A MOH presentation that shows the policy for 1Care has already been decided and accepted. The Technical Working Groups are not "consultations" on what new system to implement. This is clear from slide 19, which states that the role of the TWGs are there to provide: "Evidence to support the 1Care blueprint development."

1. Presentation Outline
1CARE 1AIM: Evidence to Policy • Translating policy directions into value-
added research
Dato’ Dr. Maimunah Abdul Hamid • Evidence-based policy-making for 1Care
Deputy Director-General of Health
(Research & Technical Support) • 1Care Concept
Ministry of Health, Malaysia
• Evidence to support the 1Care blueprint
5th National Conference for Clinical Research development
(NCCR 2011) • Evidence needs to ensure evidence-based
policies & tracking 1Care targets
23 June 2011
The Sunway Convention Centre, Selangor • Institutional strengthening for research
1 2
“AMANAT” YAB PM in 2005
Malaysians must be prepared
to………. pay more …. health and
education…… a scheme ….. quality
service. On a review of the health
Translating Government care system, Najib and the
Government was considering on a
Policy Directions into Value- sustainable basis, amid increasing
costs and demands.
added Research for 1Care “The question now is whether we can
continue with the present situation or
have some sort of scheme.” Najib said
“Gear up for less subsidy”, says
adding that he would explain more
Najib. (Sunday Star, 6 March ‘05)
about the health care system review
soon.
3
4
Discrepancy in Health Outcomes
by Geographical Location
%
Health Indicators :
Prevalence by geographical location
Evidence-based Policy- Urban Rural
making for transformation History of recent illness 22.4 25.5
Incidence of acute diarrhoea 4.7 5.5
Diabetes Mellitus 12.2 10.6
Hypertension 29.3 36.9
Smoking among adolescence 2.3 4.9
Source: National Health and Morbidity Survey (NHMS) III, 2006
5 6

2. Public & Private Sector Resources and Health expenditures per capita, 2009 prices
Workload (2008) 2000
1800 In the future with no
1600 restructuring of the
11% 1400
Health clinics (with doctors) 802 6371 1200
health system…..
38% 1000
Outpatient visits (m) 38.4 62.65 800
41%
In absence of health
600
No. of Hospitals 143 209 400 financing reform, health
78%
Hospital Beds 11689
200 system likely to become
41249
74%
0 increasingly privatized…
09
10
11
12
13
14
15
16
17
18
19
Admissions 2199310 754378 both in funding and
20
20
20
20
20
20
20
20
20
20
20
55%
Doctors (excl. Houseman) 12081 10006 GGHE pc PvtHE pc service delivery……
45%
Health Expenditure (RM billion) (2007) 13.54 16.68 2004 2009 2018
Public Private GGHE 50% 45% 35%
0% 20% 40% 60% 80% 100%
10
PvtHE 50% 55% 65%
Source: Health Informatics Center (HIC),MOH
-PvtOOP 40% 47%
Source: Dr Christopher James, WHO
7
7 -PvtOther 15% 17% WPRO – Projections from MNHA data8
1Care Concept
1Care is the restructured integrated
1Care Concept 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
9
1Care Concept Features of 1Care
Streamlined MOH → focused on governance, stewardship &
specific public health services, training & research
MOH Additional services
Patient (Out of pocket or private health insurance) Autonomous Malaysian Healthcare Delivery System
MHDS (MHDS)- integrated public & private sector providers.
Emphasis on primary health care. Gatekeeper to higher levels
Hospital of care
Regional Health PHCP Referred (Public or
Authority Public Private
Private) Publicly managed health fund - combination of general
Receive Admit government revenue & social health insurance (SHI), & may
treatment be tempered by minimal co-payments at point of seeking care
PHCE
PHCE
Single payer system, the National Health Financing Authority
PHCE
Home (NHFA) – set-up on a not-for-profit basis under the MOH
Government commits to higher levels of spending for
healthcare
11 People commit to increased cost sharing through pooling of
funds and cross-subsidy 12

