The document proposes restructuring the Malaysian health system to create a unified public-private integrated health system called "1Care". Key elements of the proposed model include:
1) Universal coverage through 1Care which integrates public and private providers and services.
2) Autonomous healthcare regions and providers with more flexibility in management and performance-based payments.
3) Strong primary care focus through registered primary care providers acting as gatekeepers and coordinators of care.
4) Harmonization of public and private human resources and incentives to address shortages and promote performance.
ISS Service Innovation Leadership Seminar, 28 March - Mrs Chew Kwee TiangNUS-ISS
ISS Service Innovation Leadership Seminar, 28 March - "Design Thinking and Service Innovation - The Khoo Teck Puat Hospital's Journey" by Mrs Chew Kwee Tiang, CEO, Khoo Tech Puat Hospital
Saiful Hidayat Pemanfaatan ICT untuk Pengembangan Rumah Sakit Pendidikan impl...Saiful Hidayat
Adalah materi presentasi saya pada Seminar Pengembangan Rumahsakit Pendidikan di Daerah Terpencil
Yogyakarta, 5 Maret 2011 yang diselenggarakan oleh Fakultas Kedokteran Universitas Gajah Mada Yogyakarta
ISS Service Innovation Leadership Seminar, 28 March - Mrs Chew Kwee TiangNUS-ISS
ISS Service Innovation Leadership Seminar, 28 March - "Design Thinking and Service Innovation - The Khoo Teck Puat Hospital's Journey" by Mrs Chew Kwee Tiang, CEO, Khoo Tech Puat Hospital
Saiful Hidayat Pemanfaatan ICT untuk Pengembangan Rumah Sakit Pendidikan impl...Saiful Hidayat
Adalah materi presentasi saya pada Seminar Pengembangan Rumahsakit Pendidikan di Daerah Terpencil
Yogyakarta, 5 Maret 2011 yang diselenggarakan oleh Fakultas Kedokteran Universitas Gajah Mada Yogyakarta
Business Experience in Implementing an Advanced Telemonitoring Service. Valdivieso Martinez B. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Market Research Report : Hospital Market in India 2012Netscribes, Inc.
For the complete report, get in touch with us at : info@netscribes.com
Netscribes (India) Pvt. Ltd., a knowledge consulting solutions company, announces the launch of its report – Hospital Market in India. The Indian hospital market is currently experiencing rapid growth over the last few years and it is expected to continue this trend in the near future.
The report provides a snapshot of the hospital market. It begins with an introduction section which offers a study of the types and specifications of the hospital in India. The market overview section provides an insight into the current and forecasted market size of the equipment.
An analysis of the drivers explains the factors for growth among which are the dearth in hospital beds in comparison to the demand it faces, growing healthcare industry, growing affordability among people, growing medical tourism, increasing lifestyle diseases, changing demographic structure and growing health insurance market. Key challenges include insufficient medical professionals, lack of investment in IT infrastructure and shortage of FDI flows in Indian hospitals.
The next section provides a study on the role of government that is taking measures to raise the number of hospitals both public and private and also providing financial incentives to the private players to encourage them to establish more and more hospitals.
The next section provides the Trends that are developing in the hospital market among which are growth in Secondary Care Hospitals, growing interest of foreign hospitals to start business in India, public private partnership projects, funding from private equity firms, increase in operation of mobile hospitals, domestic hospitals offshore expansion along with telemedicine and health city emergence in hospital market.
The competition section gives overview of hospitals in the country that have grown over time segmented on the basis of region. It is then followed by some hospitals that have or will soon commence operation in 2012-13. Thereafter, the report highlights the features of the major players operating in the market. It includes an elaborate profile of the major domestic players in the market along with their financial analysis. Porters Five Forces Analysis has been incorporated for a brief but effective understanding of the market scenario.
The strategic recommendations section focuses on some effective strategic decisions which can be taken up by companies to increase their market shares.
Overview of Meaningful Use, Stage One. Presented to Georgetown's Health Information System's class on 4/14//11. Only difference from previous lectures is the addition of slides on adoption sentiment.
Dr azilina 1 care for ph conference 12july2011 11july 2011EyesWideOpen2008
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.
