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INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Malaysian Heal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Outline
u Mal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Malaysian Heal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Hospitals in M...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Pre-Independen...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Pre-Independen...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Post-Independe...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Copyright of I...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Copyright of I...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
The New Genera...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Rural Health S...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Three Tier Sys...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
TWO TIER SYSTE...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Primary Care F...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Modern Health ...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
PHC in Other D...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
ThreePillars
P...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Health Service...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Malaysian Heal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
What have we d...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Modernisation ...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Modernisation ...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Life Expectanc...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Selected Vital...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Health Indicat...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
12/7/16
27
Rol...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Malaysian Heal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
What is wrong ...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Ministry of He...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
MultipleRoleso...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Governance
u ...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Issue of VAPE:...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Copyright of I...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Health Infrast...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Malaysia vs OE...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Hospital Beds ...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Copyright of I...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Building of Ho...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Fire at HSA JB
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Copyright of I...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Health Financi...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Source of Fund...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Total Health E...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Reforms in Hea...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Why	
  do	
  w...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
The Stakeholde...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Why Our Reform...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Research and D...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Researchers in...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Approval Proce...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
“Pakar Perubat...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Health Human R...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Specialists Tr...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Parallel Pathw...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Malaysian Budg...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
For Doctors
u...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Gred 56 For Do...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Malaysian Heal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Proposed Solut...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Decentralisati...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Benefits of
De...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Decentralisati...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Decentralisati...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Transform Role...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Transform Role...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
MultipleRoleso...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
TransformedRol...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Proposed Solut...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Priority on Pr...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Proposed Solut...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Research and D...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Proposed Solut...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Health Financi...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
NHFS	
  Implem...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Voluntary Heal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Voluntary Heal...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
The	
  Hybrid	...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Copyright of I...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Proposed Solut...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Health Technol...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Proposed Solut...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Human Resource...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Faculty of Pub...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
Conclusion
u ...
INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM)
FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
syed.aljunid@h...
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Malaysian Health System: Current Development, Budget 2017 and Future Challenges

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A seminar co-organised by PPPKAM and Jabatan Kesihatan Wilayah Persekutuan Kuala Lumpur in Institute of Health Management, Jalan Bangsar. 2nd Dec 2016

Published in: Healthcare

Malaysian Health System: Current Development, Budget 2017 and Future Challenges

  1. 1. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Malaysian Health System: Current Development, Budget 2017 and Future Challenges Professor Dato’ Dr Syed Mohamed Aljunid MD (UKM) MPH ( Singapore) PhD (London); DLSHTM (London); FAMM, FPHMM Professor of Health Policy and Management Faculty of Public Health Kuwait University & Professor of Health Economics & Public Health Medicine National University of Malaysia Copyright of ITCC-UKM
  2. 2. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Outline u Malaysian Health System: Historical Perspective u Organisation of Malaysian Health System u Roles of Private Providers u Roles of Ministry of Health u Health Financing Scenario u Implications of Budget 2017 u Proposed Solutions To Enhance MHS u Conclusion Copyright of ITCC-UKM
  3. 3. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Malaysian Health System: The History u Pre-Independent Period u 13th – 14th Century § Malacca Empire • Arrival of Arabs Merchants with some form of early modern medicine u  16th Century – 18th Century § Malacca falls to Portuguese (1511) § Dutch took over Malacca from Portuguese Occupation (1641) § British occupy Penang (1786)
  4. 4. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Hospitals in Malacca u 1641 - Dutch captured Melaka u Governor: Balthasar Bort u Surgery Clinic - M. Willen Cornelias Van Alsameer u Hospital - for Dutch citizens § Staff - senior surgeon, 4 junior surgeons Copyright of ITCC-UKM
  5. 5. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Pre-Independent Period u 19th Century § British occupied Singapore (1819) § Malacca, Singapore and Penang becomes Straits Settlement (1826) § British bring in Chinese to work in tin mines and Indians to work in rubber estates (1840s) •  Health care services in mining area and rubber estates •  Malaria and Beri-beri very common diseases § Buildings of Hospitals in major cities
  6. 6. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Pre-Independent Period u 1900 § Institute For Medical Research was established as “Pathological Institute” •  Sir Frank Athelstane Swettenham, the Resident-General of the Federated Malay States • Objectives is to “carry out scientific and sustained research into the causes, treatment and prevention of such scourges as beri-beri and all forms of malaria fevers ”.
