dr abu bakar suleiman president international medical university kuala lumpur, malaysia third annual...

Dr Abu Bakar Suleiman Dr Abu Bakar Suleiman

President President International Medical UniversityInternational Medical University

Kuala Lumpur, MALAYSIAKuala Lumpur, MALAYSIAThird Annual ETHEL Conference Third Annual ETHEL Conference

Bruges, BelgiumBruges, Belgium28-29 November 200228-29 November 2002

Reengineering a National Healthcare Reengineering a National Healthcare System: The Case of MalaysiaSystem: The Case of Malaysia

Malaysian Healthcare SystemMalaysian Healthcare System

Overall objectives:Overall objectives: Improving health status & promoting social Improving health status & promoting social

well-beingwell-being Ensuring equity and access to health Ensuring equity and access to health & healthcare& healthcare Ensuring efficiency in the use of resourcesEnsuring efficiency in the use of resources Enhancing clinical effectivenessEnhancing clinical effectiveness Improving quality of services & patient Improving quality of services & patient satisfactionsatisfaction Ensuring sustainability of the system.Ensuring sustainability of the system.

How healthcare:How healthcare: supported supported organised for service deliveryorganised for service delivery

influences country’s:influences country’s: social social economiceconomic well-being well-being politicalpolitical

Health services: Health services: important segment of important segment of services industry. services industry.

Malaysian Healthcare SystemMalaysian Healthcare System

Issues and Challenges in MedicineIssues and Challenges in Medicine

Issues Challenges

• Medical technology• Increasing consumer expectations (patient self determination)

• Escalating healthcare costs, limited resources

Changing demography• living longer, changing disease pattern• lifestyle diseases

Chronic & degenerative diseases• HIV/AIDS, Diabetes, Cardiovascular diseases, etc

Issues Challenges• variation in medical practice; evidence-based practice

• Accountability, transparency – healthcare providers

• Patient protection and safety

Emphasis on:• healthcare quality, patient safety, health outcomes, health status, quality of life (disclosure)• Incentives to be aligned to above• Restructuring healthcare services•(IOM report” 1999, 2001)

Issues and Challenges in MedicineIssues and Challenges in Medicine

Economic, Social, Scientific Pressures on Economic, Social, Scientific Pressures on MedicineMedicine

Chronic, degenerative diseases of agingChronic, degenerative diseases of aging

Lifestyle diseasesLifestyle diseases

Medical technologiesMedical technologies

Increasing consumer expectations Increasing consumer expectations

Escalating healthcare costsEscalating healthcare costs

All countries face problems financing healthcareAll countries face problems financing healthcare

Anxieties about future of medicine & healthcare.Anxieties about future of medicine & healthcare.

Economic, Social, Scientific Pressures on Economic, Social, Scientific Pressures on MedicineMedicinePolicy makers:Policy makers: Pressures on: Pressures on: efficiency, cost control efficiency, cost control

medical, healthcare reformmedical, healthcare reform

Attempts at reform:Attempts at reform:Focus mainly on:Focus mainly on:

Means of medicine, healthcareMeans of medicine, healthcare Not goals & endsNot goals & ends

or purpose & direction of medicine.or purpose & direction of medicine.

1. The prevention of disease & injury and promotion & maintenance of health

2. The relief of pain & suffering caused by maladies

Hastings Centre International Hastings Centre International Consultation: The Goals of Medicine:Consultation: The Goals of Medicine:

3. The care & cure of those with a malady, and the care of those who cannot be cured

4. The avoidance of premature death and the pursuit of a peaceful death.

Hastings Centre International Consultation: Hastings Centre International Consultation: The Goals of Medicine:The Goals of Medicine:…continued…continued

The Goals of Medicine:The Goals of Medicine:

Represent core values of medicine

Guide to practical approach: Future priorities of biomedical research Design of healthcare systems How doctors should be educated.

Present healthcare systems:Present healthcare systems: Organised around acute catastrophic illnessesOrganised around acute catastrophic illnesses Patients treated until they are wellPatients treated until they are well Episodic, fragmentedEpisodic, fragmented

Many countries:Many countries: Health financing based on “casualty” Health financing based on “casualty” approach of health insuranceapproach of health insurance Based on fundamental unpredictability of Based on fundamental unpredictability of disease & injuriesdisease & injuries Expensive health systems developed based Expensive health systems developed based on “acute care” model.on “acute care” model.