Meaningful Use Stage One, with CertificationJess Jacobs
Overview of Meaningful Use, Stage One. Presented to Georgetown's Undergraduate Health Information System's class on 12/8/10. Only difference from 1/8/10 lecture is the addition of slides on certification.
Business Experience in Implementing an Advanced Telemonitoring Service. Valdivieso Martinez B. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
Market Research Report : Hospital Market in India 2012Netscribes, Inc.
For the complete report, get in touch with us at : info@netscribes.com
Netscribes (India) Pvt. Ltd., a knowledge consulting solutions company, announces the launch of its report – Hospital Market in India. The Indian hospital market is currently experiencing rapid growth over the last few years and it is expected to continue this trend in the near future.
The report provides a snapshot of the hospital market. It begins with an introduction section which offers a study of the types and specifications of the hospital in India. The market overview section provides an insight into the current and forecasted market size of the equipment.
An analysis of the drivers explains the factors for growth among which are the dearth in hospital beds in comparison to the demand it faces, growing healthcare industry, growing affordability among people, growing medical tourism, increasing lifestyle diseases, changing demographic structure and growing health insurance market. Key challenges include insufficient medical professionals, lack of investment in IT infrastructure and shortage of FDI flows in Indian hospitals.
The next section provides a study on the role of government that is taking measures to raise the number of hospitals both public and private and also providing financial incentives to the private players to encourage them to establish more and more hospitals.
The next section provides the Trends that are developing in the hospital market among which are growth in Secondary Care Hospitals, growing interest of foreign hospitals to start business in India, public private partnership projects, funding from private equity firms, increase in operation of mobile hospitals, domestic hospitals offshore expansion along with telemedicine and health city emergence in hospital market.
The competition section gives overview of hospitals in the country that have grown over time segmented on the basis of region. It is then followed by some hospitals that have or will soon commence operation in 2012-13. Thereafter, the report highlights the features of the major players operating in the market. It includes an elaborate profile of the major domestic players in the market along with their financial analysis. Porters Five Forces Analysis has been incorporated for a brief but effective understanding of the market scenario.
The strategic recommendations section focuses on some effective strategic decisions which can be taken up by companies to increase their market shares.
Overview of Meaningful Use, Stage One. Presented to Georgetown's Health Information System's class on 4/14//11. Only difference from previous lectures is the addition of slides on adoption sentiment.
Dr azilina 1 care for ph conference 12july2011 11july 2011EyesWideOpen2008
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.
Meaningful Use Stage One, with CertificationJess Jacobs
Overview of Meaningful Use, Stage One. Presented to Georgetown's Undergraduate Health Information System's class on 12/8/10. Only difference from 1/8/10 lecture is the addition of slides on certification.
Presntation by Zorayda E. Leopando, MD, MPH
Professor of Family and Community Medicine University of the Philippines Manila at the WHO/TNO/Dutchgovernment Congres 'Connecting Health and Labour' 29 - 1 December 2012
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
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Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
1. 1Care for 1Malaysia:
RESTRUCTURING THE MALAYSIAN
HEALTH SYSTEM
Presented at the
10th Malaysia Health Plan Conference
by
Dato’ Dr Maimunah bt A Hamid
Deputy Director General of Health
(Research and Technical Support)
