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1Care for 1Malaysia Primary Health Care. Benefits 1CARE. Achieving enhanced universal coverage Integrating public and private sectors Ensuring an affordable and sustainable health care system for Malaysians - PowerPoint PPT Presentation
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1Care for 1MalaysiaPrimary Health Care
1
SJ /10Mar 2011
Benefits 1CARE 1. Achieving enhanced universal coverage2. Integrating public and private sectors 3. Ensuring an affordable and sustainable health care system
for Malaysians4. Providing equitable (in terms of access and financing),
efficient, and higher quality services; and better health outcomes for the Nation
5. Developing effective safety nets for the risk protection of vulnerable groups
6. Remodelling the health system to become more responsive to population needs
7. Enhancing client satisfaction 8. Promoting personalised and better managed care for the
individual and family9. Reducing the brain-drain of skilled personnel both
internally and internationally
SJ /10Mar 2011
2
1. Achieving enhanced universal coverage
•Every member of the population is registered (looked after) by a Primary Health Care Physician
•Urban and Rural
•All members of the population
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2. Integrating public and private sectors
•GPs and FMS will be integrated as one Primary Health Care Physician group
• In KKs public sector 1000 vs 3000 post
•200 plus 7000 GPs
3. Ensuring an affordable and sustainable health care system for Malaysians
•No payment at point of care
•Capitation : promotes preventive services and wellness and early case management
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4. Providing equitable (in terms of access and financing), efficient, and higher quality services; and better health outcomes for the Nation
•Capitation
•Benefit package from womb to tomb
•Pay for performance
5. Developing effective safety nets for the risk protection of vulnerable groups
•All members of the population▫ Rich covers the poor▫ Healthy covers the sick▫ Young covers elderly
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6. Remodelling the health system to become more responsive to population needs
•Health Package meeting needs of the population
•Covers all member of the population close to their home
•Providers of their choice
•Autonomous
•Risk sharing with providers
Core component• Restructured health care
delivery ▫ MHDS▫ Autonomous
• New financing mechanism • NHFA
▫ Capitation ▫ SHI
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SJ /10Mar 2011
MOH
• GOVERNANCE & STEWARDSHIP
• POLICY & STRATEGY FORMULATION
• STANDARD SETTING• REGULATION &
ENFORCEMENT• MONITORING &
EVALUATION• PUBLIC HEALTH• RESEARCH• TRAINING
MHDSSERVICE DELIVERY
•PRIMARY CARE
•HOSPITAL CARE
•OTHER SERVICES
NHFA
Independent bodies-Drug Regulatory Authority (DRA)-Health Technology Assessment (HTA)-Medical Research Council (MRC)-Patience Safety Council-Medical Device Bureau-National Service Framework (NSF) (Quality)-National Health Promotion Board- Food Safety Authority- Others
Professional Bodies-MMC-MDC-Pharmacy Board- Others
Figure 1: Functions Within the Restructured 1Care Health System
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SJ /10Mar 2011
MOH
STATE HEALTH DEPT
DISTRICT HEALTH OFFICE
DISTRICT HOSPITALS
STATE HOSPITALS
HKL & Special Institutions
PUBL
IC P
ROVI
DER
S
NHFA
State NHFA
PHC Board
NET
WO
RK
HEALTH CLINICS
PRIVATE PROVIDERS
PRIVATE PHCP (GPs)
PRIVATE HOSPITALS
SHI
Funding flow NHFA – part of MOH
Governance
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Receivetreatment
Home
Patient
PHCP
Public Private
Admit
Refer
HospitalPublic
Private
Return to referring PHCP
Additional services (Out of pocket or private health insurance)
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SJ /10Mar 2011
Community
Primary-care team: continuous,
comprehensive, person-centred care
Self-help group
Liaison community
health workerOther
Social services
Other
Community mental
health unitConsultant support
TB control centre
Diabetes clinicReferral for
multi-drug resistance
Referral forcomplications
Specialized care
Diagnostic services
CT Scan
Cytology lab
Diagnostic support
Papsmears
Environmental health lab Cancer
screening centre
Women’s shelter
Specialized prevention services
Waste disposal inspection
Mammography
Alcoholics anonymous
Training centre
Surgery
Maternity
Emergency department
Traffic accident Placenta
praevia
Hernia
Trainingsupport
Alcoholism
Genderviolence
NGOs
Hospital
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SJ /10Mar 2011
Primary Health Care Physician PHCP• Doctors• Solo or group• Independent contractors• Family doctor concept• Gatekeepers• Every individual is
registered to PHCP/ratio/special groups
• Trained medical doctors from accredited institutions
• Registered with the MMC and permitted to practice
• As specialist-National Specialist Register
• Over time only Primary Health Care Physicians are allowed to open a PHCP practice.
