KEYNOTE ADDRESS PRIVATEPUBLIC PARTNERSHIP IN PRIMARY HEALTH CARE
KEYNOTE ADDRESS PRIVATE-PUBLIC PARTNERSHIP IN PRIMARY HEALTH CARE By Dr. Chong Chee Kheong Acting Deputy Director General (Public Health) 10 th ASEAN & 7 th Perak Health Conference on Primary Health Care 21 st July 2017, Ipoh, Perak 1
MINISTRY OF HEALTH MALAYSIA Scope of Presentation Overview of the Current Malaysian Health System Journey Challenges Future direction
Current Healthcare System NHMS 2011 – only medical visit) 74% 49% : : HCDA study 26% 51% 3
Distribution of Health Facilities -Study on Mapping of Health Facilities and Services (by Institute of Public Health)
PRIMARY CARE Dual Function • Service at contact 1 st point of • Care coordinator & gatekeeping role Focus on preventive care & health promotion – team-based care
Population Perspective in Primary Health Care PHC provides primary continuing, comprehensive, coordinated whole person care to individuals, families and their communities from womb to tomb Lifecourse Approach
Improvement in our health status (1957 - 2013) 80, 00 75, 00 73, 50 70, 00 65, 60 65, 00 68, 90 66, 40 61, 60 60, 00 76, 30 76, 46 76, 40 76, 50 77, 00 76, 80 71, 70 71, 60 71, 70 71, 90 72, 16 74, 30 69, 50 77, 18 72, 56 70, 37 Life Expectancy At Birth 58, 00 56, 00 55, 00 77, 03 Male Female 50, 00 1957 1970 1980 1995 2006 2007 2008 2009 2010 2011 2012 2013 IMR NMR CDR TMR 7
PRIVATE/ PUBLIC Disease/ Wellness Spectrum - Changing disease patterns - Increasing use of technology for diagnosis and treatment
Primary Care Setting PUBLIC TEAM STRENGTH PRIVATE TEAM • 3, 203 • Family Medicine Specialist • Medical officers • Assistant Medical Officers • Nurses • Pharmacists • Other Allied Health Professionals (health clinics, MCH clinics, K 1 M GP Community Clinic Health Clinics) aides STRENGTH 7, 146 medical clinics
PRIVATE-PUBLIC Public health facilities Seek care Care delivery Private health facilities Population Seek care Care delivery
Challenges in Healthcare Delivery • Lack of integration of dichotomous healthcare system. • Unequal distribution of resources between public and private healthcare
Public & Private Sector Resources and Workload (2014 & 2015) Health clinics (with doctors) (2014) Outpatient visits (NHMS 2015) No. of Hospitals (2014) Hospital Beds (2014) Bed Days (NHMS 2015) Doctors(excl. Houseman) (2014) Health Expenditure RM Billion (2014) 10% 6 978 60% 40% 57 069 523 37 939 354 34% 66% 76% 24% 150 291 43 822 13 797 19% 81% 16 622 744 3 873 935 24% 76% 39 545 12 290 52% 48% 26 0% Public 90% 768 24 20% 40% 60% 80% 100% Private Source: Health Informatics Center (HIC) , Family Health Development Division, NHMS 2015, MNHA Prelim (2014)
Percentage of Primary Care Visits at Health Clinic vs GP 2012 70, 00% Percentage of visits 60, 00% 50, 00% 40, 00% 30, 00% 20, 00% 10, 00% Rural Public 12, 80%Urban 25, 80% Public Private 6, 50% Private Rural 54, 90% Source: Lim HM, et al. Plo. S One. 2017; 12(2); e 0172229
Increasing Burden of Non-Communicable Diseases Public vs. private: top 10 most frequently managed diagnoses Source: Sivasampu S, et al. NMCS 2014. NCRC; 2016.
Diabetes mellitus: Rapidly growing prevalence in 1986– 2015, with most of the increase in undiagnosed cases
Hypercholesterolemia: Rapid increase in prevalence in adult population in 2006– 2015, 80% of adults with HCL undiagnosed
Other Challenges in Healthcare Delivery • Rising cost of healthcare • Existing and emerging communicable diseases • Aging population • Rising public expectations – Role of social media in providing health information – The “informed” community does not always mean better understanding of health issues – Anti vaccination movements – Patients’ complaints
Integrated Intervention Referral to Rehab - Respiratory - Mobility Elderly : Advice for carers, home intervention, prevent falls, scheduled dementia screening Screening : mental status, sexual problem, Prone to Fall, Dementia screening Screening : lipid levels, glucose levels Screening : Physical – Inguinal hernia Diet management for chronic diseases eg hypertension Hypertension : Management of disease & Complications Physical Activity : Advice, Counseling Referral to dietician / nutritionist Smoking : Pamphlet (Universal) Referral to surgery Dental referral Smoking : Advice (Intermediate) Diabetes : Management of disease & complications Smoking : Counseling (Advanced)
BUSINESS PROCESS RE-ENGINEERING • Strengthening of primary health care • Focus on prevention as priorities • Improving organisational capacity (infrastructure and human resource) • Increasing efficiency
Family Doctor Concept ONE Family Doctor to One Family Scope FULL PRIMARY HEALTH CARE NCD SCREENING CHRONIC DISEASES MANAGEMENT MCH ORAL HEALTH
Vision For Health “A Nation Working Together for Better Health” A nation working together for better health 21
CHALLENGES To prevent, delay the onset, or detect and control NCDs in a cost-effective manner through systematic identification of individuals at different risk levels and provision of targeted interventions according to risk levels En. PHC System Community Empowerment Initiatives related to improving the current ways in which information about population level risk is collected, used and shared Initiatives related to improving the current ways in which frontline community organisations are empowered, accountable and supported to impact on population health outcomes Strategic Communications Information and Communication Technology
Pilot project for En. PHC Initiative concept/details/highlights: Implementing agency: • Family Health Development Division (BPKK), Ministry of Health Key stakeholders identified: • Medical Practice Division, MOH • DHOs, KKs, GPs • MMA and other GP associations Required resources Investment: RM 466, 720 Implementation timeframe • Start date: April 2017 • End Date: April 2019 Key milestones Initiative will begin engagement with GPs within the catchment areas of the 20 intervention KKs to pilot public-private data sharing and integration into the Population Health Database. • August and November 2017: Workshops to establish the framework for partnership • September 2018: The En. PHC system for GPs is ready to be used
FAMILY DOCTOR CONCEPT Family Health Team C Family Health Team A KD SUNGAI SIREH KD SUNGAI BURUNG KD SAWAH SEMPADAN HOSPITAL TANJUNG KARANG KD TIRAM SETIA KK TANJUNG KARANG KD SUNGAI GULANG-GULANG Family Health Team B KD BAGAN PASIR
FINANCIAL SYSTEM Additional services (Out of pocket/ private health/ Voluntary Health Insurance Patient PHC Public Private Refer/admit Secondary, tertiary & other care Public Receive treatment Home Private
THANK YOU
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