  7. 7. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Post-Independent u 1957 § Malaysia gains independent § Ministry of Health established to replace Medical Services Department under British Colony u Further Development of Rural Health Services started in 1955. •  Three Tier System u Start Training of Bidan Kampung by National Family Planning Board in 1969 u 1973 § Gradual conversion of 3 Tier to 2 Tier System
  8. 8. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  9. 9. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  10. 10. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY The New Generation Hospitals Putrajaya Hospital Ampang Hospital H Selayang Copyright of ITCC-UKM
  11. 11. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Rural Health Services u Rural Health Unit § Smallest unit in a district headed by a physician providing basic health services to the population § (WHO)
  12. 12. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Three Tier System (1957 – 1973) MCQ MHC HSC (Coverage: 50,000 people)
  13. 13. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  14. 14. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY TWO TIER SYSTEM KD HC (15,000- 20,000 People)
  15. 15. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Primary Care Facilities in Malaysia
  16. 16. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Modern Health Centre in Malaysia
  17. 17. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY PHC in Other Developing Countries: Vanuatu
  18. 18. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY ThreePillars PUBLIC •  Ministry of Health •  Ministry of Education •  Ministry of Defense •  Local Authorities PRIVATE FOR PROFIT PRIVATE NOT-FOR- PROFIT • Private Hospitals • Private Clinics • Pharmacies • Laboratories • Hospice • Nursing Homes • Cancer Care NGOs • Care for HIV/ AIDS • Palliative Care
  19. 19. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Services u Primary Health Care Services § Health Centres for MCH § Outpatient Services (GP Clinics); 65% Ambulatory Contact with Private GPs u Secondary and Tertiary Care § Public Hospitals (75% of In-patient Beds) § Private Hospitals (25% of In-patients Beds) u Hospice and Nursing Homes § Private-For-Profit § NGOs
  20. 20. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Malaysian Health System: “Important Questions” u What have we done right in our Health System ? Copyright of ITCC-UKM
  21. 21. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY What have we done right? u Priority on Primary Health Care § Health Services § Health Infrastructure u Block funding by government § Tax-based funding since Independent u Government plays major role § Ministry of Health as the main agency given almost all responsibilities u Development of Local Specialists Training § Support to local universities Copyright of ITCC-UKM
  22. 22. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Modernisation of Health System
  23. 23. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Modernisation of Health System
  24. 24. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Life Expectancy Copyright of ITCC-UKM
  25. 25. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Selected Vital Statistics 1957-2006 Copyright of ITCC-UKM
  26. 26. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Indicators: 2000-2013 Indicators 2000 2005 2008 2010 2013 Life Expectancy At Birth (Years) Male 70.0 70.6 71.6 71.9 72.6 Female 75.1 76.4 76.4 77.0 77.2 Crude Birth Rate (per 1,000 pop) 24.5 21.0 18.4 17.5 17.2 Crude Death Rate (Per 1,000 pop) 4.4 4.5 4.7 4.8 4.7 Infant Mortality Rate (per 1,000 lv. births) 6.6 5.8 6.2 6.8 6.6 Toddler Mortality Rate (per 1,00o toddlers pop) 0.6 0.5 0.4 0.4 0.4 Maternal Mortality Rate (per 100,000 live births) 30 30 27.3 27.0 25.6 Perinatal Mortality Rate (per 1,000 total births) 7.5 6.8 7.3 7.8 7.4 Neonatal Mortality Rate (per 1,000 live births) 3.8 3.8 3.9 4.4 4.0
  27. 27. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY 12/7/16 27 Roles of Private Health Care u Most Primary Health Care Facilities are in private Sector § Private Clinics – 8,736 (Medical: 6,978; Dental 1,758) § Health Centres – 1,061 u Most In-patient Beds are in Public Sector § Public sector (2014) •  Hospitals : 150 (MOH: 142; Non-MOH: 8) •  Beds : 43,822 (MOH: 40,260: Non-MOH: 3,562) § Private Sector (2014) •  Hospitals: 214 •  Beds: 14,033
  28. 28. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Malaysian Health System: “Important Questions” u What is wrong with our current Health System? Copyright of ITCC-UKM
  29. 29. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY What is wrong with our current Health System? MHSGovernance Health Infrastructure Financing Research and Development Health Human Resource Copyright of ITCC-UKM
  30. 30. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Ministry of Health Malaysia u Main provider of health care services u Responsible for most health policy matters u Main regulator of healthcare services u Very dominant role in Malaysian Health Care System
  31. 31. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY MultipleRolesofMOH MOH Policy Maker Funder Regulator Provider Education & Training R&D Copyright of ITCC-UKM