2nd February 2010 1
2. Presentation Outline
• Current Health System & Challenges
• Proposed Model for Malaysia
– Delivery system & Governance
• Primary Health Care
• Secondary Care
• Human Resource Development
– Financing
• Implications
2
5. Access to Health Providers in Malaysia
MOH Other agencies & Private sector
By passing
SECONDARY/TERTIARY
University Hospitals
CARE
Hospitals with
Private Hospitals
Subspecialty
Hospitals with
Specialists
Others
Medical Corps
Hospitals without
Specialists
Orang Asli
Facilities
GPs
PRIMARY HEALTH
Health Clinics/Centres
1 : 20,000 population
CARE
Rural/Community Clinics
1 : 4,000 population
Estate
6. Public & Private Sector Resources
and Workload (2008)
11%
Health clinics (with doctors) 802 6371
38%
Outpatient visits (m) 38.4 62.65
41%
No. of Hospitals 143 209
78%
Hospital Beds 41249 11689
74%
Admissions 2199310 754378
55%
Doctors (excl. Houseman) 12081 10006
45%
Health Expenditure (RM billion) (2007) 13.54 16.68
Public Private
0% 20% 40% 60% 80% 100%
10
Source: Health Informatics Center (HIC),MOH
6
7. Current Functions of MOH
Within the dual health care system,
MOH is Funder, Provider and Regulator
• Health Policies & Planning • Primary Care Services
– Out-patient services
• Regulation & Enforcement
– Maternal & Child Health
– Personal care
– Health Education
– Public Health – Home Visits & School Health
– Pharmacy
• Secondary & Tertiary Services
– Technology – In-patient services
– Medical Devices – Specialist care
• Monitoring & Evaluation • Pharmaceutical Services
– Quality Assurance
• Oral Health Services
– Health Technology Assessment
– Patient Safety • Imaging and Diagnostics
– Guidelines and Standards • Laboratory Services
• Training • Telehealth & Teleprimary care
• Research & Development • Public Health Activities
• Health Information Management – Communicable Disease
– Non-communicable Disease
8. Current Challenges in
Malaysian Health System
1. Lack of integration
2. Changing trends in disease pattern & socio - demography
3. Greater expectations from public
4. Dependency on govt. subsidised services – Issues of
economic inefficiency
5. Limited appraisal & reward systems for performance
6. Conflicts of interest
7. Accessibility & affordability
- Discrepancy of health outcomes
8. Limited coverage of catastrophic illness
e.g. haemodialysis, cancer therapy, transplants etc.
9. Private spending for health overtaken public since 2004
8
9. Public Private Expenditure on Health,
1997-2007 (2007 RM Value)
Source : MNHA (2007)
2.6
18,000 2.5 2.4 2.4
2.1
2.3
2.1 2.1
1.7 1.8 2.1 2.2 2.0
1.6
16,000 1.5 1.9 1.9 16,682
1.6 1.7
1.5 1.6 1.6
1.5
14,360 1.0
14,000 13,034 13,546
0.0
Percentage (%)
12,067
RM million
12,000
11,558 11,542
11,740
10,271
-1.0
10,000
9,083 10,079
8,727
-2.0
8,000
7,320
6,351 7,208
6,000 5,806 6,571
6,824 -3.0
5,616
5,658 5,970
5,538
4,000 -4.0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
Year
9
PUBLIC (RM million) real RM2007 base PRIVATE Public as % GDP Private as % GDP
10. Ratio of Out-of-Pocket (OOP), Public &
Private Expenditures
100%
90% 18.6 23.0
32.0 34.5 32.3 Gen Gov
1.3 44.2
80% Revenue
14.5
70% 17.1 Social
7.5 0.7 Security
60% 1.8 4.5 0.4 20.8 23.3 External
3.3 7.2 25.6
50% 0.1
0.4
Resources
7.7 4.1 Other
0.0 4.0 Other
40% 12.7 3.7 Private
Private
17.5 (Employers)
30% 56.3 51.4 Private
Private
21.6
40.5 Pooled
Insurance
20%
30.2 Private
22.5
10% 14.5 OOP
0%
MALAYSIA
Low Lower Malaysia
(2006)
Upper High GLOBAL
Income middle middle Income
10
Income Income Source: World Bank, 2005
11. Total Expenditure on Health (TEH)
as Percentage of GDP (2005)
TEH as % of GDP, 2005
12.0
11.2
10.0
8.6
8.0
6.6
6.0
4.8 4.7
4.2 4.2
4.0
2.0
0.0
Low Income Lower middle Income Malaysia Malaysia (2007) Upper middle Income High Income GLOBAL
11
Source : World Bank, 2005
12. Government Spending on Health as % of
Total Government Expenditure (2006)
Government Spending on Health as % of Total Government Expenditure
25
20
15
7.0%
10
Government Spending on Health as % of Total
5 Government Expenditure
0
Source : WHOSIS data 2006
13. Health expenditures per capita, 2009 prices
2000
1800 In the future with no
1600 restructuring of the
1400
1200
health system…..
