Docstoc

Malaysia National Health Accounts_ Evidence to_ Time for Change

Document Sample
Malaysia National Health Accounts_ Evidence to_ Time for Change Powered By Docstoc
					Malaysia National Health Accounts:
  Evidence to, Time for Change
         Dr Zailan Dato’ Hj Adnan,
          State Health Director,
       Negeri Sembilan Darul Khusus
            25 November 2009
                 Current issues
• Highly subsidized services and overdependence
  on government health facilities (also patronized
  by those who can afford), thus heavy workload
  and long waiting time at public health facilities
• Inadequate integration in health especially
  between public and private sectors.
   – “Brain drain” to private sector – non-optimal resource
     use
   – Need for better regulation of private health care
     providers
   – Fragmented care and clinical records
                 Current issues
• Rising health care expenditure
  – Rising demand and expectation
  – Expensive high tech diagnostic equipments and
    medicines
• “Gaps” in health care delivery system
  – E.g. equity, efficiency, accessibility, quality of
    service
               Current issues
• Changing demographic and epidemiological
  patterns
  – Increase in the ageing population
  – Increase in chronic diseases (chronic diseases are
    the major cause of death and disability in
    Malaysia, accounting for 71% of deaths and 69%
    of the total burden of disease)
               Diagram 1: Total Expenditure on Health, 1997–2008
                              (RM, Nominal Value)


               40,000.0                                                                                                                                  6.00
                                                                                                                                       4.78
               35,000.0                                                                                                                          4.75
                                                                                                4.58       4.51                                          5.00
               30,000.0                                                                                                       4.33
                                                                                                                    4.22             30666.65 35148.96
                                                                                     3.80                                                                4.00
                                                                          3.70                                              24.79
(RM Billion)




               25,000.0                                        3.40




                                                                                                                                                                (% GDP)
                                          3.20      3.20                                                21378.40 21914.79
                                 2.90                                                        19164.44
               20,000.0                                                                                                                                  3.00
                                                                                  13620.00
               15,000.0                                                12520.00
                                                            11516.00                                                                                     2.00
                                        8966.00   9743.00
               10,000.0     8213.00
                                                                                                                                                         1.00
                5,000.0

                      -                                                                                                                                  -
                                1997    1998      1999       2000       2001       2002       2003       2004     2005      2006      2007     2008

                          TEH             TEH as percentage of GDP
                                                                                     Year
Total Expenditure on Health, 1997–2008 (RM, nominal
                       value)

• The TEH has consistently increased from RM8.21
  billion in 1997 to RM35.15 billion in 2008, a more
  than four fold increase in eleven years.
• The TEH as a percentage of GDP has gradually
  increased from 2.90% in 1997 to 4.75% in 2008
  (2007: 4.78).
   Table 1: Total Expenditure on Health, 1997–2008 (RM,
                       Nominal Value)
Year   Expenditure on Health   Expenditure on   Total GDP (nominal
       (RM million)            Health as % of   value) (RM million)
                               GDP
1997           8,213                  2.9            281,795
1998           8,966                  3.2            283,243
1999           9,743                  3.2            300,764
2000          11,516                  3.4            342,612
2001          12,520                  3.7            334,309
2002          13,620                  3.8            360,568
2003          19,164                  4.6            418,769
2004          21,378                  4.5            474,048
2005          21,915                  4.2            519,451
2006          24,788                  4.3            572,555
2007          30,228                  4.7            641,864
2008          35,149                  4.7            740,721
  Per Capita Health Spending, 1997-2008 (RM,
                nominal value)
• The per capita health spending shows a progressive increase
  from RM381 in 1997 to RM1,268 in 2008, a more than three
  fold increase.
• The per capita health spending in 2008 has increased by 14%
  compared to 2007 (the most marked increase in per capita
  health spending inter year was in 2003 whereby the increase
  was 36% compared to the previous year).
Diagram 2: Per Capita Spending on Health, 1997-2008
                (RM, nominal value)

     1400
                                                                                                          1,268

     1200



     1000                                                                                             1,112


                                                                                             930
      800
                                                                           836      839
RM




                                                                   765
                                                 529
      600                                  501
                                432                        560
              381     406

      400



      200



       0
            1997    1998      1999        2000   2001   2002     2003    2004    2005     2006     2007       2008

                                                                                                              Year
                    Per Capita Spending
     Total Expenditure on Health by Source of Financing
              (Public versus Private), 1997-2008

• Between 1997 to 2003, the public sector proportion
  of health spending exceeded the private sector.
  However, from 2004 to 2008, the private sector’s
  proportion was more than the public sector’s.
• In 2008, the ratio of public to private sector’s cost
  sharing was 46 (public): 54 (private).
Diagram 3: Total Expenditure on Health by Source of Financing
                (Public vs. Private), 1997-2008




                                                                                                                                                                       18,922
                  20000




                                                                                                                                                                   16,226
                                                                                                                                                          17,131
                  18000




                                                                                                                                            13,734
                  16000




                                                                                                                                                     13,535
                                                                                                                          12,247
                  14000




                                                                                                                                   11,045
                                                                                                         10,765
                                                                                                         10,606
                                                                                                10,442
     RM million




