This MOH presentation shows the extent of privatisation in Malaysian public healthcare. 1Care will completely privatise every other aspect of public healthcare. In effect, Malaysians will be living in a "no money, no health" system like America.

1. Public-Private Integration in Health
Care Delivery - Past and Present
Symposia on Public Private Integration
Public Health Conference
12th July 2011
Dr Rozita Halina Tun Hussein
Deputy Director
Unit for National Health Financing
Planning and Development Division
Ministry of Health, Malaysia
rozitahalina@moh.gov.my

2. Theoretical Framework

3. Integrated Health Services
• Definition
The organisation and management of health
services so that ...
– people get the care they need,
– when they need it,
– in ways that are user-friendly,
– achieve the desired results and
– provide value for money
(WHO Tech Brief No.1, May 2008)
• Means to an end, not an end in itself

4. Integrated Health Services
• User – health care that is seamless, smooth and easy to
navigate continuity of care, health worker aware of
patient’s health as a whole, not just 1 aspect
• Provider – separate technical services and administrative
support systems are provided, managed, financed and
evaluated either together
- Important with increasing specialization
• Senior health managers and policy makers –
decisions are not inappropriately compartmentalised,
consider different technical programmes,
taking into account the network of public, private and
voluntary health providers, inter-sectoral opportunities

5. Role of the Private Sector in Malaysia
• Malaysia has always had private health care
– During colonial times prior to Independence
– During economic boom
– Now as engine of growth
– Future – greater integration and synergism
• Government health care delivery has been
stronger than private health care sector,
appreciate private sector growth
• Idea of public-private integration is not new in
Malaysia (Acknowledgment – Relevant MOH colleagues)

6. Past Efforts in Public-
Private Integration

7. PAST: Reduction of Maternal
Mortality
Working with Traditional Birth Attendants (TBA)
• 1960s and 70s – strong political commitment to
reduce MMR and ensure Maternal and Child safety
at delivery
– Recognise the time lag for government to train own
skilled birth attendants (SBA) such as mid-wives
– Recognise public’s preferences at that time
• Registration of TBA
• Training of TBA
(Acknowledgment – Yadav, 1987 & Dato’ Dr Narimah Awin)

8. PAST: Reduction of Maternal
Mortality
• Monitoring and supervision of TBA after training
– All mothers using TBAs screened at health centres –
assessed for risk factors
– Public health nurse kept records of all mothers and
deliveries managed by TBAs
– Sterile midwifery kits and medicines exchanged at
the health centres for free
– Monthly meetings between TBAs and public health
nurses
– Dual attendance of deliveries – government midwives
cut umbilical cords
• Improvement in mortality rates particularly MMR

9. PAST: Quality Improvement Initiatives
• QA/QI – strong focus of MOH
• Sensitisation and training of private hospitals
• 1996/97 – voluntary national accreditation
programme – MSQH – same standards for both
public and private hospitals
– Pioneered by MOH, Association of Private Hospitals
Malaysia (APHM) and Malaysian Medical Association
(MMA) – contributed funds to run programme
– Good cross-fertilisation and learning – surveyors are
from both public and private hospitals
• Benchmarking of private hospitals – NPC, MOH
• APHM annual conference – participation of
government & MOH – QI, clinical governance,
corporate governance

10. Facilitating Environment

11. Transforming the Nation towards
Developed Nation Status by 2020
1MALAYSIA
People First, Performance Now
April 2009
Government Economic
Transformation Transformation
Programme 1Care for Program
(GTP) 1Malaysia (ETP)
• effective delivery of • New Economic Model
government services – a high income,
•January 2010 inclusive and
sustainable nation
•March 2010
10th MP (June 2010) + 11th MP

12. Transforming The Nation

13. Public Sector Transformation
1. Create a citizen-centred public service
2. Reduce size of government – lean government, reduce
overlapping roles and functions
3. Improve skills of the workforce
4. Focus more on results oriented spending, look into areas
of cost-savings and efficiency of resource use
5. Strengthen govt’s facilitative role - collaborate with the
private sector and support private sector growth
6. Expand private delivery of public services – allow
competitive access to public funding e.g. in health care,
technology support
7. Enhance public agencies to drive growth 13

