1CARE healthcare transformation

1. PHC Financing for 1Care Dr Rozita Halina Tun Hussein Unit for National Health Financing Ministry of Health Malaysia 15 May 2011

2. Source : Health System Financing, WHO Report, 2010 Three Dimensions to Consider When Improving Universal Coverage and Financing HC

3. Providing Universal Coverage Changing ‘Money follows the facility’ to ‘following the patient’ Population: 138,900 MOH Hosp: 1 , Private Hosp: 0 Population: 445,900 MOH Hosp: 1 , Private Hosp: 0 Population: 140,200 MOH Hosp: 1 , Private Hosp: 0 Population: 96,600 MOH Hosp: 1 , Private Hosp: 0 Population: 385,400 MOH Hosp: 1 , Private Hosp: 0 Population: 34,700 MOH Hosp: 1 , Private Hosp: 0 Population: 56,000 MOH Hosp: 1 , Private Hosp: 0 Population: 84,600 MOH Hosp: 1 , Private Hosp: 0 Population: 72,500 MOH Hosp: 1 , Private Hosp: 0 Population: 90,000 MOH Hosp: 1 , Private Hosp: 0 Population: 97,900 MOH Hosp: 1 , Private Hosp: 0 Population: 447,200 MOH Hosp: 3 , Private Hosp: 4 Population: 162,800 MOH Hosp: 0 , Private Hosp: 0 Population: 109,900 MOH Hosp: 1 , Private Hosp: 0 Population: 74,600 MOH Hosp: 1 , Private Hosp: 0 Population: 40,400 MOH Hosp: 1 , Private Hosp: 0 Population: 188,100 MOH Hosp: 1 , Private Hosp: 0 Population: 87,400 MOH Hosp: 1 , Private Hosp: 0 Population: 200,300 MOH Hosp: 1 , Private Hosp: 0 Population: 64,100 MOH Hosp: 1 , Private Hosp: 0 Population: 19,500 MOH Hosp: 1 , Private Hosp: 0 Population: 30,900 MOH Hosp: 0 , Private Hosp: 0 Population: 28,900 MOH Hosp: 1 , Private Hosp: 0 Population: 34,600 MOH Hosp: 1 , Private Hosp: 0

4. Potential Health Care Markets PAHANG PULAU TIOMAN Rompin Pekan Kuantan Jerantut Lipis Temerloh Maran Bera Bentong Raub Population: 96,600 MOH Hosp: 1 , Private Hosp: 0 Population: 90,600 MOH Hosp: 1 , Private Hosp: 0 Population: 429,100 MOH Hosp: 1 , Private Hosp: 3 Population: 127,300 MOH Hosp: 1 , Private Hosp: 0 Population: 137,400 MOH Hosp: 1 , Private Hosp: 0 Population: 116,800 MOH Hosp: 1 , Private Hosp: 0 Population: 135,700 MOH Hosp: 1 , Private Hosp: 0 Population: 36,400 MOH Hosp: 1 , Private Hosp: 0 Cameron Highlands Population: 93,700 MOH Hosp: 1 , Private Hosp: 0 Population: 153,900 MOH Hosp: 1 , Private Hosp: 0 Population: 95,700 MOH Hosp: 0 , Private Hosp: 0

6. Targeting of Subsidies in Public Facilities Source: Rozita Halina, 2000

7. The Poor’s share of public health subsidy in Asia “ Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity

8. Poverty Impact of Health Expenditures Pen’s Parade in Malaysia

9. In absence of health financing reform, health system likely to become increasingly privatized… both in funding and service delivery…… Source: Dr Christopher James, WHO WPRO – Projections from MNHA data Future Direction of Current Health System In the future with no restructuring of the health system…..

10. 10 Leading Sources of Inefficiency Source: WHO, 2010 SOURCE OF INEFFICIENCY COMMON REASONS FOR INEFFICIENCY WAYS TO ADDRESS INEFFICIENCY 1. Underuse of generics medicine Lower perceived efficacy/safety of generic medicines; Develop costs benefits analysis 2. Use of substandard & counterfeit medicines Inadequate regulatory framework; weak procurement systems. Strengthen enforcement of quality standards ; enhance procurement systems 3. Inappropriate & ineffective use of medicines Inappropriate prescriber incentives and unethical promotion practices; inadequate regulatory frameworks. Separate prescribing & dispensing functions; improve prescribing guidance, information, training & practice; 4. Overuse/supply of equipment, procedures, investigations Supplier-induced demand; fee-for-service; defensive medicine Reform incentive & payment structures (e.g. capitation or DRG); develop & implement clinical guidelines. 5. Health workers: inappropriate or costly staff mix, unmotivated workers Conformity with pre-determined human resource policies & procedures; resistance by medical profession; inadequate salaries Undertake needs-based assessment & training; revise remuneration policies introduce performance-related pay

11. 10 Leading Sources of Inefficiency Source: WHO, 2010 SOURCE OF INEFFICIENCY COMMON REASONS FOR INEFFICIENCY WAYS TO ADDRESS INEFFICIENCY 6. Inappropriate admissions & length of stay Lack of alternative care arrangements; insufficient incentives to discharge; Provide alternative care (e.g. day care); alter incentives to hospital providers; 7. Inappropriate hospital size (low use of infrastructure) Inappropriate level of managerial resources, lack of planning for health service infrastructure development. Match managerial capacity to size; reduce excess capacity to raise occupancy rate to 80–90% 8. Medical errors & suboptimal quality of care Lack of guidelines, clinical-care standards and protocols; inadequate supervision. Undertake more clinical audits; monitor hospital performance. 9. Health system leakages: waste, corruption & fraud Poor accountability and governance mechanisms; low salaries. Improve regulation/governance, promote codes of conduct. 10. Inefficient mix/ inappropriate level of strategies for health interventions Inappropriate balance between levels of care, & or between prevention, promotion & treatment. Regular evaluation & incorporation into policy of evidence on the costs & impact of interventions, technologies, medicines, & policy options.

16. THANK YOU [email_address] Unit for National Health Financing (NHF) Planning & Development Division, MOH