“ 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.
Targeting of Subsidies in Public Facilities Source: Rozita Halina, 2000
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
Poverty Impact of Health Expenditures Pen’s Parade in Malaysia
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 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
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.
1Care for 1Malaysia Building a Stronger Health System
Putting People First & Personalised Care
Benefits of Integration and Competition
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