7. The Poor’s share of public health subsidy in Asia “ Analyzing Health Equity Using Household Survey Data” Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff and Magnus Lindelow, The World Bank, Washington DC, 2008, www.worldbank.org/analyzinghealthequity
9. In absence of health financing reform, health system likely to become increasingly privatized… both in funding and service delivery…… Source: Dr Christopher James, WHO WPRO – Projections from MNHA data Future Direction of Current Health System In the future with no restructuring of the health system…..
10. 10 Leading Sources of Inefficiency Source: WHO, 2010 SOURCE OF INEFFICIENCY COMMON REASONS FOR INEFFICIENCY WAYS TO ADDRESS INEFFICIENCY 1. Underuse of generics medicine Lower perceived efficacy/safety of generic medicines; Develop costs benefits analysis 2. Use of substandard & counterfeit medicines Inadequate regulatory framework; weak procurement systems. Strengthen enforcement of quality standards ; enhance procurement systems 3. Inappropriate & ineffective use of medicines Inappropriate prescriber incentives and unethical promotion practices; inadequate regulatory frameworks. Separate prescribing & dispensing functions; improve prescribing guidance, information, training & practice; 4. Overuse/supply of equipment, procedures, investigations Supplier-induced demand; fee-for-service; defensive medicine Reform incentive & payment structures (e.g. capitation or DRG); develop & implement clinical guidelines. 5. Health workers: inappropriate or costly staff mix, unmotivated workers Conformity with pre-determined human resource policies & procedures; resistance by medical profession; inadequate salaries Undertake needs-based assessment & training; revise remuneration policies introduce performance-related pay
11. 10 Leading Sources of Inefficiency Source: WHO, 2010 SOURCE OF INEFFICIENCY COMMON REASONS FOR INEFFICIENCY WAYS TO ADDRESS INEFFICIENCY 6. Inappropriate admissions & length of stay Lack of alternative care arrangements; insufficient incentives to discharge; Provide alternative care (e.g. day care); alter incentives to hospital providers; 7. Inappropriate hospital size (low use of infrastructure) Inappropriate level of managerial resources, lack of planning for health service infrastructure development. Match managerial capacity to size; reduce excess capacity to raise occupancy rate to 80–90% 8. Medical errors & suboptimal quality of care Lack of guidelines, clinical-care standards and protocols; inadequate supervision. Undertake more clinical audits; monitor hospital performance. 9. Health system leakages: waste, corruption & fraud Poor accountability and governance mechanisms; low salaries. Improve regulation/governance, promote codes of conduct. 10. Inefficient mix/ inappropriate level of strategies for health interventions Inappropriate balance between levels of care, & or between prevention, promotion & treatment. Regular evaluation & incorporation into policy of evidence on the costs & impact of interventions, technologies, medicines, & policy options.
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16. THANK YOU [email_address] Unit for National Health Financing (NHF) Planning & Development Division, MOH
Notas del editor
What is Tioman population and hospital facilities ???
Derived from O’Donnell, van Doorslaer et al (2007) World Bank Economic Review . With the exception of Hong Kong, Malaysia, Sri Lanka and Thailand, the poor get much less that their population share of the public health subsidy. But in most countries the poor get a greater share of the subsidy than they have of income.
16/05/11 16/05/11
The fact is that this proposal brings together many features based on the currently accepted global best practices which are suitable for the needs of Malaysia now and into the future. All these strengths and best practices, the substantiating evidence, are elaborated in the submitted document that is the basis this highly distilled presentation. SULIT SULIT 16/05/11
New slide added 16/05/11 16/05/11
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. 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.
