institutionalization of national health accounts in malaysia

INSTITUTIONALIZATION OF NATIONAL HEALTH ACCOUNTS IN MALAYSIA

Presentation By: Dr. Jameela ZainuddinHead of MNHA Unit

Planning & Development Division, MOH, Malaysia

20th. Oct 2010

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MALAYSIA

2

WHO member country ( WPRO)Size: 329,959 sq.kmPop: 28.25 million (2010P)

LE: Male =72yrs ; Female=76yrsDeveloping country (MIC)Income per capita = USD 6975 (WB, 2009)

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3

MALAYSIA

• 1997-2008 MNHA Data

• Institutionalization of MNHA in relation to following:– Environment

– Resources

– Data collection

– Data management

– Data quality

– Products information

– Dissemination and use.

• Use of NHA in Policy

CONTENTS

4

MALAYSIA NATIONAL HEALTH ACCOUNTS

1997-2002 (MNHA Project)

2nd. Cycle: 2003-2006

3rd. Cycle: 2007

4th. Cycle: 2008

55th. Cycle: 2009

6

1997 – 2008 MALAYSIA NATIONAL HEALTH

EXPENDITURE DATA

Expenditure on Health(RM Million), 1997,

8,213


8,966


9,743


11,516


12,520


13,620


19,164


21,378


21,915


24,788


30,667


35,149

Expenditure on Health as percentage

of GDP (%), 1997, 2.90


of GDP (%), 1998, 3.20


of GDP (%), 1999, 3.20


of GDP (%), 2000, 3.40


of GDP (%), 2001, 3.70


of GDP (%), 2002, 3.80


of GDP (%), 2003, 4.58


of GDP (%), 2004, 4.51


of GDP (%), 2005, 4.22


of GDP (%), 2006, 4.33


of GDP (%), 2007, 4.78


of GDP (%), 2008, 4.75

Expenditure on Health(RM Million)

Expenditure on Health as percentage of GDP (%)

TOTAL EXPENDITURE ON HEALTH, 1997-2008, Nominal value (RM)

7Note: 1 USD = 3 RM (Ringgit Malaysia)

Per Capita Spending on Health, 1997 – 2008, Nominal vs Real value (RM)*

8

TEH per Capita (Nominal), 1997, 377












TEH Per capita (Real), 1997, 615







TEH Per capita (Real), 2004, 1051TEH Per capita (Real),

2005, 1008


TEH Per capita (Real), 2007, 1245TEH Per capita

(Real), 2008, 1268

RM p

er C

apit

a

Year

TEH per Capita (Nominal)

TEH Per capita (Real)

Note: *Adjusted for inflation to Base Year 2008

Note: 1 USD = 3 RM (Ringgit Malaysia)

TOTAL EXPENDITURE ON HEALTH –TREND PUBLIC VS PRIVATE SECTOR,1997-2008, Real value (RM)*

9

Adj

uste

d Pu

blic

Exp

, 199

7, 6

,669

.5

Adj

uste

d Pu

blic

Exp

, 199

8, 6

,894

.9

Adj

uste

d Pu

blic

Exp

, 199

9, 7

,542

.1

Adj

uste

d Pu

blic

Exp

, 200

0, 8

,484

.7

Adj

uste

d Pu

blic

Exp

, 200

1, 9

,981

.1

Adj

uste

d Pu

blic

Exp

, 200

2,

10,4

60.4

Adj

uste

d Pu

blic

Exp

, 200

3,

13,9

25.3

Adj

uste

d Pu

blic

Exp

, 200

4,

13,3

41.7

Adj

uste

d Pu

blic

Exp

, 200

5,

11,6

12.0

Adj

uste

d Pu

blic

Exp

, 200

6,

12,7

83.7

Adj

uste

d Pu

blic

Exp

, 200

7,

14,9

35.6

Adj

uste

d Pu

blic

Exp

, 200

8,

16,2

26.3

Adj

uste

d pr

ivat

e Ex

p, 1

997,

6,7

19.4

Adj

uste

d pr

ivat

e Ex

p, 1

998,

6,5

76.2

Adj

uste

d pr

ivat

e Ex

p, 1

999,

7,0

89.6

Adj

uste

d pr

ivat

e Ex

p, 2

000,

7,6

16.3

Adj

uste

d pr

ivat

e Ex

p, 2

001,

7,8

04.9

Adj

uste

d pr

ivat

e Ex

p, 2

002,

8,3

01.6

Adj

uste

d pr

ivat

e Ex

p, 2

003,

11,

631.

