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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