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1Care for 1Malaysia Primary Health Care

1Care for 1Malaysia Primary Health Care. Benefits 1CARE. Achieving enhanced universal coverage Integrating public and private sectors Ensuring an affordable and sustainable health care system for Malaysians

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1Care for 1Malaysia Primary Health Care

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  1. 1Care for 1MalaysiaPrimary Health Care SJ /10Mar 2011

  2. Benefits 1CARE Achieving enhanced universal coverage Integrating public and private sectors Ensuring an affordable and sustainable health care system for Malaysians Providing equitable (in terms of access and financing), efficient, and higher quality services; and better health outcomes for the Nation Developing effective safety nets for the risk protection of vulnerable groups Remodelling the health system to become more responsive to population needs Enhancing client satisfaction Promoting personalised and better managed care for the individual and family Reducing the brain-drain of skilled personnel both internally and internationally SJ /10Mar 2011

  3. Achieving enhanced universal coverage 2. Integrating public and private sectors • GPs and FMS will be integrated as one Primary Health Care Physician group • In KKs public sector 1000 vs 3000 post • 200 plus 7000 GPs • Every member of the population is registered (looked after) by a Primary Health Care Physician • Urban and Rural • All members of the population SJ /10Mar 2011

  4. 3. Ensuring an affordable and sustainable health care system for Malaysians 4. Providing equitable (in terms of access and financing), efficient, and higher quality services; and better health outcomes for the Nation • Capitation • Benefit package from womb to tomb • Pay for performance • No payment at point of care • Capitation : promotes preventive services and wellness and early case management SJ /10Mar 2011

  5. 5. Developing effective safety nets for the risk protection of vulnerable groups 6. Remodelling the health system to become more responsive to population needs • Health Package meeting needs of the population • Covers all member of the population close to their home • Providers of their choice • Autonomous • Risk sharing with providers • All members of the population • Rich covers the poor • Healthy covers the sick • Young covers elderly SJ /10Mar 2011

  6. Core component • Restructured health care delivery • MHDS • Autonomous • New financing mechanism • NHFA • Capitation • SHI SJ /10Mar 2011

  7. SJ /10Mar 2011 Figure 1: Functions Within the Restructured 1Care Health System

  8. SHI MOH NHFA HKL & Special Institutions PRIVATE PROVIDERS PRIVATE HOSPITALS STATE HEALTH DEPT STATE HOSPITALS State NHFA NETWORK PUBLIC PROVIDERS PHC Board DISTRICT HEALTH OFFICE DISTRICT HOSPITALS PRIVATE PHCP (GPs) HEALTH CLINICS Funding flow NHFA – part of MOH Governance

  9. SJ /10Mar 2011

  10. SJ /10Mar 2011

  11. Primary Health Care Physician PHCP • Doctors • Solo or group • Independent contractors • Family doctor concept • Gatekeepers • Every individual is registered to PHCP/ratio/special groups • Trained medical doctors from accredited institutions • Registered with the MMC and permitted to practice • As specialist-National Specialist Register • Over time only Primary Health Care Physicians are allowed to open a PHCP practice. • Secondary care specialist -not be registered as PHCPs SJ /10Mar 2011

  12. REGISTRATION OF PHCP • Data base of both PHCP and population : matching population density to supply • Gatekeeper • Training and accreditation mechanism • Mechanism for payment, tracking and monitoring • Mechanism for addressing disruption of services • Relocation • Vacation • Locum and substitute doctor • Arrangements for with group practices • Features to encourage group practices • Patients • reliable mechanism for registering without duplications • register according to residence, work place / school • changing provider SJ /10Mar 2011

  13. Distribution of primarycare doctors SJ /10Mar 2011

  14. SJ /10Mar 2011

  15. SJ /10Mar 2011

  16. Benefit package for PHC • Child health • Adolescent health • Women’s health • Men’s health • Family planning • Antenatal care • Postnatal care • Elderly health • Prevention /promotive • Curative care • Diagnostic Services • Radiological • Pharmacy • Pathology SJ /10Mar 2011

  17. KKs will become Super PHCP Clinic SJ /10Mar 2011

  18. Primary Health Care Physician“scope of practice” They are responsible for maintaining optimal health of their ‘registered population’ to provide “essential health package” through: • Screening and health assessment from of “womb to tomb” • Health promotion and counseling /patient education • Prevention activities (paps smear, immunization …) • Diagnosis / differential diagnosis • Intervention and treatment of common illness and medical conditions • Careplans , long-term care and follow-up • Referral • Data collection for patient and population analysis • Participate in CPDs / CMEs SJ /10Mar 2011

  19. Primary Health Care Physicians“operations” • Registers designated population • Receives reimbursement based on per capita for the provision of essential services • Collects patients data and submit data and information as required • Compliance to all standards and guidelines as well as service targets • Commission secondary care from hospitals for patients where relevant (at what rate?) • Other services may include : • Emergency services and Call Centres • School health Services • Rehab Services • Flying Doctors Services SJ /10Mar 2011

  20. FUNDING & INCENTIVES • Funding through capitation • Case-mix methodology will be employed • Additional Incentives will be provided for: • Specialist qualifications • House calls • Additional payments for exceeding stipulated performance of benchmarks • Funding training and topping up courses • Those working in rural or unpopular locations • Those who treat more chronic patients SJ /10Mar 2011

  21. CO-PAYMENT ? • Co-payments will be nominal • To address abuse / moral hazard and to promote responsible use of services • Likely services are for medicine and dental services. • Need to identify range and scope of services like duration, type and entitlement • Very sensitive issue and require strong social advocacy • Mechanism for waiver for those who cannot afford and those with entitlement SJ /10Mar 2011

  22. Benefits to the Nation Benefits to the people Benefits to the Providers • More access to providers • Care nearer to home • No payment at point of seeking care (during hardship) • Vulnerable group better protected • Quality care • Client satisfaction • Greater health outcomes for community • Bridge gaps remuneration and workload • Optimize HR both sectors • Encourage serving in rural areas • Appropriate level of competency and standard of care • Strengthen national unity • Stimulate the health care market • Reduces unnecessary dependence on government fund • Financial safety nets for lower and middle income groups • Contain the rapid growth in health care cost and inflation SJ /10Mar 2011

  23. Next agenda • Develop full blueprint within 2y • Building blocks • Mapping of population & providers • Professional & care standards • Benefit packages • Monitoring & Evaluation • Phased implementation, evaluation and monitoring SJ /10Mar 2011

  24. TOR TWG PHC • Study the existing service provision and perform mapping of gaps • Develop draft framework for PHC delivery • Develop phases for implementation • awareness and motivation / buy-ins • essential universal package • standards, accreditation, credentialing and privileging SJ /10Mar 2011

  25. TOR TWG PHCDevelop phases for implementation (cont’d) • Health informatics • Registration of providers and population • Registration list of Primary Care Providers to the Population • Propose Organisational and Management Structure of the various levels • Develop clear roles and relationship of Primary Care related NGOs & other Organizational Support Systems • Develop indicators to monitor risks or impact SJ /10Mar 2011

  26. TOR TWG PHC • Perform risk mitigation for each phase • Identify, characterize, and assess threats (political and resources) • Assess the vulnerability of critical implications to specific threats (scope too big or too small, cost too high etc) • Determine the risk (i.e. The expected consequences of specific types of attacks on specific assets) • Identify ways to reduce those risks • Prioritize risk reduction measures based on a strategy SJ /10Mar 2011

  27. 1Care for 1Malaysiamandate: PHC : Equity, Universality, Solidarity SJ /10Mar 2011

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