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FUTURE OF HEALTH CARE FINANCING IN MALAYSIA

PRESENTATION OUTLINE. Scope of Healthcare FinancingAimObjectivesProblem StatementsCurrent IssuesOptions PrinciplesNHFABenefit PackagesConclusion. SCOPE OF HEALTHCARE FINANCING. Revenue CollectionSource of FinancingStructureCollection mechanismPooling of FundsManaged by an intermediary bodyPurchasing

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FUTURE OF HEALTH CARE FINANCING IN MALAYSIA

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    1. FUTURE OF HEALTH CARE FINANCING IN MALAYSIA DR ABD RAHIM MOHAMAD PLANNING & DEVELOPMENT DIVISION MINISTRY OF HEALTH 18TH JANUARY 2009

    3. SCOPE OF HEALTHCARE FINANCING Revenue Collection Source of Financing Structure Collection mechanism Pooling of Funds Managed by an intermediary body Purchasing – from health providers

    5. Aim of Healthcare Financing Provision of accessible healthcare and peace of mind Comprehensive healthcare protection Improve health through prevention More choice of service Right mix of financing option to deliver health care Government will still be main player Complemented by NHI

    6. 6

    7. WHY DO WE NEED CHANGE

    8. PROBLEM STATEMENTS Issues raised concerning public medical services Long waiting time Postponed cases Overworked staff in 3rd class wards – impersonal….. Lack of choice Inadequate amenities Issues raised concerning private sector Exorbitant charges Increasing private insurance premium adverse selection vs cherry picking Appropriateness of care vs. overservicing

    9. PROBLEM STATEMENTS 2 National Health Account Study 2006 Out-of-pocket (OOP) spending in Malaysia is high (40% of THE) RM 9805 million OOP spending in developed countries is low <20% Health Expenditure trend in Malaysia Equity High cost private healthcare– available only to those who can afford, insured or covered by employer Fairness in financing – high OOP payment (inequitable financing and can lead to impoverishment due to catastrophic health expenditure) Economics More efficient use of resources (especially HR)

    14. Per Capita Spending on Health, 1997-2006 (RM, Nominal Value)

    18. Private Health Expenditure (PHE) (MNHA 2006) Total PHE: RM 13,393 million OOP: RM 9,804 million (73%) OOP from 2003 to 2006: rising trend (quantum)

    19. 7. Challenges of globalization & liberalization: Cross border flow (human, life-stock, etc) Transmission of diseases Cross border transactions and practice – ethics, credentials and quality Foreign workers Utilizing subsidised services Health insurance coverage not mandated currently Outsourcing / offshore activities Health tourism – competing with local consumers for resources

    20. Health Expenditure Trends in Malaysia (MNHA 2006) Increasing Total Expenditure of Health (TEH) Plateauing TEH as % of GDP OOP rising Private Expenditure exceeded public expenditure since 2004

    21. WHERE DO WE GO FROM HERE?

    22. OPTIONS Change present system Introduce NHI through community rating Further integrate public-private health sectors AND / OR Strengthen present system Improve efficiency and quality of public and private sectors Further regulate private sector to improve quality and contain cost

    23. Financing Strategy Introduce a National Health Financing Mechanism & restructuring of MOH hospitals and clinics. Develop National Health Insurance with government intermediary body (National Health Financing Authority) as a single fund manager.

    25. PROPOSAL: NATIONAL HEALTH FINANCING AUTHORITY (NHFA)

    27. PROPOSAL: - PREMIUM LEVEL & INCENTIVES AFFORDABLE & ACCEPTABLE PREMIUM According to ability to pay (Progressive) GOVERNMENT ASSISTANCE For the disadvantaged group.

    30. ROLL-OUT OF NHFM Recommendations of previous consultants Adopt incremental approach E.g. Population coverage (formal vs. Informal sector) Service coverage (outpatient vs. inpatient) Accessibility (public vs. private) Path dependent – while adopting good practices of other countries Implement certain activities during 9MP Case-mix Accuracy of Diagnosis Unit costing Social Advocacy (meeting with stakeholders)

    31. Assurance Government will still be main source of healthcare fund Government will subsidise the disadvantaged. MOH will monitor the following: Access Utilization Quality and safety

    32. Press comments on Proposed Privatisation of IJN by IJN staff “Hospital staff deny demand for higher pay linked to proposal. Medical consultants at the National Heart Institute (IJN) have reiterated their commitment to serve IJN in its current form” “However, the perception that the privatisation proposal is in response to demands for higher remunerations by its medical staff is misconceived and must be corrected accordingly to safeguard and preserve the trust placed upon us by our patients” The Star, 20th December 2008

    33. Press comments by IJN pioneer surgeon “It (IJN) was never meant to be commercial institute. It was meant to be a centre of research, a premier academic institute.” “Therefore, I am rather suspicious of the privatisation idea. It is not as if the hospital is not doing well. Ideally, a health institution such as IJN should be physician-led” Tan Sri Dr. Yahya Awang The Star, 21st December 2008

    34. CONCLUSION Implementation of the NHFM should be: Incremental Path Dependent Most appropriate for the country (Creative and Innovative)

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