3. Presentations to YAB PM & No Change and 1Care Reform:
Total Expenditure on Health (TEH)
Economic Council
• 11 August 2009 - 1Care for 1Malaysia concept
• Follow-up - 22 March 2010, MOH presented research
information requested by the Prime Minister and EC:
i. Financial projection of health spending
- in collaboration with Dr Christopher James, Health Economist, WHO
- projections by Bank Negara Malaysia for comparison
ii. Focus Group Discussion with various stakeholders
iii. Impact Assessment
- in collaboration with Prof Soonman Kwon, Seoul National University
- local consultant - Chang Yii Tan, PE research
13 2009 base year 14
Summary of Financial Projections Financial Reforms PHI,
9%
Pvt
Corp
&
Others Gen
8% Tax
1. No Change No Change 35%
– Health system likely to be increasingly dichotomous
Current system (2018)
(2009)
– Private health expenditure will rise faster than public
expenditure PHI OOP
7% 48%
– Private spending is mainly from out-of-pocket payment → Pvt
Corp &
greater inequity & financial risk to the people and further Others Socso &
erosion of the public health system 7% EPF, 0.0
0%
Gen
Tax
2. 1Care Reform 44%
Pvt. Spending Gen Tax Public
– Can contain growth of total health expenditure based on public 11% Health &
sector management and prudency OOP40
%
others 17%
– Savings are more in private spending Socso
&
– Shortfall in SHI contribution due to health expenditure growing EPF,
faster than wages
– Government portion of health expenditure will be higher
0.4%
1Care
(2018) SHI
SHI - Pvt Gen Tax
contribution 37%
15 34%
16
Focus Group Discussions with Impact Analysis
Stakeholders - FINDINGS
A) Assessing impact on the
Population
• Overall ability to pay
• General consensus among funders, • Willingness to pay C) Assessing impact on
users & providers - concept and proposal • Un-insured population the Health System
was favorable •
•
Informal sector
Immigrant population
• Health Care Utilisation
• Quality of Care and Health
Outcomes
• Most stakeholders were in favour of the B) Assessing impact on the • Health Care Cost
• Equity in Access to Health
delivery concept Economy Services
• Workforce mobility
• Impact on Providers
• Labour market
• Consumption • Impact on Medical Tourism
• Funders & users were concerned about • Government Finance
• Cost of Institutional Change
having to pay • Private Health Insurance
17 18

4. Blueprint Development : Technical
Working Groups (TWGs)
1. Primary Health Care
Secondary & Tertiary Care
Evidence to support the 2.
3. Health Financing
1Care blueprint development 4. Governance & Stewardship
5. Legislation, Regulation & Enforcement
6. Human Resource
•Technical Working Groups (TWGs) 7. ICT
• Evidence & data 8. Public Health
9. Oral Health
10. Pharmaceutical Services
19 Additional group – Strategic Communication 20
On-going research to support blueprint
development
7 research areas identified since 2008 – only 1 pending, 1
done Evidence needs to ensure evidence-
based policies
1. Health Facility & Services Survey & Population profiling:
Mapping health facilities & services against health care needs for strategic policy development
& tracking 1Care targets:
2. Health Care Demand Analysis: Utilisation & equity analysis, models & policy
monitoring & evaluation
simulation for 1Care
3. Cost Analysis: unit costing for out-patient & ambulatory services in public hospitals
4. Analysis of Financial Arrangements & Expenditures: in public
& private sectors
5. Community Perception: on health care delivery systems
21
22
Targets of 1Care for 1Malaysia Sources of data
• Universal coverage Healthcare System level Patient or
Population
level (public and private) organisation
• Integrated health care delivery system research Including M&E level research
• Affordable & sustainable health care • Disease burden Resource Care Service • Individual : clinical
outcome
incidence & Inputs Processes Outputs 1. Intermediate (eg. BP
prevalence
• Equitable (access & financing), efficient, higher • Perception on • Financing • Diagnosis • Out-patients
control)
quality care & better health outcomes healthcare system
• Manpower • Therapy • In-patients
2. Ultimate (eg Mortality,
QOL, Rehabilitation)
• Utilisation on
• Effective safety net healthcare system
(incl financial
• Facilities • Clinical
• Centre level
arrangement) services performance
• Drugs
• Responsive health care system • Devices • Procedures 1. Effectiveness
2. Equity
• Client satisfaction 3. Efficiency
4. Responsiveness
• Personalised care Where are the data?
NHMS= National Health Morbidity Surveys; BOD = burden of disease report; MNHA=Malaysian National Health Account;
• Reduce brain-drain PR =Patient registries; HSI =Healthcare statistics initiatives (Drugs, Device/Med. Technology, Healthcare Workforce &
Facilities surveys); HRMIS= Human Resource Management Information System, HIC =Health Informatics Center , CD
23 =Communicable disease, NCD =Non communicable diseases
Modified from Lim TO, 2007

