Dr azilina 1 care for ph conference 12july2011 11july 2011


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Slide 18 shows the implementation process of 1Care. In phases 1 to 3 the name 1Care doesn't even appear but it is part of the process.

The MOH Deputy Director General, Datuk Dr Noor Hisham Abdullah has confirmed that 1Care is currently in phase 1 & 2 of implementation.

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  • 17/03/12 Semi Confidential Semi Confidential March 17, 2012
  • 17/03/12 SULIT SULIT
  • 17/03/12 SULIT March 17, 2012
  • 17/03/12
  • DRAFT Pls do not circulate or cite SULIT SULIT SULIT 11 August 09
  • 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. Small hospitals will have a narrow range of services Larger hospitals will have a bigger range of services Services with high end and expensive technology will only be available in one/some regions to serve neighboring services.
  • 17/03/12 SULIT SULIT March 17, 2012
  • 17/03/12 SULIT 11 August 09
  • 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.
  • Semi Confidential Semi Confidential March 17, 2012
  • 17/03/12 SULIT March 17, 2012
  • 17/03/12
  • Dr azilina 1 care for ph conference 12july2011 11july 2011

    1. 1. Towards Public Private Integration: Aspiration for 1Care 6th PUBLIC HEALTH CONFERENCE 2011 SEREMBAN NEGERI SEMBILAN 12TH JULY 2011Dr. Azilina Abu BakarUnit for National Health FinancingPlanning and Development DivisionMinistry of Health 1
    2. 2. Presentation Outline• Transforming the Health System – Service Delivery – Financing – Governance – Phases of Transformation 2
    4. 4. 1Care Concept1Care is the restructured integrated 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 equityConglomeration of many features based oncurrently known global best practices, suitablefor the needs of Malaysia now & into the future 4
    5. 5. Targets of 1Care• Universal coverage• Integrated health care delivery system• Affordable & sustainable health care• Equitable (access & financing), efficient, higher quality care & better health outcomes• Effective safety net• Responsive health care system• Personalised care• Client satisfaction• Reduce brain-drain 5
    6. 6. Features of 1Care• Streamlined MOH → focused on governance, stewardship and specific public health services, training and research• Malaysian Healthcare Delivery System (MHDS) – integrate the autonomous public providers and private providers.• People register with a particular primary health care providers (PHCP) - gatekeeper to higher levels of care• Publicly managed health fund - combination of general government revenue and social health insurance (SHI), and tempered by minimal co-payments at point of seeking care• Autonomous Single payer system, the National Health Financing Authority (NHFA) – set-up on a not-for-profit basis under the MOH - to pool and purchase personal health services from health care providers who are either public, NGO or private providers• Government commits to higher levels of spending for healthcare• People commit to increased cost sharing through pooling of funds and cross-subsidy 6
    8. 8. SERVICE DELIVERY & PATIENT FLOW National Health Financing Authority (NHFA) Additional services Patient (Out of pocket or private health insurance) MOH MHDS PHCP Referred Private Public Private HospitalRegional Health Public Authority Admit Receive treatment PHCA Return to referring Home Family DoctorPHCA PHCA 8
    9. 9. Service Delivery in 1CarePrimary Health Care Services (Public & Private Providers)  Thrust of health care services - strong focus on promotive-preventive care & early intervention  Every member of the population will be registered with a PHCP (public or private)  Family doctor & gatekeeper  referral system  Development of multi-disciplinary team with allied health personnel carrying out more functions 9
    10. 10. Service Delivery in 1Care – Secondary & Tertiary CareSecondary and Tertiary Healthcare Services (Public &Private Providers)  Patients referred by PHCP  Public hospitals will be coordinated on regional network o Small hospital will have narrow range of services o Services with high end and expensive technology will only be available in some regions – serve neighbouring services  Private hospitals & private specialised clinics will work together with the public sector to support integration of care 10
    11. 11. FINANCING 11
    12. 12. Financing Arrangements• Combination of financing mechanisms – Social health insurance (SHI) + General government revenue (GGR) + minimal Co- payments for a defined Benefits Package – Pooled as single fund to promote social solidarity and unity as per 1Malaysia concept• Social Health Insurance contribution – mandatory – SHI premium – community rated & calculated on sliding scale as percentage of income – From employer, employee & government• Government’s contribution covers – Public health & other MOH activities – PHC portion of SHI for whole population – SHI premiums for registered poor, disabled, elderly (60 years & above), government’s role as employer – Higher spending by govt – 2.9% (In 2007 govt spending 2.1%) 12
    13. 13. Operational Structure of SHI Program Insurer National Health Financing Authority (NHFA) Insurance Review, Payment benefit Ministry for Health (planning, supervising) Contribution Claim, data Medical service Providers Insured (public & private) Co-payment
    14. 14. Provider Payment MechanismPrimary Healthcare (Public and Private Providers)  Capitation with some broad case-mix adjustment  Co-payment for pharmaceutical and dentalSecondary and Tertiary Healthcare (Public and Private Providers)  Financing through case-mix adjustments o Global budget for public hospitals o Case-based payment for private hospitals and other institutions Incentives for providers to work in remote areas & achieving performance targets 14
    15. 15. GOVERNANCE
    16. 16. FUNCTIONS WITHIN THE RESTRUCTURED HEALTH SYSTEM Professional Bodies -MMC Independent bodies -MDC -Drug Regulatory Authority (DRA) -Pharmacy Board -Health Technology Assessment (HTA) - Others -Medical Research Council (MRC) -Patience Safety Council MO -Medical Device Bureau -National Service Framework (NSF) (Quality) H -National Health Promotion Board NHFA - Food Safety Authority - Others • GOVERNANCE & STEWARDSHIP • POLICY & STRATEGY FORMULATION • STANDARD SETTING MHDS • REGULATION & ENFORCEMENT SERVICE DELIVERY • MONITORING & EVALUATION •PRIMARY CARE • PUBLIC HEALTH • RESEARCH •HOSPITAL CARE • TRAINING •OTHER SERVICES
    18. 18. Phases of Health Sector Development Steady State – 1Care for 1Malaysia Phase 4 1Care: Full reform funded through GT & SHI 1Care: PHC reform funded through GT Phase 3 Phase 2 1Care: Public Facility autonomy funded through GT1Care: Strengthening of the current health system Phase 1 18
    19. 19. SummaryPublic private integration in 1Care:  Integration of public and private health care providers  Integration of levels of care  Integration of sources of financing  Others: standard setting, quality of care, enforcement, ICT etc 19
    20. 20. THANK YOU 20