In coming decades:In coming decades:Increased predictability of risks of disease (Lots of research still to be done)

Major advances in:Major advances in: Immunology Predictive genetics & human genome project

enable to predict disease long before symptoms occur.

Concept of illnessConcept of illnessNot all are unpredictable or “Acts of God”Not all are unpredictable or “Acts of God”

Trauma, infections Trauma, infections remain unpredictable remain unpredictable smaller part of burden of smaller part of burden of

illnessillness

Predictive genetics Predictive genetics illnesses that can be illnesses that can be predicted predicted

Implications:Implications: responsibility for dealing with responsibility for dealing with avoidable or manageable avoidable or manageable illnesses.illnesses.

Paradigm Change for HealthcareParadigm Change for Healthcare

Consequential to genetic predictive testing what approach to take for illness that are Consequential to genetic predictive testing what approach to take for illness that are predictable?predictable?

Social responsibility:Social responsibility:Proactive management: Proactive management: avoidance avoidance

early managementearly management risk factors and illnessrisk factors and illness

? Continue to consider it as “accidents”? Continue to consider it as “accidents”

Balance:Balance: Individual Individual responsibility forresponsibility for Societal Societal cost of care.cost of care.


Health financing:Health financing:New tools- transfer ability, moral responsibility New tools- transfer ability, moral responsibility for, for, individuals individuals

familiesfamilies communitiescommunities

to manage own health more effectivelyto manage own health more effectively Telehealth blueprint.Telehealth blueprint.


““Early warning systems”- individual & Early warning systems”- individual & population healthpopulation health

““Managed care” Managed care” improving: improving: health status health status health outcomeshealth outcomes

Community-based healthcare systemsCommunity-based healthcare systems hospital- “back up”hospital- “back up”

supports primary care supports primary care “engine” of “engine” of health health service delivery service delivery

Patient-centred healthcare system. Patient-centred healthcare system. (Note: 8 goals of health system in Telehealth blueprint changing roles of: hospitals, healthcare (Note: 8 goals of health system in Telehealth blueprint changing roles of: hospitals, healthcare

providers, patients)providers, patients)


Move from: Move from: diagnosis & treat, salvagediagnosis & treat, salvage

toto predict & early management of:predict & early management of:health risk factorshealth risk factorsillnessillness

Major implications:Major implications: “Acute care” model of “Acute care” model of healthcare delivery healthcare delivery

““Casualty” model of Casualty” model of health insurance.health insurance.


Promote different thinking about:Promote different thinking about: health, wellnesshealth, wellness

illnessillness

To the extent illness- predictable & manageableTo the extent illness- predictable & manageablePassivePassive healthcare deliveryhealthcare deliveryReactiveReactive health financinghealth financing

Change to:Change to:Proactive approach that involves:Proactive approach that involves:

individual, patient, family, community.individual, patient, family, community.

approachapproach


Focus on:Focus on: Developing full potential in health- “wellness”Developing full potential in health- “wellness” Manage individual health while still in state of “wellness”Manage individual health while still in state of “wellness” Screen for health risk factorsScreen for health risk factors Early management of identified health risk factorsEarly management of identified health risk factors Early management of illness.Early management of illness.


• Equitable• Affordable• Efficient• Technologically appropriate• Environmentally adaptable• Consumer friendly

Health system • Quality• Innovation• Health promotion• Respect for human dignity

Emphasis

• Individual responsibility• Community participation

Promotion

Malaysia is to be a nation of healthy

individuals, families and communities

Malaysia’s Health Vision

towards an enhanced quality of life

The Four Integrated Telehealth The Four Integrated Telehealth Pilot ProjectsPilot Projects

Provides up-to-date Knowledge

Empowers individual.

Provides continuing up-to-date knowledge

and skills tohealthcareproviders

MCPHIE CMELHP

Provide a personalized proactive and prospective lifetime health plan to

achieve a continuum of care to keepthe individual in the highest possible

state of health

Enhance capabilities of primary care centres, extend the reach of specialized healthcare, optimize the utilization of

specialists and reduce patient transfers.

