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Presentation Outline
Translating policy directions into valueadded research Evidence-based policy-making for 1Care 1Care Concept Evidence to support the 1Care blueprint development Evidence needs to ensure evidence-based policies & tracking 1Care targets Institutional strengthening for research
2
% Rural
25.5 5.5 10.6 36.9 4.9
6
802
38%
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
2018 35% 65%
47% 17%
Source: Dr Christopher James, WHO 8 WPRO Projections from MNHA data
41%
No. of Hospitals
78%
143 41249
74%
400 200 0
2199310 12081
45%
Doctors (excl. Houseman) Health Expenditure (RM billion) (2007) Public Private 0%
13.54
20%
GGHE PvtHE
-PvtOOP -PvtOther
1Care Concept
1Care Concept
Streamlined MOH focused on governance, stewardship & specific public health services, training & research
MOH MHDS
Patient
PHCP
Public Private
Referred Admit
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
11
Receive treatment
PHCE PHCE PHCE
Home
People commit to increased cost sharing through pooling of funds and cross-subsidy 12
20 09 20 10 20 11 20 12 20 13 20 14 20 15 20 16 20 17 20 18 20 19
GGHE pc PvtHE pc
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
Features of 1Care
ii.
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Financial Reforms
Current system
(2009)
PHI 7%
Pvt Corp & Others 7% Gen Tax 44% OOP40 % Socso & EPF, 0.4%
PHI, 9%
No Change
(2018)
OOP 48%
Socso & EPF, 0.0 0%
1Care
(2018)
SHI - Pvt contribution 34% SHI Gen Tax 37%
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15
Impact Analysis
A) Assessing impact on the Population
Overall ability to pay Willingness to pay Un-insured population Informal sector Immigrant population
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Primary Health Care Secondary & Tertiary Care Health Financing Governance & Stewardship Legislation, Regulation & Enforcement Human Resource ICT Public Health Oral Health
2. 3. 4. 5. 6. 7. 8. 9.
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2. Health Care Demand Analysis: Utilisation & equity analysis, models & policy
simulation for 1Care
Evidence needs to ensure evidencebased policies & tracking 1Care targets: monitoring & evaluation
3. Cost Analysis: unit costing for out-patient & ambulatory services in public hospitals 4. Analysis of Financial Arrangements & Expenditures: in public
& private sectors
21 22
Sources of data
Healthcare System level
(public and private) Including M&E
Resource Inputs
Financing Manpower Facilities Drugs Devices
Care Processes
Diagnosis Therapy Clinical services Procedures
Service Outputs
Out-patients In-patients
Where are the data? NHMS= National Health Morbidity Surveys; BOD = burden of disease report; MNHA=Malaysian National Health Account; PR =Patient registries; HSI =Healthcare statistics initiatives (Drugs, Device/Med. Technology, Healthcare Workforce & Facilities surveys); HRMIS= Human Resource Management Information System, HIC =Health Informatics Center , CD =Communicable disease, NCD =Non communicable diseases Modified from Lim TO, 2007
Using Research Evidence to Improve Health System Performance E.g. from NHS, UK
25
30
75 65 50
62 45
66
57
28 25 17 16 5 5
NZ NO R SW E
25
14
19 2 8
UK US
0
NZ NE TH NO R GE R CA N FR UK
NE TH
SW IZ
SW E
GE R
CA N
AU S
US
AU S
FR
* Base: Answered question. Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries. 30
SW IZ
75
52
50
46 33 34 33 20 33 29
44 34 26 16 17 4 3
TH NZ R W E N O
25
0
G E R N E TH N Z N R FR S IZ
N S R NE
SW IZ
UK
W E
US
FR
N O
SW
G E
AU
CA
AU
C A
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
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our dream:
MOH Scientific Committee for Medical Research Scientific Advisory Committee
Office of Administrative Management:
General Administration Human Resource Finance & Procurement Facility Management
1NIH
Office of Research Ethics and Policy Office of Program Coordination and Strategic Initiatives Office of Research Management, Evaluation & Technology Transfer & commercialization Office of Communications and Public Liaison
MOH
IHM
CRC
IMR
IKU
IHSR
IHBR
Data Warehouse
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our dream The Proposed 1NIH must be BETTER than current model
Strengths of current system will be preserved Stronger supportive role Separation of administrative & technical functions Better integration of research activities More responsive to MOH needs & expectations through increased autonomy
Artists impression
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our AIM: Evidence to Policy & Practice WE CAN make better contribution to health
Julio Frenk
Former Mexican Minister of Health
Better interventions Informing decision & policy making Internalisation by individuals changing behaviours & empowering people
THANK YOU
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