dr rozita halina tun hussein public private intergration in malaysia past and current
DESCRIPTION
This MOH presentation shows the extent of privatisation in Malaysian public healthcare. 1Care will completely privatise every other aspect of public healthcare. In effect, Malaysians will be living in a "no money, no health" system like America.TRANSCRIPT
Public-Private Integration in Health Care Delivery - Past and Present
Dr Rozita Halina Tun HusseinDeputy Director
Unit for National Health FinancingPlanning and Development Division
Ministry of Health, [email protected]
Symposia on Public Private IntegrationPublic Health Conference
12th July 2011
Theoretical Framework
Integrated Health Services• DefinitionThe organisation and management of health
services so that ...– people get the care they need,– when they need it,– in ways that are user-friendly,– achieve the desired results and– provide value for money
(WHO Tech Brief No.1, May 2008)
• Means to an end, not an end in itself
Integrated Health Services• User – health care that is seamless, smooth and easy to
navigate continuity of care, health worker aware of patient’s health as a whole, not just 1 aspect
• Provider – separate technical services and administrative support systems are provided, managed, financed and evaluated either together
- Important with increasing specialization• Senior health managers and policy makers – decisions are not inappropriately compartmentalised, consider different technical programmes, taking into account the network of public, private and
voluntary health providers, inter-sectoral opportunities
Role of the Private Sector in Malaysia
• Malaysia has always had private health care– During colonial times prior to Independence– During economic boom– Now as engine of growth– Future – greater integration and synergism
• Government health care delivery has been stronger than private health care sector, appreciate private sector growth
• Idea of public-private integration is not new in Malaysia (Acknowledgment – Relevant MOH colleagues)
Past Efforts in Public- Private Integration
PAST: Reduction of Maternal Mortality
Working with Traditional Birth Attendants (TBA)• 1960s and 70s – strong political commitment to
reduce MMR and ensure Maternal and Child safety at delivery
– Recognise the time lag for government to train own skilled birth attendants (SBA) such as mid-wives
– Recognise public’s preferences at that time• Registration of TBA• Training of TBA
(Acknowledgment – Yadav, 1987 & Dato’ Dr Narimah Awin)
PAST: Reduction of Maternal Mortality
• Monitoring and supervision of TBA after training– All mothers using TBAs screened at health centres –
assessed for risk factors – Public health nurse kept records of all mothers and
deliveries managed by TBAs– Sterile midwifery kits and medicines exchanged at
the health centres for free– Monthly meetings between TBAs and public health
nurses– Dual attendance of deliveries – government midwives
cut umbilical cords
• Improvement in mortality rates particularly MMR
PAST: Quality Improvement Initiatives• QA/QI – strong focus of MOH• Sensitisation and training of private hospitals• 1996/97 – voluntary national accreditation
programme – MSQH – same standards for both public and private hospitals– Pioneered by MOH, Association of Private Hospitals
Malaysia (APHM) and Malaysian Medical Association (MMA) – contributed funds to run programme
– Good cross-fertilisation and learning – surveyors are from both public and private hospitals
• Benchmarking of private hospitals – NPC, MOH• APHM annual conference – participation of
government & MOH – QI, clinical governance, corporate governance
Facilitating Environment
Economic Transformation
Program (ETP)
• New Economic Model – a high income, inclusive and sustainable nation•March 2010
Government Transformation
Programme (GTP)
• effective delivery of government services•January 2010
Transforming the Nation towards Developed Nation Status by 2020
1MALAYSIAPeople First, Performance Now
April 2009
10th MP (June 2010) + 11th MP
1Care for 1Malaysia
Transforming The Nation
13
Public Sector Transformation1. Create a citizen-centred public service
2. Reduce size of government – lean government, reduce overlapping roles and functions
3. Improve skills of the workforce
4. Focus more on results oriented spending, look into areas of cost-savings and efficiency of resource use
5. Strengthen govt’s facilitative role - collaborate with the private sector and support private sector growth
6. Expand private delivery of public services – allow competitive access to public funding e.g. in health care, technology support
