HEALTHCARE REFORMS IN MALAYSIA * 07/16/96 HEALTHCARE REFORMS IN MALAYSIA DR RIDZWAN BAKAR MBBS FRCP(LON) President Association of Private Hospitals, Malaysia e-mail: aphm@po.jaring.my http://www.hospitals-malaysia.org *

23 million people Dual system of health delivery: public vs private Public: 127 hospitals 32,000 beds Private: 224 hospitals 9,547 beds Doctors: public 8,723 private 6,780

* 07/16/96 STRENGTH OR WEAKNESS? 88.5% of the population is within 5km of a public health clinic or private practitioner dual system of healthcare delivery (public/private) almost total government subsidy for all services in public hospitals infant mortality rate: 7.9 per 1,000 livebirths (1998) maternal mortality rate:0.2 per 1,000 livebirths (1998) healthcare expenses: 4% of G.D.P. NOTES: - Regulatory role - PHFS Act *

FACTORS INFLUENCING GLOBAL TRENDS IN HEALTHCARE Emphasis on patient empowerment & responsibility shift to the wellness paradigm redressing of social inequities awareness of human rights the consumerism movement concern/awareness to the eco-systems & environs

* 07/16/96 Vision 2020 “By the year 2020, Malaysia is to be a united nation with a confident Malaysian Society infused by strong moral and ethical values, living in a society that is democratic, liberal and tolerant, caring, economically just and equitable, progressive and prosperous, and in full possession of an economy that is competitive dynamic, robust and resilient” *

* 07/16/96 Vision for Health Malaysia is to be a nation of healthy individuals, families and communities, through a health system that is equitable, affordable, efficient, technologically appropriate, environmentally adaptable and consumer- friendly, with emphasis on quality, innovation, health promotion and respect for human dignity, and which promotes individual responsibility and community participation towards an enhanced quality of life. *

GOALS OF THE VISION FOR HEALTH * 07/16/96 GOALS OF THE VISION FOR HEALTH focus on wellness focus on the person informed person self-help care provided at home or near to home seamless care tailored services effective, efficient, affordable services *

Some major healthcare reforms….

* 07/16/96 SMART PARTNERSHIP Necessary to maximise the utilisation of resources between private and public sectors 4 vital elements: shared vision agreement and commitment building on strengths actions to overcome weaknesses NOTES Win-win approach *

SMART PARTNERSHIP Some examples: * 07/16/96 SMART PARTNERSHIP Some examples: annual dialogues, meetings and seminars joint consultative panel meetings patient referrals to private sector facilities/services engagement of private specialists to public hospitals establishment of accreditation standards *

TELEHEALTH IN MALAYSIA "Malaysia's Telehealth initiative is not just about point-to-point teleconsultation. It incorporates the full spectrum of multimedia technologies to bring about benefits to all players in the health sector. It will transform the healthcare services and shape new relationships between people and their healthcare providers.” -Minister of Health,Malaysia.

TELEHEALTH FLAGSHIP APPLICATIONS * 07/16/96 TELEHEALTH FLAGSHIP APPLICATIONS the technology enabler to realise the Vision for Health part of the government-funded Multimedia Super Corridor(MSC) the integration of ICT and medical technology to deliver healthcare empowering the individual, family and community to manage their health *

The Telemedicine Flagship Applications The Mass Customised/Personalised Health Information and Education Project (MCPHIE) Lifetime Health Plans Project Continuing Medical Education (CME) Project Teleconsultation Project

Medical Records LIFETIME HEALTH RECORDS Access TELECONSULTATION Consumer Healthcare System Provider Consumer Health Information MCPHIE Provider Health Information CME

HEALTHCARE FINANCING The universal issues: * 07/16/96 HEALTHCARE FINANCING The universal issues: How to mobilise sufficient funds How to allocate How to control costs ____________________________________________ 2 possible Malaysian models: medical savings account social health insurance *

MEDICAL SAVINGS ACCOUNT * 07/16/96 HEALTHCARE FINANCING MEDICAL SAVINGS ACCOUNT 2 essential components: -a compulsory personal fund with balances -back-up insurance scheme NOTES i) remain the property of the individual ii) contributed by employer/employee iii) co-payment iv) Govt. continues to fund marginalised groups *

HEALTHCARE FINANCING SOCIAL INSURANCE * 07/16/96 HEALTHCARE FINANCING SOCIAL INSURANCE - contribution to a centralised health fund by employers and employees - government contributes on behalf of civil servants and marginalised groups - community-rated NOTES - equitable access to basic services - risk-pooling between sick & healthy, rich & poor - creates moral hazards (rationing needed) *

except from a vending machine." "Change is inevitable - except from a vending machine." -- Robert C. Gallagher

Thank You