• Secondary care specialist -not be registered as PHCPs
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SJ /10Mar 2011
REGISTRATION OF PHCP
• Data base of both PHCP and population : matching population density to supply▫ Gatekeeper▫ Training and accreditation mechanism▫ Mechanism for payment, tracking and
monitoring▫ Mechanism for addressing disruption of
services Relocation Vacation Locum and substitute doctor
▫ Arrangements for with group practices Features to encourage group practices
• Patients▫ reliable mechanism for registering without
duplications▫ register according to residence, work place /
school▫ changing provider
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Population : 116,800Private Hosp. : 0, MOH Hosp. : 1
Population : 36,400Private Hosp. : 0, MOH Hosp. : 1 Population : 96,600
Private Hosp. : 0, MOH Hosp. : 1
Population : 90,600 Private Hosp. : 0, MOH Hosp. : 1
Population : 93,700Private Hosp. : 0, MOH Hosp. : 1
Population : 127,300Private Hosp. : 0, MOH Hosp. : 1
Population : 137,400Private Hosp. : 0, MOH Hosp. : 1
Population : 153,900Private Hosp. : 0, MOH Hosp. : 1
Population : 135,700Private Hosp. : 0, MOH Hosp. : 1
Population : 95,700
Population : 429,100Private Hosp. : 3, MOH Hosp. : 1
Distribution of primarycare doctors
WILAYAH PERSEKUTUAN KUALA LUMPUR & PUTRAJAYA
Daerah Klinik KerajaanBilangan klinik
yang ada Pegawai Perubatan
Klinik Swasta
Wilayah Persekutuan Kuala Lumpur 13 13 943
Wilayah Persekutuan Putrajaya 1 1 8
JUMLAH 14 14 951
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KEDAH
Daerah Klinik KerajaanBilangan klinik yang ada
Pegawai PerubatanKlinik Swasta
Kumpulan Sasar
Pegawai Kerajaan
Pesara Kerajaan Jumlah
Kota Setar 10 8 80 22,062 9,557 31,619
Kulim 9 6 38 6,851 2,980 9,831
Baling 5 4 6 1,330 1,103 2,433
Pendang 3 2 8 3,691 600 4,291
Bandar Bahru 3 2 0 541 456 997
Sik 2 1 3 4,143 345 4,488
Padang Terap 3 3 0 797 613 1,410
Yan 2 2 2 536 481 1,017
Kuala Muda 6 4 1 18,727 6,545 25,272
Kubang Pasu 8 5 1 17,870 2,348 20,218
Langkawi 3 2 11 3,435 483 3,918
JUMLAH 54 39 150 79,983 25,511 105,494
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SARAWAK
Daerah Klinik KerajaanBilangan klinik yang ada
Pegawai PerubatanKlinik Swasta
Kumpulan Sasar
Pegawai Kerajaan Pesara Kerajaan Jumlah
Daerah Betong / Betong 9 0 2 3,361 191 3,552Daerah Betong / Saratok 5 0 1 813 214 1,027Daerah Bintulu / Bintulu 5 0 24 3,103 828 3,931Daerah Bintulu / Tatau 4 0 - 27 17 44Daerah Kapit / Kapit 10 1 1 2,577 151 2,728Daerah Kapit / Belaga 6 0 - 39 37 76Daerah Kapit / Song 5 1 - 69 37 106Daerah Kuching / Kuching 13 3 136 45,287 10,236 55,523Daerah Kuching / Bau 2 0 2 482 404 886Daerah Kuching / Lundu 4 0 2 479 160 639Daerah Limbang / Limbang 4 0 3 2114 372 2486Daerah Limbang / Lawas 9 0 3 994 205 1,199Daerah Miri / Marudi 21 0 1 335 59 394Daerah Miri/Miri 8 3 42 7,810 1,490 9,300Daerah Mukah / Dalat 2 0 - 30 66 96Daerah Mukah/ Daro 8 0 - 756 47 803Daerah Mukah/Matu 6 0 - 77 53 130Daerah Mukah 9 0 3 1,346 280 1,626Daerah Samarahan / Samarahan 6 0 6 2,006 15 2,021Daerah Samarahan / Serian 8 0 3 536 537 1,073Daerah Samarahan / Simunjang 6 0 - 156 89 245Daerah Sarikei / Julau 6 1 8 63 37 100Daerah Sarikei / Meradong 6 1 - - - 0Daerah Sarikei / Pakan 4 0 - 38 5 43Daerah Sarikei 2 1 - 1,771 588 2,359Daerah Sibu / Kanawit 4 0 1 113 146 259Daerah Sibu / Selangau 4 0 - - - 0Daerah Sibu / Sibu 4 2 48 5,137 2,064 7,201Daerah Sri Aman / Lubuk Antu 6 2 - 247 33 280Daerah Sri Aman / Sri Aman 7 1 3 2,484 754 3,238JUMLAH 193 16 289 82,250 19,115 101,365
Benefit package for PHC
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•Child health•Adolescent health•Women’s health •Men’s health•Family planning•Antenatal care •Postnatal care •Elderly health •Prevention /promotive •Curative care
•Diagnostic Services•Radiological•Pharmacy•Pathology
KKs will become Super PHCP Clinic
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Primary Health Care Physician“scope of practice”They are responsible for maintaining optimal health of their ‘registered population’ to provide “essential health package” through:•Screening and health assessment from of “womb to tomb”•Health promotion and counseling /patient education•Prevention activities (paps smear, immunization …)•Diagnosis / differential diagnosis•Intervention and treatment of common illness and medical conditions •Careplans , long-term care and follow-up•Referral•Data collection for patient and population analysis•Participate in CPDs / CMEs