Teleconsultation

Eight Goals of the Health System:Eight Goals of the Health System: Wellness focus Person focus Informed persons Self-help Care provided at house/close to home Coordinated, continuous, seamless care Services tailored to individuals/groups with special needs Effective, efficient, affordable services.

Realization of 8 goals will result in achieving the vision for health.

Health Services Goals Health Services Goals for the Health System of the Futurefor the Health System of the Future1. Wellness focus Services to promote individual wellness throughout life

2. Person Focus Focus services on the person and ensure services are

available whenever & wherever required

3. Informed personProvide accurate & timely information and promote knowledge through personalized education services to enable individuals to make informed health decisions

4. Self helpIncrease ability of individuals & families to manage own health through knowledge transfer and interactive network-based health management tools

5. Care provided at home or close to homeDistributed multimedia networks to provide physical and virtual services into homes, health settings and community centres

6. Coordinated, Continuous, seamless careManage and integrate care across different settings and episodes of care throughout life

7. Services tailored as much as possibleCustomize services to needs of individuals and groups with special circumstances

8. Effective, efficient affordable services Enhanced access, integration and timely delivery of quality services at affordable cost.

Health Services Goals Health Services Goals for the Health System of the Future for the Health System of the Future

Technology enabler to realise Technology enabler to realise the vision for health the vision for healthEmphasis on :Emphasis on :

Health promotion

Disease prevention

Health risk assessment in management of individual, community health

Empowerment of individuals, families, communities.

Telehealth BlueprintTelehealth Blueprint

Lifetime Health PlanLifetime Health Plan To facilitate continuum of care for the lifetime

health data in state of wellness & illness systematically captured and available to healthcare providers

Ensures patient focused, continuous, coordinated, integrated care throughout life

Lifetime Health Record to be created


Emphasise Primary CareEmphasise Primary Care Major thrust of healthcare system

Need to be extended towards management of community health, extended, shared and homecare, including self-care.

Need for careful review on the future role of :Need for careful review on the future role of : Hospitals Doctors Nurses and other health professionals Patients and families Linkages between hospitals and primary care and extended care, including home care.



Promoting the Health ParadigmPromoting the Health Paradigm Emphasize preventive and promotive aspects of healthcare Support individuals/families make lifestyle choices that best maintain health Provide services during state of wellness to support maintenance of health Health system should “invert” the healthcare pyramid – secondary & tertiary care, curative services should support preventive, promotive services at primary care level,and care should be brought to the home.

Telehealth Blueprint Telehealth Blueprint

Promoting the Health ParadigmPromoting the Health Paradigm

Essential health services :

information and education forindividuals to support the

wellness paradigm consultations to maintain health or to provide early

treatment of illness,

all underpinned by a lifetime health plan and lifetime health record.

TelehealthTelehealth Technology enabler to realise vision for health Potential to develop superior & modern health system

TransformationTransformation Empowerment of individual on health Emphasis on services for wellness and for care Greater involvement of patients in own health and care Coordinated, continuous, seamless care Development of patient-centred health services

Telehealth – implications for change:Telehealth – implications for change: Structure Process Outcomes

PresentPresent

Structure:Structure: Independent doctors’ practices

Network of doctors Network of hospitals

Providers separate from funders

FutureFuture

Groups of doctors’ practices integrated with

hospital in a system

System & network through integrated health delivery system

Integrated financing & delivery

Process:Process: Illness focused, fragmented episodic care

Emphasis on wellness & health status Development of services for wellness as well as for care

Telehealth – implications for change:Telehealth – implications for change: Structure Process Outcomes

Outcome:Outcome: Emphasis on episodes/ encounter Quality Assurance through peer review

Emphasis on health status throughout life Quality Assurance through outcomes measurement.

PresentPresent FutureFuture

PresentPresentHealth information

system developed

around episodes/

encounter of care,

collecting information

for bill collection

Patient-centred Health SystemPatient-centred Health System

FutureFutureHealth information

System will be

person/patient -centred,

collecting health

data to become lifetime

health record.

Health Information SystemHealth Information System

PresentPresent Episodic, finance

orientation Episodic, fragmented

application Individual, provider- based Financial measurement Rectrospective decision support Fee for service billing

FutureFuture Person/patient orientation Enterprise-wide application Enterprise- wide based Financial, quality, outcomes measurement Concurrent decision support Delivery & financing (e.g. managed care, casemix DRG, capitation, etc.