1000
800
600
In absence of health
400 financing reform, health
200 system likely to become
0
increasingly privatized…
09
10
11
12
13
14
15
16
17
18
19
both in funding and
20
20
20
20
20
20
20
20
20
20
20
GGHE pc PvtHE pc service delivery……
2004 2009 2018
GGHE 50% 45% 35%
PvtHE 50% 55% 65%
-PvtOOP 40% 47%
Source: Dr Christopher James, WHO
-PvtOther 15% 17% WPRO – Projections from MNHA data
14. The Combination of Organisational and
Financial Reforms A Nation Chooses
Depends on What Goals A Nation Wants to
Achieve
15. Aligning Our Health System To
Our Country’s Aspirations
New Economic Model ?
Malaysia Economic Monitor: Repositioning for Growth
- 4 Key Elements (World Bank, November 2009)
1. Specialising the economy - high value-added, innovation-based, strong
growth potential, enabling environment internally-competitive appropriate soft
and hard infrastructure knowledge economy
2. Improving the skills of the workforce – specialised and skilled labour
moving up the value-chain, social and private returns to education and skills
upgrading, increase productivity
3. Making growth more inclusive – Strong inclusiveness policies, equity,
helping household cope with poverty through health care
4. Bolstering public finances – broaden the country’s narrow revenue base,
lessen subsidies, reduce the crowding-out of private initiatives, shift expenditure
to areas of specialisation, skills and inclusiveness
15
17. 1Care Concept
• 1Care is restructured national health
system that is responsive and provides
choice of quality health care, ensuring
universal coverage for health care
needs of population based on solidarity
and equity
18. 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
• Client satisfaction
• Personalised care
• Reduce brain-drain
18
19. Features of Proposed Model:
BETTER than current system
• Strengths of current system will be preserved
• Stronger stewardship role for MOH & government
• Separation of purchaser-provider functions
• 1Care - Integration of health care providers &
services
• More responsive to population health needs &
expectation through increased autonomy
• Payments linked closely to performance of provider
19
21. FUNCTIONS WITHIN THE RESTRUCTURED HEALTH SYSTEM
Professional Bodies Independent bodies
-MMC
-Drug Regulatory Authority (DRA)
-MDC -Health Technology Assessment (HTA)
-Pharmacy Board -Medical Research Council (MRC)
- Others -Patience Safety Council
-Medical Device Bureau
MOH -National Service Framework (NSF) (Quality)
-National Health Promotion Board
NHFA - Food Safety Authority
- Others
• GOVERNANCE &
STEWARDSHIP
• POLICY & STRATEGY
FORMULATION
• STANDARD SETTING
MHDS
• REGULATION &
SERVICE DELIVERY
ENFORCEMENT
• MONITORING &
• PRIMARY CARE
EVALUATION
• PUBLIC HEALTH • HOSPITAL CARE
• RESEARCH
• TRAINING • OTHER SERVICES
22. CHANGES TO CURRENT FUNCTIONS OF MOH
WITH PROPOSED RESTRUCTURING
Professional Bodies
-MMC Independent bodies
-MDC -Drug Regulatory Authority (DRA)
-Pharmacy Board -Health Technology Assessment (HTA)
-Medical Research Council (MRC)
- Others
-Patience Safety Council
-Medical Device Bureau
-National Service Framework (NSF) (Quality)
MOH -National Health Promotion Board
NHFA - Food Safety Authority
- Others
POLICY REGULATION & TRAINING RESEARCH
MHDS
PERSONAL
MAKING CARE
PUBLIC MONITORING & ENFORCEMENT
HEALTH EVALUATION
-Disease -Basic
Control -Post-Basic
-Patient Safety Enforcement Primary Hospital
-HIC Legislation
-Food - Services
- MNHA Regional Regional
Safety & - Research
- Surveillance Authority Authority
Quality - TCM
- H20 Quality -Professionals
- TCM - Human - Allied Health
-Health Resources -Nursing
Education -Drugs Development
- Quality - Finance PHCT PHCT PHCT
- HTA - Infrastructure &
Equipment
-HTA
- Quality
- ICT
23. Scope of Autonomy
for Independent MOH-owned bodies
• Not-for-profit
• Accountable to MOH
• Independent management board
• Self accounting – manages own budget
• Able to hire and fire
• Flexibility to engage and remunerate staff
based on capability and performance
23
24. SERVICE DELIVERY & PATIENT FLOW
Additional services
