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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

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

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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
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
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)
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
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
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 ”.

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

  • 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. 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. 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. 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. 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  • 9. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  • 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  • 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Primary Care Facilities in Malaysia
  • 16. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Modern Health Centre in Malaysia
  • 17. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY PHC in Other Developing Countries: Vanuatu
  • 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. 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Modernisation of Health System
  • 23. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Modernisation of Health System
  • 24. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Life Expectancy Copyright of ITCC-UKM
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  • 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  • 39. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Building of Hospitals Copyright of ITCC-UKM
  • 40. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Fire at HSA JB
  • 41. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  • 42. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Health Financing Scenario
  • 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  • 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. 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. 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Researchers in Malaysia Copyright of ITCC-UKM
  • 52. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Approval Process Copyright of ITCC-UKM
  • 53. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY “Pakar Perubatan Penyelidikan” Copyright of ITCC-UKM
  • 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. 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  • 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Gred 56 For Doctors & Dentists
  • 61. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  • 62. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  • 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY
  • 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Copyright of ITCC-UKM
  • 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. 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. 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. 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. INTERNATIONAL CENTRE FOR CASEMIX AND CLINICAL CODING (ITCC-UKM) FACULTY OF PUBLIC HEALTH, KUWAIT UNIVERSITY Faculty of Public Health, Kuwait University
  • 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. 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