  32. 32. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Governance u Too much power with too much diversified roles u “Jack of all Trade; Master of None” u Work in Silos § Poor coordination with other ministries § Carry out actions with no expertise § Recent Vape/e-Cigarette issues u Reactive response and fire fighting rather than proactive § Dengue Epidemic Copyright of ITCC-UKM
  33. 33. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Issue of VAPE: MOH vs Ministy of Rural and Regional Development Vs Ministry of Youth and Sports Copyright of ITCC-UKM
  34. 34. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  35. 35. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Infrastructure u Poor planning in development of health infrastructure u Building of hospitals based on political and commercial need rather than health needs § Affect in distribution of hospital services u Poorly planned health facilities § 1 Malaysia Clinic Copyright of ITCC-UKM
  36. 36. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Malaysia vs OECD Hospital Beds Per 10,000 Pop (2013) Copyright of ITCC-UKM 133 110 91 83 77 73 70 66 65 63 63 58 58 51 50 49 48 48 47 46 39 38 34 34 33 32 31 31 30 29 28 28 28 27 27 26 23 23 22 17 16 15 0 20 40 60 80 100 120 140 Japan Korea RussianFed. Germany Austria Lithuania Hungary Poland CzechRep. France Belgium SlovakRep. Latvia Luxembourg Estonia Finland Greece OECD Switzerland Slovenia Norway Australia Italy Portugal China Iceland Israel Denmark Spain UnitedStates Ireland NewZealand UnitedKingdom Canada Turkey Sweden Brazil SouthAfrica Chile Malaysia Mexico Colombia
  37. 37. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Hospital Beds in Malaysia (2009) State Total Nos of Beds Beds/10,000 Pop MALAYSIA 35,745 17.06 Perlis 404 17.05 Kedah 2,634 13.56 Pulau Pinang 3,913 24.77 Perak 4,387 18.07 Selangor 7,332 14.57 WP Kuala Lumpur 6,875 40.37 Negeri Sembilan 1,964 19.63 Melaka 1,665 21.86 Johor 4,542 13.89 Pahang 2,036 13.42 Terengganu 1,382 13.34 Kelantan 2,541 15.50 Sabah 4,050 12.36 Sarawak 3,861 15.63
  38. 38. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  39. 39. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Building of Hospitals Copyright of ITCC-UKM
  40. 40. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Fire at HSA JB
  41. 41. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  42. 42. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Financing Scenario
  43. 43. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Source of Funding for Health u Public (52%) § Taxation • Direct Taxation (60%) • Indirect Tax (40%) including GST-Introduce in April 2015) u Private (48%) § Out-of-Pocket Payment (39%) § Private Insurance (7%) § Other Private (2%)
  44. 44. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Total Health Expenditure Malaysia (1997-2013) Copyright of ITCC-UKM
  45. 45. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  46. 46. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Reforms in Health Financing System of Malaysia u High OOP Expenditure and Catastrophic Expenditure u Long Waiting times in public facilities u Shortage of drugs in public faculties esp for CNCD u Brain drain of specialists to private sector u Too much wastages in health spending (eg: Drugs etc u Lack of Quality and Efficiency monitoring mechanism u Five attempts to Reform since 1985 Copyright of ITCC-UKM Health Financing Issues in SEA: Challenges in Achieving UHC. Lancet (2011), 377 : 863-73
  47. 47. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Why  do  we  need  NHFS?   u Low  level  spending  on  health  care  in  most   less  developed  countries     u Fragmenta<on  in  source  of  funding   u Lack  of  con<nuity  of  and  streamlining  of   healthcare  services   u Poor  coordina<on  of  care  provided  by   public  and  private  providers   u Need  to  separate  payers  and  providers  to   promote  efficiency   Copyright of ITCC-UKM
  48. 48. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY The Stakeholders……. Public Providers Private Providers Consumers Politicians Trade Unions Employers Medical Associations Ministry of Health MCOs Private Insurers Drug Companies Copyright of ITCC-UKM HEALTH FINANCING SCHEME
  49. 49. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Why Our Reforms Failed? u Lack of Political Will to pursue the reform u Weakness of Reform Team §  Technical Capacity of MOH Staff/Silos) u Lack of Information (Cost/PPM etc) u Fighting over control of the proposed Agency: MOH vs EPU u Role of Potential losers: Private Insurers u Lack of Transparency and Public Consultation u Loss of public confidence on government to handle large fund (Cronyism, Corruptions)
  50. 50. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Research and Development in Health u Gross lack of trained researchers u Inadequate and fragmented research funding u National Institute of Health Research §  Inefficient use of tax-payer money §  Limited output and poor quality research §  Staff not properly trained researchers §  Creates obstacles for researchers in universities §  Lack of outstanding publication records u Clinical Research Centres §  Many hospitals have these centres §  Staff are mainly MOs who are not trained in research Copyright of ITCC-UKM
  51. 51. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Researchers in Malaysia Copyright of ITCC-UKM
  52. 52. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Approval Process Copyright of ITCC-UKM