8

Adj

uste

d pr

ivat

e Ex

p, 2

004,

13,

551.

5

Adj

uste

d pr

ivat

e Ex

p, 2

005,

14,

736.

1

Adj

uste

d pr

ivat

e Ex

p, 2

006,

15,

906.

2

Adj

uste

d pr

ivat

e Ex

p, 2

007,

18,

904.

2

Adj

uste

d pr

ivat

e Ex

p, 2

008,

18,

922.

7

RM M

illio

n

Year

Adjusted Public Exp

Adjusted private Exp

Note: *Adjusted for inflation to Base Year 2008


PUBLIC & PRIVATE HEALTH EXPENDITURE AS PERCENTAGE OF GDP, 1997-2008

10

% G

DP

Year

Public HE as % GDP

Private HE as % GDP

Year Public HE as %

GDP

Private HE as %

GDP

THE as % GDP

1997 1.45 1.46 2.91

1998 1.62 1.55 3.17

1999 1.67 1.57 3.24

2000 1.77 1.59 3.36

2001 2.10 1.64 3.74

2002 2.11 1.67 3.78

2003 2.49 2.08 4.58

2004 2.24 2.27 4.51

2005 1.86 2.36 4.22

2006 1.93 2.40 4.33

2007 2.11 2.67 4.78

2008 2.19 2.55 4.75Note: 1 USD = 3 RM (Ringgit Malaysia)

PRIVATE SECTOR EXPENDITURE ON HEALTH, 1997-2008, Nominal VS Real value (RM)

11Note: *Adjusted for inflation to Base Year 2008

Private Exp, 1997, 4,121.8

Private Exp, 1998, 4,376.8

Private Exp, 1999, 4,720.7

Private Exp, 2000, 5,447.3

Private Exp, 2001, 5,493.9

Private Exp, 2002, 6,026.2

Private Exp, 2003, 8,722.3

Private Exp, 2004, 10,772.6

Private Exp, 2005, 12,256.6

Private Exp, 2006, 13,742.7

Private Exp, 2007, 17,131.5

Private Exp, 2008, 18,922.7

Adjusted private Exp, 1997, 6,719.4 Adjusted private Exp, 1998,

6,576.2

Adjusted private Exp, 1999, 7,089.6








Adjusted private Exp, 2007, 18,904.2 Adjusted private Exp, 2008,

18,922.7 RM

Mill

ion

Year

Private Exp

Adjusted private Exp


OOP EXPENDITURE AS PERCENT OF PRIVATE AND TOTAL HEALTH EXPENDITURE, 1997-2008

12

Series1, 1997, 76

Series1, 1998, 75

Series1, 1999, 75

Series1, 2000, 75

Series1, 2001, 74

Series1, 2002, 74

Series1, 2003, 72

Series1, 2004, 75

Series1, 2005, 75

Series1, 2006, 73

Series1, 2007, 55

Series1, 2008, 57

OO

P as

% o

f Pri

vate

Exp

endi

ture

Series1, 1997, 38Series1,

1998, 36Series1, 1999, 36

Series1, 2000, 36Series1,

2001, 32Series1, 2002, 33

Series1, 2003, 33

Series1, 2004, 38

Series1, 2005, 42

Series1, 2006, 41

Series1, 2007, 31

Series1, 2008, 31

OO

P %

of T

EH

13

ENVIRONMENT

ENVIRONMENT

• 2001-2005 NHA Project conducted by MOH, Malaysia in collaboration with Economic Planning Unit (EPU). Funded by United Nations Development Programme (UNDP).

• In Sept 2005 Malaysia National Health Accounts Unit was set up under purview of Planning and Development Division, MOH.