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Primary Health Care Physicians“operations”•Registers designated population•Receives reimbursement based on per capita for the
provision of essential services•Collects patients data and submit data and information as
required•Compliance to all standards and guidelines as well as
service targets•Commission secondary care from hospitals for patients
where relevant (at what rate?)•Other services may include :
▫ Emergency services and Call Centres▫ School health Services▫ Rehab Services▫ Flying Doctors Services
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FUNDING & INCENTIVES
•Funding through capitation•Case-mix methodology will be employed•Additional Incentives will be provided for:
• Specialist qualifications• House calls• Additional payments for exceeding stipulated
performance of benchmarks• Funding training and topping up courses• Those working in rural or unpopular locations• Those who treat more chronic patients
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CO-PAYMENT ?
•Co-payments will be nominal•To address abuse / moral hazard and to promote
responsible use of services•Likely services are for medicine and dental
services.•Need to identify range and scope of services like
duration, type and entitlement•Very sensitive issue and require strong social
advocacy •Mechanism for waiver for those who cannot
afford and those with entitlement
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Benefits to the Nation
• Strengthen national unity
• Stimulate the health care market
• Reduces unnecessary dependence on government fund
• Financial safety nets for lower and middle income groups
• Contain the rapid growth in health care cost and inflation
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SJ /10Mar 2011
Benefits to the people
• More access to providers • Care nearer to home• No payment at point of
seeking care (during hardship)
• Vulnerable group better protected
• Quality care• Client satisfaction• Greater health outcomes
for community
Benefits to the Providers
• Bridge gaps remuneration and workload
• Optimize HR both sectors
• Encourage serving in rural areas
• Appropriate level of competency and standard of care
Next agenda •Develop full blueprint within 2y▫Building blocks
Mapping of population & providers Professional & care standards Benefit packages Monitoring & Evaluation
•Phased implementation, evaluation and monitoring
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SJ /10Mar 2011
TOR TWG PHC
1.Study the existing service provision and perform mapping of gaps
2.Develop draft framework for PHC delivery3.Develop phases for implementation▫ awareness and motivation / buy-ins▫ essential universal package▫ standards, accreditation, credentialing
and privileging
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SJ /10Mar 2011
TOR TWG PHC Develop phases for implementation (cont’d)
▫ Health informatics Registration of providers and population
▫ Registration list of Primary Care Providers to the Population
▫ Propose Organisational and Management Structure of the various levels
▫ Develop clear roles and relationship of Primary Care related NGOs & other Organizational Support Systems
▫ Develop indicators to monitor risks or impact
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SJ /10Mar 2011
TOR TWG PHC
4.Perform risk mitigation for each phase▫ Identify, characterize, and assess threats (political and
resources)▫ Assess the vulnerability of critical implications to specific
threats (scope too big or too small, cost too high etc)▫ Determine the risk (i.e. The expected consequences of
specific types of attacks on specific assets)▫ Identify ways to reduce those risks▫ Prioritize risk reduction measures based on a strategy
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SJ /10Mar 2011
1Care for 1Malaysiamandate: PHC : Equity, Universality, Solidarity
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SJ /10Mar 2011
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