1CARE 1AIM: Evidence to Policy

Dato Dr. Maimunah Abdul Hamid

D ep u ty D ire ct o r- G e ne r al o f H e al th (R e se a rc h & Tec h Su p p or t) calni Min is tr y o f H ea lt h, Ma la ys ia 5th N at ion al C on f eren ce f or Cl in ica l Res earc h

Presentation Outline
Translating policy directions into value-

added research
Evidence-based policy-making for 1Care 1Care Concept Evidence to support the 1Care blueprint

development
Evidence needs to ensure evidence-based

(NC CR 2 01 1)

policies & tracking 1Care targets

2 3 J un e 2 0 1 1 The S un w a y C o nv en t ion C e n tr e, Se la n g or 1 2

Institutional strengthening for research

AMAN AT YAB PM in 2005

Malaysians must be prepared to. pay more . health and education a scheme .. quality service. On a review of the health care system, Najib and the Government was considering on a sustainable basis, amid increasing costs and demands. The question now is whether we can continue with the present situation or have some sort of scheme. Najib said adding that he would explain more about the health care system review up f or l es s s ubs idy , say s soon. (S unda y S tar , 6 Mar ch 05)

Translating Government Policy Directions into Valueadded Research for 1Care

Gear N ajib.

Discrepancy in Health Outcomes by Geographical Location

Evidence-based Policymaking for transformation

% H ea lt h I nd i ca tor s : Pre va le n ce b y g eo g ra ph i ca l l o cati o n U rb an R u ral

H ist or y o f rece nt i ll nes s 2 2.4 25. 5 In cide nce of a cut e dia rrho ea 4. 7 5. 5 D iab et es M el li t us 1 2.2 10. 6 H ypert en sio n 2 9.3 36. 9 Sm o kin g am ong ad ol escen ce 5 2. 3 4. 9 6

Public & Private Sector Resources and Workload (2008)

11% 38% 41% 78% 74% 55% 45%

In the future with no restructuring of the health system.. In absence of health financing reform, health system likely to become increasingly privatized both in funding and service delivery
20 0 4 20 0 9 2 01 8 GGH E 5 0% 4 5% 35 % Pvt H E 5 0% 5 5% 65 %

S ourc e: H eal th MOH

Informati c s 7

Center

(H IC),

- P v tO OP 40% 4 7% 8 - P v tO t her 15% 1 7% S our c e: Dr Chri s topher J ames ,W PRO Proj ec ti ons from MN H A data WH O

1Care Concept
1Care is the restructured integrated health system that is responsive and provides choice of quality health care, ensuring universal coverage for the health care needs of the population based on solidarity and equity

1Care Concept

1Care Concept

Features of 1Care
Streamlined MOH focused on governance, stewardship & specific public health services, training & research Autonomous Malaysian Healthcare Delivery System (MHDS)- integrated public & private sector providers. Emphasis on primary health care. Gatekeeper to higher levels of care Publicly managed health fund - combination of general government revenue & social health insurance (SHI), & may be tempered by minimal co-payments at point of seeking care Single payer system, the National Health Financing Authority (NHFA) set-up on a not-for-profit basis under the MOH Government commits to higher levels of spending for healthcare People commit to increased cost sharing through pooling of funds and cross-subsidy

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Presentations to YAB PM &

11 August 2009 - 1Care for 1Malaysia concept information requested by the Prime Minister and EC:

Total Expenditure on Health (TEH)

- i n col lab ora ti on w it h Dr C hri sto ph er Jame s, H ea lt h Eco nom ist , W HO

ii. Focus Group Discussion with various stakeholders

- in c oll abo rat io n w it h Prof Soo nma n Kwo n, Seo ul N at io nal Un ivers it y

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2009 base year

Summary of Financial Projections

No Change
He alt h syst e m l ike ly t o be i n cr eas i ng l y d ic h oto m ou s exp en dit ur e ero s io n of t h e pu bli c hea lt h syst em (20 09 )
P HI 7%

PH I , 9% 8% Ge n Ta x

48% C orp 7% G en T ax O O P4 0 So cso & EP F, 0.4 % So cso &

Ca n c on ta i n g ro w th of to t al h ea lt h ex pen di tu re b ase d on pu bli c sect or ma na gem ent an d pru den cy Sav in g s ar e more i n p ri va te sp en d i ng

G en Ta x Pu b lic

(20 18)
G en T ax 3 7% 3 4% 16

Impact Analysis
A) Assessing impact on the

General consensus among funders, was favorable Most stakeholders were in favour of the delivery concept

