5th discussion (24 Jan 2012 - On whether 1Care is still in conceptual stage or implementation stage)
#taknak1care
_This is a powerpoint slide from the 6th public health conference held in July 2011 and organised by the MOH. This presentation was entitled "Towards Public/Private Integration - Aspirations for 1Care" presented by Dr Azilina Abu Bakar of the MOH's Unit for National Health Financing
Replies:
- #taknak1care Datuk Dr Hisham, the Deputy Director General of the Malaysian Ministry of Health, mentioned in one of his comments here that nothing has been confirmed about 1Care, and the govt is only exploring options. In his own words:
"We only have started the first stage of transformation that is strengthening of the existing healthcare services. The second stage is to study various models assisted by WHO and professor William Hsiao and team." Datuk also said: "it's premature for use to speculate and make assumption on things we have not studied."
The question playing in the rakyat's mind now is:
HOW CAN THERE BE AN ENTIRE 5-STEP 1CARE IMPLEMENTATION PROGRAM IN PLACE IF THE GOVT IS STILL MERELY EXPLORING OPTIONS FOR 1CARE AND NOTHING HAS BEEN CONFIRMED?
I mean, it's like saying someone is has already planned an entire wedding while still looking for a suitable bride!January 24 at 9:04am · Like · 1 - JooLee Tan Does SHI stand for Social Health Insurance? What does GT stand for?January 24 at 9:05am · Like
- #taknak1care GT - General Taxes
Public Facilities - Govt clinics, hospitals, etc
PHC - Public Healthcare
SHI - Social Health InsuranceJanuary 24 at 9:07am · Like · 1 - #taknak1care Maybe a little more explanation is needed:
Slide 2 - "Public service autonomy" basically means the corporatisation of govt facilities. Each will be run like an independent company and is free to set its own policies and guidelines. Semi-private la in other words - examples would be the UH, HUKM, IJN. This would be the first step towards completely privatising healthcare in Malaysia January 24 at 9:11am · Like - Azrul Mohd Khalib Should refer to Datuk Hasan's (DG of Health) recent published comments. Need to focus as the other officers run interference and confuse the issue.January 24 at 9:16am · Like
- #taknak1care You mean his December letter to Mkini? That what they ALL say, EVERY TIME, even internal discussions. It's like they just copy paste the answers. You could see it in the previous discussions here too.
However, the Dep DG did mention here who the govt is working with to formulate 1Care. We've done some research on that consultant and it's not pretty. Stay tuned, more info coming your way.January 24 at 9:28am · Like - Azrul Mohd KhalibI am actually privy to some of the discussions from the UN side. It is a mess.January 24 at 9:30am · Like
- JooLee Tan In your opinion then, Azrul Mohd Khalib, is the government planning to fast track the bill this year? Will they be able to do it?January 24 at 9:36am · Like
- #taknak1care Wonderful! Then you can perhaps answer this question: 1Care concept has already long been agreed upon. Only the exact mechanics of implementation and quantum of payments are yet to be worked out, yes?January 24 at 9:38am · Like
- Azrul Mohd KhalibThe 1Care overall concept has indeed been long agreed upon. There should not be any debate about that. The whole of 2010 was spent developing the concept. As you know and can see the discussions are at quite an advanced stage. He is correct in that the first stage in ongoing and has in fact involved implemention including in non-MOH facilities. However, it is important to highlight that referring to their own presentations, the framework of implementation and quantum of payments have in fact been drafted out.January 24 at 9:51am · Like
- Azrul Mohd Khalib What the UN work is suppose to do is examine feasibility and finalise the draft framework. This year will also be spent on doing the selling/ marketing for the model. At the same time. I suspect that these sessions with various practitioners (e.g recent session with Malaysian Dental Association) will be described as consultations rather than top down briefings which are what they are.January 24 at 9:55am · Like
- Azrul Mohd Khalib On the fast tracking of the bill for this year, it is less likely to happen as the discussions are no where near finalised and ready.January 24 at 9:57am · Like
- Azrul Mohd Khalib The problem lies in the MOH top management being enamoured with the NHS and there being no earlier feasibility study carried out prior to the discussion of 1Care (as usual).January 24 at 10:00am · Like
- JooLee Tan enamoured with the NHS? are they deaf and blind? the NHS is sinking under its own weight.January 24 at 10:19am · Like · 1
- JooLee Tan thank you for the clarifications, Azrul Mohd Khalib :)January 24 at 10:19am · Like
- #taknak1care Many thanks Azrul Mohd Khalib!January 24 at 10:57am · Like
- #taknak1care Azrul Mohd Khalib "the framework of implementation and quantum of payments have in fact been drafted out."
