Slide 18 shows the implementation process of 1Care. In phases 1 to 3 the name 1Care doesn't even appear but it is part of the process.
The MOH Deputy Director General, Datuk Dr Noor Hisham Abdullah has confirmed that 1Care is currently in phase 1 & 2 of implementation.
Dr azilina 1 care for ph conference 12july2011 11july 2011
1. Towards Public Private Integration:
Aspiration for 1Care
6th PUBLIC HEALTH CONFERENCE 2011
SEREMBAN
NEGERI SEMBILAN
12TH JULY 2011
Dr. Azilina Abu Bakar
Unit for National Health Financing
Planning and Development Division
Ministry of Health
1
4. 1Care Concept
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
Conglomeration of many features based on
currently known global best practices, suitable
for the needs of Malaysia now & into the future
4
5. 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
5
6. 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 6
8. SERVICE DELIVERY & PATIENT FLOW
National Health Financing Authority (NHFA)
Additional services
Patient (Out of pocket or private health insurance)
MOH
MHDS
PHCP Referred Private
Public Private Hospital
Regional Health Public
Authority Admit
Receive
treatment
PHCA Return to referring
Home Family Doctor
PHCA PHCA 8
9. Service Delivery in 1Care
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 system
Development of multi-disciplinary team with allied
health personnel carrying out more functions
9
10. Service Delivery in 1Care –
Secondary & Tertiary Care
Secondary and Tertiary Healthcare Services (Public &
Private Providers)
Patients referred by PHCP
Public hospitals will be coordinated on regional
network
o Small hospital will have narrow range of services
o 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 10
12. 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
13. Operational Structure of SHI Program
Insurer
National Health Financing
Authority (NHFA)
Insurance Review, Payment
benefit
Ministry for Health
(planning, supervising)
Contribution Claim, data
Medical service
Providers
Insured (public & private)
Co-payment
14. Provider Payment Mechanism
Primary Healthcare (Public and Private Providers)
Capitation with some broad case-mix adjustment
Co-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 14
16. FUNCTIONS WITHIN THE RESTRUCTURED HEALTH SYSTEM
Professional Bodies
-MMC
Independent bodies
-MDC -Drug Regulatory Authority (DRA)
-Pharmacy Board -Health Technology Assessment (HTA)
- Others -Medical Research Council (MRC)
-Patience Safety Council
MO -Medical Device Bureau
-National Service Framework (NSF) (Quality)
H
-National Health Promotion Board
NHFA - Food Safety Authority
- Others
• GOVERNANCE &
STEWARDSHIP
• POLICY & STRATEGY
FORMULATION
• STANDARD SETTING MHDS
• REGULATION &
ENFORCEMENT SERVICE DELIVERY
• MONITORING &
EVALUATION •PRIMARY CARE
• PUBLIC HEALTH
• RESEARCH •HOSPITAL CARE
• TRAINING
•OTHER SERVICES
18. Phases of Health Sector Development
Steady State – 1Care for 1Malaysia
Phase 4
1Care: Full reform funded through GT & SHI
1Care: PHC reform funded through GT Phase 3
Phase 2
1Care: Public Facility autonomy funded through GT
1Care: Strengthening of the current health system Phase 1
18
19. Summary
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
19
17/03/12 Semi Confidential Semi Confidential March 17, 2012
17/03/12 SULIT SULIT
17/03/12 SULIT March 17, 2012
17/03/12
DRAFT Pls do not circulate or cite SULIT SULIT SULIT 11 August 09
Every individual is registered with a PHCP. primary health care services will be the foundation of the health services with strong focus on promotive-preventive care and early intervention. Primary health care providers (PHCP) will function as family doctors and dentists and act as gatekeepers to secondary and tertiary care.
Public hospitals will be coordinated on regional networks and funded through a global budget based on case adjustments using DRG. Private hospitals services will be paid through case-based payments. Small hospitals will have a narrow range of services Larger hospitals will have a bigger range of services Services with high end and expensive technology will only be available in one/some regions to serve neighboring services.
17/03/12 SULIT SULIT March 17, 2012
17/03/12 SULIT 11 August 09
Payment for service is by capitation with case-mix adjustments and additional incentives for achieving performance targets and as inducement for working in less desirable areas. The benefit package of services will be developed. Other payment mechanisms apply for dental and pharmaceutical prescriptions where patients will make some co-payments when receiving service. But identified population groups will be exempted from these co-payments. Except for emergencies, PHCPs as gatekeepers will refer patients to higher levels of care when necessary. Public hospitals will be coordinated on regional networks and funded through a global budget based on case adjustments using DRG. Private hospitals services will be paid through case-based payments.
Semi Confidential Semi Confidential March 17, 2012
