,600 MOH Hosp: 1 , Private Hosp: 0 Population: 40,400 MOH Hosp: 1 , Private Hosp: 0 Population: 188,100 MOH Hosp: 1 , Private Hosp: 0 Population: 87,400 MOH Hosp: 1 , Private Hosp: 0 Population: 200,300 MOH Hosp: 1 , Private Hosp: 0 Population: 64,100 MOH Hosp: 1 , Private Hosp: 0 Population: 19,500 MOH Hosp: 1 , Private Hosp: 0 Population: 30,900 MOH Hosp: 0 , Private Hosp: 0 Population: 28,900 MOH Hosp: 1 , Private Hosp: 0 Population: 34,600 MOH Hosp: 1 , Private Hosp: 0
  • 4. Potential Health Care Markets PAHANG PULAU TIOMAN Rompin Pekan Kuantan Jerantut Lipis Temerloh Maran Bera Bentong Raub Population: 96,600 MOH Hosp: 1 , Private Hosp: 0 Population: 90,600 MOH Hosp: 1 , Private Hosp: 0 Population: 429,100 MOH Hosp: 1 , Private Hosp: 3 Population: 127,300 MOH Hosp: 1 , Private Hosp: 0 Population: 137,400 MOH Hosp: 1 , Private Hosp: 0 Population: 116,800 MOH Hosp: 1 , Private Hosp: 0 Population: 135,700 MOH Hosp: 1 , Private Hosp: 0 Population: 36,400 MOH Hosp: 1 , Private Hosp: 0 Cameron Highlands Population: 93,700 MOH Hosp: 1 , Private Hosp: 0 Population: 153,900 MOH Hosp: 1 , Private Hosp: 0 Population: 95,700 MOH Hosp: 0 , Private Hosp: 0
  • 5.
    • “ We cannot allow it to be said by history that the difference between those who lived and died… was nothing more than poverty, age or skin colour.”
    • John Lewis, Congressman from Georgia,
    • on the devastation caused by hurricane Katrina
    • Financial Times, 4 th September 2005
    Ensuring Equity Pay according to ability, use according to need.
  • 6. Targeting of Subsidies in Public Facilities Source: Rozita Halina, 2000
  • 7. The Poor’s share of public health subsidy in Asia “ Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity
  • 8. Poverty Impact of Health Expenditures Pen’s Parade in Malaysia
  • 9. In absence of health financing reform, health system likely to become increasingly privatized… both in funding and service delivery…… Source: Dr Christopher James, WHO WPRO – Projections from MNHA data Future Direction of Current Health System In the future with no restructuring of the health system…..
  • 10. 10 Leading Sources of Inefficiency Source: WHO, 2010 SOURCE OF INEFFICIENCY COMMON REASONS FOR INEFFICIENCY WAYS TO ADDRESS INEFFICIENCY 1. Underuse of generics medicine Lower perceived efficacy/safety of generic medicines; Develop costs benefits analysis 2. Use of substandard & counterfeit medicines Inadequate regulatory framework; weak procurement systems. Strengthen enforcement of quality standards ; enhance procurement systems 3. Inappropriate & ineffective use of medicines Inappropriate prescriber incentives and unethical promotion practices; inadequate regulatory frameworks. Separate prescribing & dispensing functions; improve prescribing guidance, information, training & practice; 4. Overuse/supply of equipment, procedures, investigations Supplier-induced demand; fee-for-service; defensive medicine Reform incentive & payment structures (e.g. capitation or DRG); develop & implement clinical guidelines. 5. Health workers: inappropriate or costly staff mix, unmotivated workers Conformity with pre-determined human resource policies & procedures; resistance by medical profession; inadequate salaries Undertake needs-based assessment & training; revise remuneration policies introduce performance-related pay
  • 11. 10 Leading Sources of Inefficiency Source: WHO, 2010 SOURCE OF INEFFICIENCY COMMON REASONS FOR INEFFICIENCY WAYS TO ADDRESS INEFFICIENCY 6. Inappropriate admissions & length of stay Lack of alternative care arrangements; insufficient incentives to discharge; Provide alternative care (e.g. day care); alter incentives to hospital providers; 7. Inappropriate hospital size (low use of infrastructure) Inappropriate level of managerial resources, lack of planning for health service infrastructure development. Match managerial capacity to size; reduce excess capacity to raise occupancy rate to 80–90% 8. Medical errors & suboptimal quality of care Lack of guidelines, clinical-care standards and protocols; inadequate supervision. Undertake more clinical audits; monitor hospital performance. 9. Health system leakages: waste, corruption & fraud Poor accountability and governance mechanisms; low salaries. Improve regulation/governance, promote codes of conduct. 10. Inefficient mix/ inappropriate level of strategies for health interventions Inappropriate balance between levels of care, & or between prevention, promotion & treatment. Regular evaluation & incorporation into policy of evidence on the costs & impact of interventions, technologies, medicines, & policy options.
  • 12. 1Care for 1Malaysia Building a Stronger Health System
        • Putting People First & Personalised Care
        • Benefits of Integration and 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
        • Conglomeration of many features based on currently known global best practices, suitable for the needs of Malaysia now & into the future
  • 13.
    • Government commits to higher levels of spending for healthcare
    • People commit to increased cost sharing through pooling of funds and cross-subsidy
    • Universal coverage
    • Public private integration
    • Affordable & sustainable health care
    • Equitable (access & financing), efficient, higher quality care & better health outcomes through Pay for Performance
    • Effective safety net
    • Publicly managed health fund - combination of general revenue & social health insurance (SHI), and tempered by minimal co-payments at point of seeking care
    • Single payer system , the National Health Financing Authority (NHFA) – set-up on a not-for-profit basis under the MOH
    Financial Features of 1Care
  • 14.
    • Not-for-profit, autonomous body under MOH
    • Low administration cost
    • Manages overall health care financing in close collaboration with MOH and MHDS
    • Main responsibilities include:
      • Collection, pooling and payment of the combined health fund
      • Design Benefit Package with MOH & MHDS
      • Monitor fiscal performance of agencies within MHDS
      • Develop formularies for premiums, PPM, pay-for-performance and unit costs/fees etc.
    Role of NHFA
  • 15.
    • Primary Health Care
      • Thrust of health care services - strong focus on promotive-preventive care & early intervention
      • Family doctor & gatekeeper  referral system
      • Payment of provider – capitation
      • Adjusted by case mix
      • Incentives – serving rural population
      • FFS – specific aspects with strong policy implications e.g. disease reporting, needle exchange programmes
    • Secondary and Tertiary Health Services
      • Patients referred by PHCP
      • Financing (Case mix adjusted)
        • Global budget for public hospitals
        • Case-based payment for private hospitals & other institutions – stand alone ambulatory specialist centres
    • Pay for Performance
    Payment Mechanisms in 1Care
  • 16. THANK YOU [email_address] Unit for National Health Financing (NHF) Planning & Development Division, MOH