This is the information that we have received. In fact, we understand that several numbers have been proposed in the past few years, with the latest "discussion" on figures held with medical professionals in late 2011. We have based our assertions on those latest figures.January 24 at 11:17am · Like - #taknak1care Reply from Datuk Dr Hisham Abdullah:
The stages of implementation 5 stages have started. We have talk on healthcare reform more than 20 years but at least we have started. The principle in hand is to increase the quality of healthcare in the public sector within the current existing system with minimal cost of course. So when I came to office we started the retention package to decrease the brain drain. It's is still ongoing and our doctors are generally happy but more to be done. Next to talk on quality and performance. If you read and do some research we have published on performance monitoring internationally. Here we introduce the. Decongestion program, addressing long waiting time, parking problems etc. we look in dept and introduced efficiency for example the pain free hospital concepts. Integrating pain as the 5 vital signs, minimal invasive surgery and acupuncture. We believe less pain shorter hospitalisation, more daycare cases, start community clinic and visits, introduce back Lowe risk centre out of the hospitals and simple surgery LA cases of of hospitals like cataract centre. Some are done I partnerships with NGO or with other ministry cutting cost. Now when the quality continue to improve we see more patients, longer queue in the public sector. Say if we have world class department or hospitals we will attract more patients rich and poor, locally, regionally and internationally. However even the foreigner pay minimum despite the first class charges as its a subsided by government. And the funding is limitedJanuary 24 at 12:41pm · Like
(Note: How can you start implementation of something that has not even been decided yet at the concept stage? The DDG is contradicting himself. We cannot give any credibility to such a fundamental contradiction! Either he has no idea what's going on, or he is not telling us the whole truth!) - #taknak1care Reply from Datuk Dr Hisham Abdullah:
I believe in this transformation in stages and trying to make a difference to improve the healthcare in this country looking at quality, competency and performance. I am still practising as a surgeon and would like to see changes in a more cost effective way. We must have a system of reform with universal coverage and equity, with this reform rakyat may access to either a public or private hospitals based on their performance not costing. Today we are seeing more patients from private and regionally referring back to government hospitalsJanuary 24 at 12:54pm · Like - #taknak1care Reply from Dr Hisham Abdullah (Dep DG of MOH)
Even if I have 20% increase old of patients. So we introduce the case in to study the funding and quality are. For a specialist or doctor if I see 10 patients a day or I see 100 patients the salary is the same. If you are efficient you be given more work. This is the system we have now. With case mix we can see the performance and costing of the dept and hospitals. So now if depts and hospitals are autonomy as in stage two of reform funding will be based on the performance. Autonomy is not privatisation or corporatisation. So the more patients you see the more funding you will get from the GT. somehow in the current system if I see 200 patients last year and 200 patients this year, on follow up,is accumulating. Can you imagine if I am 10 years in service, we can't discharge to KK as they are already congested. Some of the regular blood monitoring, follow up and treatment can be discharged back to the GPs. Come to hospital only if necessary. That's the reason why we must get back the gate keepers. Otherwise we need more specialists in this country and less GPs. That's why we come to stage two and three of reform. The question is how best to do it with maximal benefits and impact to the rakyat and minimal cost and better still at I cost. I believe we have to make a difference is healthcare towards high qualitycare for the people.January 24 at 1:02pm · Like · 1 - #taknak1care Reply from Dr Hisham Abdullah (Dep DG of MOH)
John was talking on to regulate the non professional fees, yes it's a good idea but on what basis what evidence do we have to cap the rate? So we should introduce casemix study looking at the costing before we can implement this. For example you build a hospital at cost of 50 million and another at cost of 500 million, we can have the same rate can we but more important how to we set the standard of payment of non professional fees. This is what we need to study on.
16 minutes ago · Like
I see there lots of questions and confusion. I must say reading and responding this has taken much of my time. But I hope to clear the air as much as I could.