  53. 53. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY “Pakar Perubatan Penyelidikan” Copyright of ITCC-UKM
  54. 54. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Human Resource u Rural-urban Maldistribution of doctors u Public-private skewness of specialists u Planning for Human Resource in Health u Allied health and Support staff u Role of MOH in Specialist Training u Pay-For-Performance Copyright of ITCC-UKM
  55. 55. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Specialists Training in Malaysia: Role of MOH u Role of Universities § Local Master Programmes u Open and Close System § Access to MOH Hospitals for Training u Creation of Parallel Pathways § Link to training programme overseas/off-shore/ Exported Programme Copyright of ITCC-UKM
  56. 56. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Parallel Pathway to Train Specialists: What is the Impact on Local Universities? Copyright of ITCC-UKM
  57. 57. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Malaysian Budget u 2017 § Total Budget: 260.8 billion RM § Operations: 214.8 § Development: 46.0 § MOH: 25 billion u 2016 § Total Budget: 267.2 billion RM § Operations: 215.2 § Development: 52.0 § MOH: 23 billion
  58. 58. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  59. 59. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY For Doctors u Introduction of Gred 56 § Between 54 and Jusa C § To reduce out flow of doctors and dentists to private sector u Contract Appointment § 2600 Doctors and Dentist to be appointed on contract basis for housemenship
  60. 60. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Gred 56 For Doctors & Dentists
  61. 61. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  62. 62. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  63. 63. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Malaysian Health System: “Important Questions” u What should we do now to enhance our Health System? Copyright of ITCC-UKM
  64. 64. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Proposed Solutions SOLUTIONSDecentralisation Higher Priority on Prevention Active R&D in Health Social Health Insurance Enhance Efficiency Effective Human Resource Planning
  65. 65. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Decentralisation of Health Services u What is Decentralisation: § “the transfer of authority and responsibility for public functions from the central government to intermediate and local governments or quasi- independent government organizations and/or the private sector” “ World Bank” § is a complex multifaceted concept. Copyright of ITCC-UKM
  66. 66. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Benefits of Decentralisation u  A more rational and unified health service that caters to local preferences u  Improved implementation of health programs u  Decrease in duplication of services as the target populations are more specifically defined u  Reduction of inequalities between rural and urban areas u  Cost containment from moving to streamlined targeted programs u  Greater community financing and involvement of local communities u  Greater integration of activities of different public and private agencies u  Improved intersectoral coordination, particularly in local government and rural development activities. Copyright of ITCC-UKM
  67. 67. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Decentralisation of Health Services in Malaysia u Transfer of ownership of hospitals and clinic to Regional Health Authorities (RHA) u Combine State Health and Medical Services Departments as fully-functioning RHA Greater autonomy given to hospitals to provide services u RHA given full responsibility to plan, deliver and monitor health services Copyright of ITCC-UKM
  68. 68. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Decentralisation of Health Services in Malaysia u Limited number of hospitals owned and maintain by MOH directly § National Referral Centre § Specialised Hospitals • National Cancer Hospitals • Mental Institutions • Respiratory Centre • Hospital for Infectious Disease Copyright of ITCC-UKM
  69. 69. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Transform Role of MOH u Development of Health Policy u Health Planning and Development u Regulation and Enforcement § Licensing and accreditation of hospitals and clinics § Monitor private providers u Minor role as Service providers u Health Promotion and Preventive Services Copyright of ITCC-UKM
  70. 70. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Transform Role of MOH u Enhance role of MOH in Monitoring and Evaluation § Benchmarking of Hospitals § Set and Monitor KPI u Health Management Information System § Systematic collection of Health Information § More detail and high quality data to support strategic decision making § High quality data analysis Copyright of ITCC-UKM
  71. 71. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY MultipleRolesofMOH MOH Policy Maker Funder Regulator Provider Education & Training R&D Copyright of ITCC-UKM
  72. 72. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY TransformedRolesofMOH MOH Health Policy Monitoring and Evaluation Service Provider Copyright of ITCC-UKM
  73. 73. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Proposed Solutions SOLUTIONSDecentralisation Higher Priority on Prevention Active R&D in Health Social Health Insurance Improve Efficiency Effective Human Resource Planning