Patient (Out of pocket or private health insurance)
PHCP Refer Private
Public Private Hospital
Public
Admit
Receive
treatment
Return to referring PHCP
Home
25. FUNDING & GOVERNANCE
NHFA MOH
MHDS
Regional
Health
Authority
PHCT
PHCT PHCT
Outpatient and Hospital care free at point of service
Minimal co-payments e.g. for dental & pharmacy
26. Primary Health Care
Primary Health Care
• Thrust of health care services - strong focus on
promotive-preventive care & early intervention
• Primary Health Care Providers (PHCP):
– PHCP are independent contractors
– Family doctor & gatekeeper referral system
• Register entire population to specific PHCP
according to location of home/work/schooling
• Dispensing of drugs by independent pharmacies
• Payment - capitation with additional incentives
– casemix adjustments
26
27. Primary Health Care Provider
• PHCPs are led by Family Medicine Specialists (FMS)
• The FMS is registered with the MMC and the National
Specialist Register
• Secondary care specialist are not registered as PHCPs
• Conversion of GPs to FMS – thru x months training
from accredited training centres/providers
• Over time only Primary Health Care Specialists are
allowed to open a PHCP practice
• Accreditation of facilities, credentialing and privileging
of PHCP will be done
27
28. Hospital Services
• Regional arrangement for hospital services &
set-up to better serve the needs of local
community in each region
• Patients referred by PHCP
• Autonomous hospital management
• Financing through casemix adjustments
– ? Global budget for public hospitals
– ? Case-based payment for private hospitals
28
29. Human Resource
• Integration of public & private health care providers →
increase access for population
• Gaining of number & skills through integration
• Facilitate providers working in both sectors – suitable
arrangements have to be developed
• Harmonise/equalise remuneration for public & private
• Pay for performance
- Incentives are being considered to promote performance
- Incentives for performance over benchmark, people who work in
remote areas
30. Role of Allied Health
• Utilisation of allied health personnel will reduce cost &
support the role of health professionals
• This will contribute towards overcoming the shortage
of human resource
• In line with 1Malaysia Clinic launched by PM, it is
possible for allied health personnel to carry out certain
functions, such as:
– Preventive care by nurses
– Triaging, basic treatment e.g. T&S, STO, etc by nurses
& AMOs.
31. Human Resource: Training
• MOH still determines the human capital needs of the country
• Within integrated system in-service training has to be planned between
public & private facilities
• ? outsource training to institution or teaching facilities
• ? Open system for formal post-graduate training of doctors
- Universities need to review current programme
• Credentialing & Privileging
– Independent Body – e.g. National Credentialing Committee (NCC),
Academy of Medicine etc.
• Continuing Professional Development (CPD)
– Current system
• fund - health facilities / self funded
– Compulsory – minimum CPD points/per year for APC 31
– Use for recertification.
33. Financing Arrangements
• Combination of financing mechanisms
– Social health insurance (SHI) + General taxation + minimal Co-payments
for a defined Benefits Package
– Pooled as single fund to promote social solidarity and unity as per
1Malaysia concept
33
34. A Summary of Ranking of Different
Health Financing Methods
Equity Risk Reduce Risk Efficiency*
Pooling Selection
BEST
General Rev General General Rev User Fee, OOP, MSA
Rev (Low administrative cost
but sometimes hard to
collect – so higher cost)
Social Ins Social Ins Social Ins Social Ins
Comm Fin. Comm Fin Comm.Fin Comm. Fin.
Private Ins Private Ins Private Ins Private Ins (High
Administrative Cost)
WORST User Fee, User Fee, --------------- General Rev/ Direct
OOP, MSA OOP, MSA Provision (Inefficient ) –
Generally – may not be
the case in Malaysia
*Efficiency factors include technical efficiency and administrative costs.