Experience from developed countries – based on commonExperience from developed countries – based on commongoals nations set for health systems:goals nations set for health systems:Equity:Equity: Universal coverageUniversal coverage General tax/ Social insurance General tax/ Social insurance & equal access& equal access Cost ControlCost Control

StrongStrong Global budget Global budget Single channel - paymentSingle channel - payment

Efficient use of resourcesEfficient use of resourcesHigh (or moderate) High (or moderate) General tax/ Social insurance General tax/ Social insurance

Consumer choiceConsumer choiceHighHigh Indirect provision of services Indirect provision of services

Integrated servicesIntegrated services General tax/ Social insurance. General tax/ Social insurance.

Restructuring Malaysia’s Healthcare SystemRestructuring Malaysia’s Healthcare System

Experience from developed countries:Experience from developed countries:

1. To promote solidarity, social justice:1. To promote solidarity, social justice: financing to be organised into explicit financing to be organised into explicit

systems systems government government centre of decision making centre of decision making

allocation & use of resourcesallocation & use of resources ensure achievement ensure achievement of national health policies. of national health policies.



2. To achieve:2. To achieve: universal & equal access to healthcareuniversal & equal access to healthcare control health expenditurecontrol health expenditure ensure efficient use of resourcesensure efficient use of resources

FinancingFinancing Organisation of payment & deliveryOrganisation of payment & delivery

must be must be integrated.integrated.


of healthcareof healthcare

Experience from developed countries:Experience from developed countries:3. Two major approaches to achieve goals3. Two major approaches to achieve goalsa) Demand side strategies:a) Demand side strategies:

Efficiency Efficiency market competition market competition consumer choice, empowermentconsumer choice, empowerment management of “wellness”management of “wellness”

b) Supply side strategies:b) Supply side strategies: Universal coverage & equal access-Universal coverage & equal access-

general taxgeneral tax compulsory social insurancecompulsory social insurance global budget or budgetary processglobal budget or budgetary process distribution of health resources distribution of health resources (rural health programme).(rural health programme).



Controlling health expenditures while providing Controlling health expenditures while providing

universal coverage & equal access have not been universal coverage & equal access have not been

achieved through market mechanisms.achieved through market mechanisms.


Experience from developed countries:Experience from developed countries: Some types of healthcare systems are more successful in achieving various Some types of healthcare systems are more successful in achieving various

healthcare policy goalshealthcare policy goals Consider those that can meet Malaysia’s healthcare policy goalsConsider those that can meet Malaysia’s healthcare policy goals Consistent with: Consistent with: Vision 2020 Vision 2020

Vision for healthVision for health Telehealth blueprint, Telehealth blueprint, 8 goals of the healthcare system8 goals of the healthcare system

One-tier healthcare systemOne-tier healthcare system Implications: predictive geneticsImplications: predictive genetics

human genome.human genome.


Role of government:Role of government: FundingFunding Allocation & use of resourcesAllocation & use of resources Conduct of process to set global budgetConduct of process to set global budget (e.g. negotiation with providers, etc)(e.g. negotiation with providers, etc) Ensure universal coverageEnsure universal coverage (e.g. programme for rural coverage)(e.g. programme for rural coverage) Develop & enforce policiesDevelop & enforce policies Capital, facilities, Capital, facilities,

manpower distribution manpower distribution paymentpayment


Service Service distributiondistribution

Universal coverage, equal accessUniversal coverage, equal access Health FundHealth Fund

General tax, social insurance General tax, social insurance contributioncontribution

One-tier health systemOne-tier health system One channel payment systemOne channel payment system Global budgetGlobal budget Indirect provisionIndirect provision

- optimise use of public & - optimise use of public & private sectorsprivate sectors

Integrated servicesIntegrated services


Health Fund: Health Fund: govt-ownedgovt-owned non-profitnon-profit

Network of public Network of public healthcare services: healthcare services: govt-ownedgovt-owned non-profitnon-profit entityentity

In line with In line with Telehealth blueprintTelehealth blueprint

Thank YouThank You

dr abu bakar suleiman president international medical university kuala lumpur, malaysia third annual...

Documents

health healthcare

healthcare quality

healthcare reformattempts

future of medicine healthcare

present healthcare systems

healthcare costsall

national healthcare

goals of medicine