dr azilina 1 care for ph conference 12july2011 11july 2011
DESCRIPTION
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.TRANSCRIPT
Towards Public Private Integration: Aspiration for 1Care
Dr. Azilina Abu BakarUnit for National Health Financing Planning and Development DivisionMinistry of Health
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6th PUBLIC HEALTH CONFERENCE 2011SEREMBAN
NEGERI SEMBILAN12TH JULY 2011
Presentation Outline
• Transforming the Health System– Service Delivery
– Financing
– Governance
– Phases of Transformation
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TRANSFORMING THE HEALTH SYSTEM
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
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Conglomeration of many features based on currently known global best practices, suitable for the needs of Malaysia now & into the future
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
• Personalised care
• Client satisfaction
• Reduce brain-drain
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Features of 1Care• Streamlined MOH → focused on governance, stewardship and
specific public health services, training and research• Malaysian Healthcare Delivery System (MHDS) – integrate the
autonomous public providers and private providers. • People register with a particular primary health care providers
(PHCP) - gatekeeper to higher levels of care• Publicly managed health fund - combination of general
government revenue and social health insurance (SHI), and tempered by minimal co-payments at point of seeking care
• Autonomous Single payer system, the National Health Financing Authority (NHFA) – set-up on a not-for-profit basis under the MOH - to pool and purchase personal health services from health care providers who are either public, NGO or private providers
• Government commits to higher levels of spending for healthcare• People commit to increased cost sharing through pooling of funds
and cross-subsidy
SERVICE DELIVERY
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SERVICE DELIVERY & PATIENT FLOW
National Health Financing Authority (NHFA)
Receivetreatment
Home
Patient
PHCP
Public Private
Admit
Referred
HospitalPublic
Private
MOH
Regional Health Authority
PHCA PHCA
PHCA
MHDS
Additional services (Out of pocket or private health insurance)
Return to referring Family Doctor
Primary Health Care Services (Public & Private Providers)
Thrust of health care services - strong focus on promotive-preventive care & early intervention
Every member of the population will be registered with a PHCP (public or private)
Family doctor & gatekeeper referral systemDevelopment of multi-disciplinary team with allied
health personnel carrying out more functions
Service Delivery in 1Care
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Secondary and Tertiary Healthcare Services (Public & Private Providers)
Patients referred by PHCPPublic hospitals will be coordinated on regional
networko Small hospital will have narrow range of serviceso Services with high end and expensive technology will
only be available in some regions – serve neighbouring services
Private hospitals & private specialised clinics will work together with the public sector to support integration of care
Service Delivery in 1Care – Secondary & Tertiary Care
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FINANCING
Financing Arrangements• Combination of financing mechanisms
– Social health insurance (SHI) + General government revenue (GGR) + 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 covers– Public health & other MOH activities
– PHC portion of SHI for whole population
– SHI premiums for registered poor, disabled, elderly (60 years & above), government’s role as employer
– Higher spending by govt – 2.9% (In 2007 govt spending 2.1%) 12
Operational Structure of SHI Program
Review, Payment
Providers(public & private)
InsuredMedical service
Insurance benefit
Co-payment
Contribution Claim, data
InsurerNational Health
Financing Authority (NHFA)
(planning, supervising)
Ministry for Health
Primary Healthcare (Public and Private Providers)Capitation with some broad case-mix adjustmentCo-payment for pharmaceutical and dental
Secondary and Tertiary Healthcare (Public and Private Providers)Financing through case-mix adjustments
o Global budget for public hospitals o Case-based payment for private hospitals and other
institutions
Incentives for providers to work in remote areas & achieving performance targets
Provider Payment Mechanism
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GOVERNANCE
MOH
• GOVERNANCE & STEWARDSHIP
• POLICY & STRATEGY FORMULATION
• STANDARD SETTING• REGULATION & ENFORCEMENT
• MONITORING & EVALUATION
• PUBLIC HEALTH• RESEARCH• TRAINING
MHDSSERVICE DELIVERY
•PRIMARY CARE
•HOSPITAL CARE
•OTHER SERVICES
FUNCTIONS WITHIN THE RESTRUCTURED HEALTH SYSTEM
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
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PHASES OF TRANSFORMATION
Steady State – 1Care for 1Malaysia
1Care: Full reform funded through GT & SHI
1Care: PHC reform funded through GT
1Care: Public Facility autonomy funded through GT
Phases of Health Sector Development
1Care: Strengthening of the current health system Phase 1
Phase 2
Phase 3
Phase 4
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Public private integration in 1Care:
Integration of public and private health care providers
Integration of levels of care
Integration of sources of financing
Others: standard setting, quality of care, enforcement, ICT etc
Summary
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THANK YOU
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