O v er a ll a b ility to pa y W illin g n es s t o p a y I nf or ma l se ct or I mmig ra n t po p u la tio n O u tc om e s E qu it y in Acc e ss to H e al th W o rk fo r ce mo b ility L a b ou r ma r ke t

I mp ac t on Med ic al To ur ism

having to pay
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C o st of I ns tit ut io na l Ch a n ge

Blueprint Development : Technical Working Groups (TWGs)

Evidence to support the 1Care blueprint development

Technical Working Groups (TWGs) Evidence & data

1 . Pri m ary H ea lt h Ca re 2 . Sec o nd a ry & T er ti ary C ar e 3 . He al th F i n an ci n g 4 . G o ver na n ce & St ew ard s h ip 5 . L eg is l ati o n, Re g ul ati o n & E nfo r ce men t 6 . Hu m an R es o ur ce 7 . IC T 8 . Pu bl i c He al th 9 . O ral He al th 1 0. Ph ar mac eu ti ca l Se rvi c es 19 Ad d iti o n al gr ou p Stra teg i c Co m mu n ic ati o n 2 0

On-going research to support blueprint development

7 research areas identified since 2008 only 1 pending, 1 done 1. Health Facility & Services Survey & Population profiling:
Ma pp in g h e alt h fa c ilitie s & s e rv ice s a ga in st h e al th c ar e n ee des v fo r stme n t g cy d el op ra te ic p ol i 2. Health Care Demand Analysis: U tilis a tio n & eq u ity a n al ysis , mo de ls & po lic y sim ula t ion f o r 1C a re 3. Cost Analysis: u n it c o st ing fo r ou t -p a tie n t & a mb ul at o ry se r vic e s in pu b lic h os pi ta ls 4. Analysis of Financial Arrangements & Expenditures: in pu b lic & p r iva te se ct or s 5. Community Perception: o n h e al th c ar e d el ive ry s ys te ms

Evidence needs to ensure evidencebased policies & tracking 1Care targets: monitoring & evaluation

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Targets of 1Care for 1Malaysia

P op ula t io n le v el re se ar ch

Sources of data
Pa t ie nt o r or g a nisa t io n l ev el r ese a rc h Care Pr oc ess es D ai g n o sis Th er a p y C linic a l se r vic e s Pr o ce d ur e s Indiv idual : clinical out come 1. Intermedi ate (eg. BP c ontrol ) O ut -p a tie n ts 2. Ul ti mate (eg M ortal i ty, Q O L, R leh tati on) i abi In -p a tie n ts Se rv i ce O utp uts C entr e level per for mance 1. Eff ec ti v enes s 2. Eqty ui 3. Effi c i enc y 4. R esp onsi v enes s

R eso ur ce D isease b urd en in cidence & Input s p revalen ce P ercep tion on Fina n c ig n h ealthcar e system U tilisat ion o n Man p o we r h ealthcar e system ( incl fin ancial Fa cilit ies ar ran gemen t) Dr u g s De vci e s

DR FOSTER INTELLIGENCE, Imperial College

Using Research Evidence to Improve Health System Performance E.g. from NHS, UK

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Dr Foster Report Card

Dr Foster Report Card

Developing Evidence-based Clinical Practice Guideline

100

Regional Comparative Analysis :

Access to Doctor or Nurse When Sick or Needed Care
Sam e- o r ne xt-d a y ap p o in tm en t
Pe r c ent * 93 78 7 5 65 50 45 70 62 66 72 45 33 25 14 1 7 16 55 0 2 8 28 2 5 57 57

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W ai ted si x d ays o r m or e

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Z E I Z UK US E Z UK US O AU C AN FR ER S G NETH NZ SWW NO R S AU S CA N FR NETH N RSW W I GER N S * Bas e: An sw ered ques ti on. 30 Sour ce: 2010 C om monw eal th F und Internati onal H eal th Pol i c y Sur vey i n E l ev en C ountri es .

Wait Time in Emergency Room Before Being Treated

Pe r ce nt

Institutional strengthening for

52 50 33 25 3433 16 43 CA N F R I S WE AUS IZUKUS G ENRET H N O R S W NZ 31 20 12 11

Sourc e: 20 10 Comm onweal th F und Internati onal H eal th Pol i c y Surv ey inEl

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Why health research system needs to transform?

to be a high income nation Breakdown walls to improve efficiency & reducing duplication of

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What shall we do?

1. Improving governance

Leadership Defined career structure (entry as trainee, researcher &

More focused Avoid duplication & improve efficiency Better synergy

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