7. Enhance public agencies to drive growth
1. Specialising the economy - high value-added, innovation-based, strong growth potential, GTP → enabling environment → internally-competitive, appropriate soft & hard infrastructure knowledge economy
2. Improving the skills of the workforce – specialised & skilled labour moving up the value-chain, increase productivity, social and private returns to education & skills upgrading
3. Making growth more inclusive – Strong inclusiveness policies, equity, improved social protection → helping household cope with poverty through health care
1. 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 & inclusiveness 14
Economic Transformation Programme
National Key Economic Areas (NKEAS)NKEAs - drivers of economic activity that has the potential to
directly and materially contribute a quantifiable amount of economic growth to the Malaysian economy
Current Efforts in Public- Private Integration
PRESENT – Govt or MOH Investments• Medical tourism - MHTC– 1-stop centre on hc travel
– Private hospitals - at least national level accreditation– Government incentives – tax exemptions on private capital
investments for medical tourism• Outsourcing with Contractual agreements (SLA) - e.g.-
– 5 hospital support services and catering of food– Pharmaceuticals with Hospital Pharmacy Information System
(drug inventory programme for MOH hospitals)– Health care services
• when machine breakdowns• when services are not available e.g radiotherapy, urology• when public services are inadequate – dialysis
– ICT system development and support – HMIS, THIS• Buying available private hospitals – Sabah and Sarawak
Private Financing Initiatives (PFI)– Research arrangements with industry
• Randomised Control Trials (RCTs) - CRC• Transgenic mosquitoes for Dengue control – IMR
– Development of new facilities – MOH RFPs• Private sector build & maintain - MOH rent first then transfer
ownership to government – Women and Child Hospital • Land swap – old MOH institutions on prized commercial land –
private sector build new complexes on private or MOH land – 1NIH research complex, Pharmacy complex
– Entry Point Projects (EPP) of NKEA Healthcare and ICT• Hospital Information System, Teleprimary Care and Oral Health
Information System for MOH facilities• Private health insurance for foreign workers• Training schools – John Hopkins with Perdana University
PRESENT – Private Sector Funds
Training of medical students/nurses/allied health • from private colleges in public facilities
Methadone programme • authorised GPs and later community pharmacists• govt provides methadone FOC• patients pay GPs consultation fees
Repeat medicine delivery via courier services • Pos Malaysia Sdn Bhd – RM5• patient’s choice and payment, CSR – 5% profits goes to
fund cancer drugs for those in need
PRESENT – Enhancing Service Delivery
Patient’s purchase of implants and prosthesis• Public providers facilitate – introduce patients to sales reps
for patient’s ease , having specific shops in hospitals• Extending financial support for eligible low-income
households to purchase artificial limbs and prosthetics. • Improve access to prosthetics by setting up at least one
prosthetics centre per state.
Locum arrangements • public doctors in private facilities
Contracting of private providers in public facilities• in PHC clinics and hospital on sessional basis• traditional and complementary care (TCM)
PRESENT – Enhancing Service Delivery
Current Challenges
22
Overview of the MalaysianHealth System
12081
2199310
41249
143
38.4
802
10006
754378
11689
209
62.65
6371
0% 20% 40% 60% 80% 100%
Doctors (excl. Houseman)
Admissions
Hospital Beds
No. of Hospitals
Outpatient visits (m)
Health clinics (with doctors)
Series1 Series2
Public & Private Sector Resources and Workload (2008)
23Source: Health Informatics Center (HIC),MOH
11%
38%
41%
78%
74%
55%
PUBLIC PRIVATE
Challenges in Quantity and Severity
Manpower constraints(i) Absolute numbers
(ii) Mal-distribution - between public-private- within the public sector
24
2009 doctor: population ratio - 1:1,255 (excluding houseman)New doctors registered with MMC1 - 1,4512 - 2,4133 - 3,172Target for Malaysia – 1:600
About 70% of patients managed by public sector specialists were complex cases compared with 25% of similar cases by
private sector specialists. Recently - backlash of Health Tourism
MOH primary health care providers treated more chronic illnesses compared to private GPs – treat the ‘healthy ill’(Source: PHC ACG study with Johns Hopkins, 2007)
THANK YOU
Dr Rozita Halina Tun [email protected]