5. DR FOSTER INTELLIGENCE, Imperial College
Using Research Evidence to Improve
Health System Performance
– E.g. from NHS, UK
25
Dr Foster Report Card Dr Foster Report Card
30
Developing Evidence-based Clinical Regional Comparative Analysis :
Access to Doctor or Nurse When Sick or Needed Care
Practice Guideline
Same- or next-day Waited six days
Percent* appointment or more
100 93
78
72 70
75 65 66
62
57 57
50 45 45
33
28 25
25 17 16 19
14
5 5 8
2
0
NZ
N
R
TH
R
NZ
FR
UK
N
R
TH
R
S
IZ
FR
UK
E
US
S
E
US
IZ
SW
SW
GE
AU
CA
GE
NO
AU
CA
NO
SW
SW
NE
NE
* Base: Answered question.
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries. 30

6. Regional Comparative Analysis :
Wait Time in Emergency Room Before Being Treated
Less than 30 minutes Four hours or more
Percent
75
52 Institutional strengthening for
46
50 44 research
33 34 33 33 34 31
29
26
25 20 20
16 17
12 11 13
4 6 4
3
0
Z
N
R
TH
R
N
R
TH
R
NZ
FR
S
S
IZ
IZ
UK
FR
UK
E
E
US
US
N
E
E
W
W
AU
CA
AU
A
O
O
SW
SW
E
NE
G
G
C
N
N
S
S
N
Base: Used ER in past two years.
31 32
Source: 2010 Commonwealth Fund International Health Policy Survey in Eleven Countries.
Why health research system needs to
transform? 6 NIH (National Institutes of Health Research)
• To contribute towards the achievement for Malaysia
to be a high income nation
• To better support MOH’s new role in 1Care
• Breakdown walls to
– enhance function & roles of research institutions
– improve efficiency & reducing duplication of
research activities
33 34
Research Excellence - the Vision What shall we do?
1. Improving governance
• Leaders in niche research areas – Strengthening research governance
- Tract record in publications 2. Improving capacity & capability of human resource
- Opinion leaders – Leadership
- Attract external funding – Attracting & retaining quality researchers
- Attract internal collaboration – Defined career structure (entry as trainee, researcher &
• Improvements in policy & practice senior researcher)
– patients care 3. Realigning & consolidating current roles
– patients outcome – More focused
• Recognition – Avoid duplication & improve efficiency
– Earn major awards – Better synergy
– Fellowships of prestigious academies &
collages
35 36

7. What shall we do? our dream: 1NIH
MOH Scientific Committee for MOH
4. Optimising the use of scarce research expertise & other Medical Research
resources Office of Research Ethics and Policy
Office of Program Coordination and Strategic
Scientific Advisory Committee
– Sharing of physical & human resources Initiatives
Office of Research Management, Evaluation &
Technology Transfer & commercialization
Office of Administrative
5. Improving funding Management: Office of Communications and Public Liaison
General Administration Office of the NIH Director
Human Resource
– Generating funds Finance & Procurement
Facility Management
Office of International Collaboration
Office of Research & Technical Services
6. Adopting newer roles
– Broker (searching for external funds & outsourcing of
research)
IHM CRC IMR IKU IHSR IHBR
– Marketing of services & products
7. Application of advance technology Centre for Information
Technology Data Warehouse Centre for Biostatistics
37 (incl clinical support system) 38
our dream
The Proposed 1NIH
must be BETTER than current model our dream: 1NIH Complex Artist’s impression
• Strengths of current system will be preserved
• Stronger supportive role
• Separation of administrative & technical
functions
• Better integration of research activities
• More responsive to MOH needs &
expectations through increased autonomy
39 40
our AIM: Evidence to Policy & Practice
WE CAN make better contribution to health
• Better interventions
• Informing decision & policy making
Julio Frenk • Internalisation by individuals -
Former Mexican
Minister of
Health changing behaviours &
empowering people
THANK YOU 41