35. Social Health Insurance
• SHI is another financing approach for mobilising
funds & pooling risks, earmarked tax
• Community-rated, not risk-rated as in private
health insurance (PHI) – all are eligible
• High levels of cross-subsidization
– Rich to poor
– Economically productive to dependants
– Healthy to ill
• 3 distinct characteristics
– Compulsory enrollment, payment of premium.
– Benefits eligible for those who contribute only
– Benefit Package is predetermined
35
36. Social Health Insurance
Advantages Disadvantages
• Pools Risk & Resources • Challenges in coverage of informal
• Mobilise funds designated for sector & determining the poor
health system - public • Need to have a good administrative
acceptance capacity
• Planned prepayment - OOP • SHI requires legislation to provide a
• Equity legal framework for authorising
– payment according to ability to mandatory, earmarked
pay
contributions
– improve equity in access
• Promote health system • Need accurate estimates of the
development benefits package & costs
– health information system • PPM that shifts financial risk of
– rational planning of health provision to the provider, e.g.
services & resources capitation need to be continuously
monitored & evaluated
• Abuse of SHI fund may be a threat 36
37. Financing Arrangements
• Combination of financing mechanisms
– Social health insurance (SHI) + General taxation + 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 (from general taxation) covers
– Public health & other MOH activities
– PHC portion of SHI for whole population
– SHI premiums for registered poor, disabled, elderly (60 years &
above), government pensioners & civil servants + 5 dependants
– Higher spending by govt – 2.85% (In 2007 govt spending 2.11%) 37
39. Total Health Expenditures with and without
1Care restructuring
90,000
Constant 2009 prices (millions)
80,000
70,000
60,000
50,000
40,000
30,000
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
No major changes 1Care
41. Implications of Proposed System
• Public-private integration
• Stronger governance role in a slimmer MOH
• Defined practice standards
• Benefits package
• Payment by performance
• Registries for providers and patients
• Gate-keeping role by primary care providers
• Autonomous management public healthcare providers
• Services free at point of care – minimal co-pay
• Mandatory regular contribution (prepaid) under SHI
• More funding of health with increased coverage
41
42. Benefits to Individuals
• Access to both public & private providers
• Reduced payment at the point of seeking care
• Care nearer to home
• Increased quality of care & client satisfaction
• Personalised care with specific PHCP
• Access for vulnerable group
• Better health outcome
• Higher work productivity
• All (except govt covered groups) will have to
pay to be within the system 42
43. Benefits to Employers
• Relieve burden to reimburse worker or give loan for
medical spending
• Relieve burden to cover work and non-work related
illnesses (beyond SOCSO)
• Pay low contributions to cover employee and family
• Reduce administration to process medical benefits
• Avoid systems in which unnecessary care leads to
higher expenditure e.g. PHI, MCO & Panel doctors
• Healthier workforce and higher productivity
• All companies have to contribute – ? tax rebate
43
44. Benefits to Health Care Providers
• Bridge the gap between remuneration and work
load among health workers in the public and
private sectors.
• Creates more effective demand for healthcare
• Re-address distribution of health staffs through
the provision of specific incentives.
• Defined standards of care
• Ensure appropriate competency through training
credentialing and privileging
• Reduce brain-drain, increase available pool of
providers 44
45. Benefits to the Nation
• Strengthen National Unity
- 1Care for 1Malaysia
• Ensure social safety nets for lower & middle income
- Reduce OOP at point of seeking care
- Address equity & access of care
- Ties-in with current policies of govt
• Contain rapid growth in health care cost
• Stimulate health care market – create more effective
demand for health care, multiplier effect
• Capitalise on liberalisation and global health care
market
• Reduce dependence on government
45
46. Cautions & Concerns
• Manage change effectively
• Need for strategic communication of issues and plan
• Longer term planning.
• Adequate time for phased implementation including
preparation of manpower, ICT & infrastructure
• Increase investments to effect change
• Acts and Regulations to enable change
• Current economic & global situation may not be an
ideal time for change but is an ideal time for
planning & preparing the groundwork
46