14

15

RESOURCE

RESOURCE

Manpower Expanded from initial total 5 staffs (2005) to 8

staffs involved in analysis+ 5 data entry + 3 administrative work

Continuous on-job training in analysis methods, software (excel & Stata)

Half technical staff are temporary workers

Physical Moved 3X and now share 1 floor with 2 other

units

Expansion of units have led to overcrowding 16

RESOURCE

Financial Budget allocation through annual operating

budget specified under Planning & Development Division

WHO support for consultancies & additional scope of work

Sometimes other priorities take precedence for limited budget

17

18

DATA COLLECTION

DATA COLLECTION

Multiple sources of data: surveys, reports, agency database (eg. AG), websites, etc.

Good stakeholder networking for data collection

Dedicated staff to track data

Disseminate analyzed data back to stakeholders

Temporary staff need guidance

Significant budget allocation for postage, printing, etc. 19

20

DATA MANAGEMENT

DATA MANAGEMENT

Established 3 separate manual procedures for data collection, data analysis & data dissemination with flow charts of required activities

Unpublished data management manual for unit consumption on collection & analysis

Specific software designed for data outputs

21

DATA MANAGEMENT

Lack of expertise in temporary staff can sometimes delay analysis and timely data production

Several database from various cycles of analysis

Previous coding using local framework & mapping to international codes after analysis

Problems with vendor to manage software –maintenance & Licensing

22

23

DATA QUALITY

24

Since MNHA framework based on SHA framework, able to produce data for international reporting

24

DATA QUALITY

Data collectionData Processing & Consultation Data Outputs

Data Cleaning& Data entry

Quality Checks

Quality checks made at all levels of data management, from data collection to report writing.

25

INFORMATION & PRODUCTS

INFORMATION & PRODUCT

Basic NHA data reported in national document called “Health Facts” - health indicator reference produced by MOH annually

MNHA Unit produces NHA Reports based on SHA classification with timely data of previous year

Differences in boundaries of MNHA and SHA causes discrepancies in coding

Disaggregation of NHA by geographical areas, programmes, diseases, age and gender needs to be developed

26

27

DISSEMINATION & USE

DISSEMINATION & USE

Health expenditure data release subjected to prior approval by MNHA Steering Committee

NHA data disseminated to all stakeholders in report format and additional data made available upon request

Data presentations in graphical forms often used for policy discussions and in health planning

NHA data used to make gross financial allocation for health in public sector

Financial resource allocation in MOH based on historical expenditure data

28

USE OF MNHA:HEALTH SECTOR

POLICY DECISIONS

29

CHALLENGES IN HEALTH FINANCING

• Sustainability of good health care system if current HE trend continues as Malaysia moves towards an upper income country by the year 2020

• Escalating total health expenditure & per capita HE

• Limited public funding vs increased needs & demands as noted in the utilization trends

• Private HE growing faster than Government HE

• High OOP expenditure indicating insufficient pre-paid mechanism which could result in equity issues, impoverishment from catastrophic HE, etc.)

30

HEALTH CARE SYSTEM TRANSFORMATION

31

HEALTHCARE FINANCING

SYSTEM

HEALTHCARE DELIVERY SYSTEM

Integration of public & private healthcare providers & services through structured

quality delivery system with mechanisms to ensure efficient utilization

UNIVERSAL ACCESS(MOH Governance)

Pre-paid financial risk protection through national pooling of finances from SHI, taxation & other sources of funding, &

better targeting of subsidized HC

POLICY RELEVANCE

32

• Largest component of private health expenditure (70-75%)

OOP EXPENDITURE

• Largest component of public health expenditure (75-85%)

MOH EXPENDITURE

MNHA UNIT WORK PLAN - 2010

1

2009 MNHA DATA 2

OOP SUB-ACCOUNT

3

MOH SUB-ACCOUNT

33

MNHA STEERING COMMITTEE APPROVAL

2010 MNHA DATA RELEASE

4

REVIEW PAST ANALYSIS

institutionalization of national health accounts in malaysia

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