14. Economic Transformation
Programme
• Specialising the economy - high value-added, innovation-
based, strong growth potential, GTP → enabling environment →
internally-competitive, appropriate soft & hard infrastructure
knowledge economy
• Improving the skills of the workforce – specialised & skilled
labour moving up the value-chain, increase productivity, social
and private returns to education & skills upgrading
• Making growth more inclusive – Strong inclusiveness
policies, equity, improved social protection → helping household
cope with poverty through health care
• Bolstering public finances – broaden the
country’s narrow revenue base, lessen subsidies,
reduce the crowding-out of private initiatives,
shift expenditure to areas of specialisation,
skills & inclusiveness 14

15. National Key Economic Areas (NKEAS)
NKEAs - drivers of economic activity that has the potential to
directly and materially contribute a quantifiable amount of
economic growth to the Malaysian economy

16. Current Efforts in Public-
Private Integration

17. PRESENT – Govt or MOH Investments
• Medical tourism - MHTC– 1-stop centre on hc travel
– Private hospitals - at least national level accreditation
– Government incentives – tax exemptions on private capital
investments for medical tourism
• Outsourcing with Contractual agreements (SLA) - e.g.-
– 5 hospital support services and catering of food
– Pharmaceuticals with Hospital Pharmacy Information System
(drug inventory programme for MOH hospitals)
– Health care services
• when machine breakdowns
• when services are not available e.g radiotherapy, urology
• when public services are inadequate – dialysis
– ICT system development and support – HMIS, THIS
• Buying available private hospitals – Sabah and Sarawak

18. PRESENT – Private Sector Funds
Private Financing Initiatives (PFI)
– Research arrangements with industry
• Randomised Control Trials (RCTs) - CRC
• Transgenic mosquitoes for Dengue control – IMR
– Development of new facilities – MOH RFPs
• Private sector build & maintain - MOH rent first then transfer
ownership to government – Women and Child Hospital
• Land swap – old MOH institutions on prized commercial land –
private sector build new complexes on private or MOH land –
1NIH research complex, Pharmacy complex
– Entry Point Projects (EPP) of NKEA Healthcare and ICT
• Hospital Information System, Teleprimary Care and Oral Health
Information System for MOH facilities
• Private health insurance for foreign workers
• Training schools – John Hopkins with Perdana University

19. PRESENT – Enhancing Service Delivery
Training of medical students/nurses/allied health
• from private colleges in public facilities
Methadone programme
• authorised GPs and later community pharmacists
• govt provides methadone FOC
• patients pay GPs consultation fees
Repeat medicine delivery via courier services
• Pos Malaysia Sdn Bhd – RM5
• patient’s choice and payment, CSR – 5% profits goes to
fund cancer drugs for those in need

20. PRESENT – Enhancing Service Delivery
Patient’s purchase of implants and prosthesis
• Public providers facilitate – introduce patients to sales reps
for patient’s ease , having specific shops in hospitals
• Extending financial support for eligible low-income
households to purchase artificial limbs and prosthetics.
• Improve access to prosthetics by setting up at least one
prosthetics centre per state.
Locum arrangements
• public doctors in private facilities
Contracting of private providers in public facilities
• in PHC clinics and hospital on sessional basis
• traditional and complementary care (TCM)

21. Current Challenges

22. Overview of the Malaysian
Health System
22

23. Public & Private Sector Resources and
Workload (2008)
11%
Health clinics (with doctors) 802 6371
38%
Outpatient visits (m) 38.4 62.65
41%
No. of Hospitals 143 209
78%
Hospital Beds 41249 11689
74%
Admissions 2199310 754378
55%
Doctors (excl. Houseman) 12081 10006
PUBLIC PRIVATE
Series1 Series2
0% 20% 40% 60% 80% 100%
Source: Health Informatics Center (HIC),MOH 23

24. Challenges in Quantity and Severity
Manpower constraints 2009 doctor: population ratio - 1:1,255
(excluding houseman)
(i) Absolute numbers New doctors registered with MMC
• - 1,451
• - 2,413
• - 3,172
Target for Malaysia – 1:600
(ii) Mal-distribution - between public-private
- within the public sector
MOH primary health care providers treated more chronic
illnesses compared to private GPs – treat the ‘healthy ill’
(Source: PHC ACG study with Johns Hopkins, 2007)
About 70% of patients managed by public sector specialists
were complex cases compared with 25% of similar cases by
private sector specialists. Recently - backlash of Health 24

25. THANK YOU
Dr Rozita Halina Tun Hussein
rozitahalina@moh.gov.my