  74. 74. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Priority on Prevention and Promotion u Higher spending on Preventive and Promotive Services u Empower community and Local Authorities u Employ more innovative approach in Prevention u Focus on Primary and Secondary Prevention u Trained more health workers on Prevention and Promotion § Trained more Public Health Medicine Specialists
  75. 75. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Proposed Solutions SOLUTIONSDecentralisation Higher Priority on Prevention Active R&D in Health Social Health Insurance Enhance Efficiency Effective Human Resource Planning
  76. 76. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Research and Development u Establish National Research Council (Korean Model) u Collate all funding resources under NRC u Research funding on competitive basis u Stop block research funding directly to specific agencies or ministries u Assess contribution and productivity of NIH in MOH u Enhance role of universities in R&DCopyright of ITCC-UKM
  77. 77. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Proposed Solutions SOLUTIONSDecentralisation Higher Priority on Prevention Active R&D in Health Social Health Insurance Improve Efficiency Effective Human Resource Planning
  78. 78. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Financing System u Establish National Health Fund based on SHI concept outside MOH u Coordinate contributions from public and private sector u Introduce Provider and Purchase Split u Set-up Multiple agencies to process payment and claims from providers u Use Strategic Purchasing Methods (Prospective payment: Capitation and Casemix) Copyright of ITCC-UKM
  79. 79. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY NHFS  Implemen<ng  Agency   u Set  up  by  legal  provision   u Public  non-­‐profit  organisa<on   u Responsible  for  All  aspects  of  Policy   Development   u With  Strong  Link  and  control  of    Cabinet   u Monitors  the  implementa<on  of  HFM   u Appoint  agent  to  operate  the  HFM   Copyright of ITCC-UKM
  80. 80. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  81. 81. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Voluntary Health Insurance u Potential Strengths § More acceptable to population than private-for- profit health insurance § Easier to set-up than Social Health Insurance § More freedom of choice to enrollees § Government in control since the entity is under MOH § Benefit package might be the same as present § Fund may be injected by government
  82. 82. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Voluntary Health Insurance u Weakness and Issues § Prone to adverse selection (the sick and high risk will be more attractive to join) § Limited risk pooling and risk sharing § Premium may be too high without government subsidy § Provider payment method must be carefully design to promote efficiency § Providers have to enticed to join the scheme
  83. 83. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY The  Hybrid  Model…   Social Health Insurance •  Mandatory •  Working population •  Formal Sector & Informal Sector •  Curative Care Taxation •  Poor and Unemployed •  Preventive and Promotive Services Private Insurance •  The Rich •  Top-up from Basic Benefit Package Copyright of ITCC- UKM
  84. 84. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  85. 85. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Proposed Solutions SOLUTIONSDecentralisation Higher Priority on Prevention Active R&D in Health Social Health Insurance Improve Efficiency Effective Human Resource Planning
  86. 86. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Technology Assessment u Establish a dedicated independent agency on HTA u Conduct HTA activities covering new and existing technologies in public and private health sector u Source staff from universities with proper skills in HTA u Strict use of Economic Evaluation in decision making: (CE Threshold < 3 GDP) u HTA Report should be taken on board by implementing agency Copyright of ITCC-UKM
  87. 87. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Proposed Solutions SOLUTIONSDecentralisation Higher Priority on Prevention Active R&D in Health Social Health Insurance Enhance Efficiency Effective Human Resource Planning
  88. 88. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Human Resource For Health u Give priority to Local Specialists Programme u Reduce the number of Medical Schools u Establish more Faculty of Public Health/ School of Public Health u Start undergraduate Training in Public Health u Use innovative approach in HRM
  89. 89. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Faculty of Public Health, Kuwait University
  90. 90. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Conclusion u Malaysian Health System has undergone series of gradual development since pre- independent era u Priority to primary health care and rural development has benefitted most Malaysian u MHS need to be transformed to provide effective, efficient, equitable and innovative services to the Malaysian population u Budget 2017 posed major challenges to MHS Copyright of ITCC-UKM
  91. 91. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY syed.aljunid@hsc.edu.kw saljunid@gmail.com smohamed@ppukm.ukm.edu.my www.casemix.com.my Casemix E IQ Copyright of ITCC-UKM

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