                  12000




                                                                                                                  9,658
                                                                                            8,715
                  10000




                                                                                    7,593
                                                                        7,026
                                                            6,068
                   8000




                                                                                6,026
                                                                    5,494
                                                 5,022




                                                         5,447
                                       4,589




                                               4,721
                           4,091




                   6000
                                     4,377
                          4,122




                   4000

                   2000

                      0
                          1997      1998       1999      2000       2001        2002        2003         2004     2005             2006              2007          2008

                                                                                                                                                          Year
                                   Public sector                            Private sector
         TEH by Source of Financing, 2008

• By Source of Financing, MOH was the highest contributor to
  TEH. It contributed RM13.04 billion (37.1%), followed by
  private household out-of-pocket (OOP), RM10.80 billion
  (30.7%), all corporations (excluding health insurance)
  RM4.78 billion (13.6%), private insurance, RM2.97 billion
  (8.4%), other federal agencies, RM1.60 billion (4.5%), MOE
  RM1.05 billion (3.0%) and others RM0.92 billion (0.7%).
Diagram 4: Total Expenditure on Health by Source of
                  Financing, 2008

                     50.00

                     45.00

                     40.00        37.09

                     35.00
                                              30.73
                     30.00
    Per cent (%)




                     25.00

                     20.00

                     15.00                               13.60

                     10.00                                            8.44
                                                                                  4.51
                         5.00                                                                 3.00
                                                                                                       0.95
                         0.00
                                                                   SOURCES



                   MOH      OOP   All Corporations    Private insurance      Other Federal agencies   MOE     Private MCO
            TEH in the Public Sector by
            Source of Financing, 2008
• In the public sector, the highest contribution came
  from MOH. It spent RM13.04 billion (80.3%) of the
  public sector’s total health expenditure. This was
  followed by other federal agencies including
  statutory bodies RM1.58 billion (9.8%), Ministry of
  Higher Education (MOHE), RM1.05 billion (6.5%)
  and others RM0.55 billion (3.4%).
Diagram 5: TEH in the Public Sector by
      Source of Financing, 2008



               90.00
                             80.24
               80.00
               70.00

               60.00
Per cent (%)




               50.00

               40.00

               30.00

               20.00
                                     9.88
               10.00                        6.49
                                                   1.31   0.88    1.21
                0.00
                                            SOURCES


     MOH           Other Federal agencies   MOE      Local authorities   SOCSO   Others
Diagram6: Total Expenditure on Health in Public Sector by Source of
                      Financing, 2003-2008
Cross Classification of the Public Sector Expenditure by Provider
                     of Health Services, 2008

• In the Public Sector, by Provider of Health Services, the
  highest spending was at the hospitals, which amounted to
  RM9.49 billion (58.5%), followed by providers of public
  health programs (preventive and promotive) RM3.24 billion
  (20.0%), providers of general health administration and
  insurance, RM1.88 billion (11.6%), providers of ambulatory
  health care (non-hospital setting), RM0.80 billion (4.9%),
  institutions providing health related services RM0.69 billion
  (4.3%) and others RM0.12 billion (0.7%).
Diagram 7: Cross Classification of the Public Sector Expenditure by
                Provider of Health Services, 2008



                                                           4.28 %

                                   11.59%




                            4.94%

                                                             Public ector
                                                            expenditure :
                                                            46.16% of THE                                58.50%
                                                            (RM16 billion)


                      19.97%




           HOSPITALS                                                         Provision and administration of public health programmes
           General health administration and insurance                       Providers of ambulatory health care
           Institution providing health related services
 Cross Classification of Public Sector Expenditure by
          Function of Health Services, 2008

• In the public sector, by Function of Health Services,
  the highest spending was for services of curative
  care, amounting to RM8.86 billion (54.6%), followed
  by prevention and public health services, RM2.62
  billion (16.1%), health administration and health
  insurance RM1.93 billion (11.9%), capital formation
  and health care provider institutions, RM1.67
  (10.3%) and others RM1.16 billion (7.1%).
Diagram 8: Cross Classification of Public Sector Health
  Expenditure by Functions of Health Services, 2008


                                                           2.33%
                                                  2.88%



                        10.29%




                                                    Public Sector
                    16.12%
                                                    expenditure :
                                                    46.16% of THE                            54.58%
                                                    (RM16 billion)


                       11.87%




    Services of curative care                              Prevention and public health services
    Health adm inistration and health insurance            Capital form ation of health care provider institutions
    Education and training of health personnel             Medical goods dispensed to out-patients
Diagram 9: Total Expenditure on Health in the Private Sector by Source of
                            Financing, 2008
      Diagram 10: TEH in the Private Sector Health Expenditure by Sources of
                              Financing, 2003-2008



      80

      70

      60                                                                                 Private household out-of-
                                                                                         pocket expenditures
      50
(%)




      40                                                                                 All Corporations (other than
                                                                                         health insurance)
      30
                                                                                         Private insurance enterprise
      20

      10
                                                                                         Non-profit organizations
       0                                                                                 serving households
               2003          2004           2005          2006             2007   2008

                                            Year of Financing
       Notes :-
       Rest of the world
       2003=0.09, 2004=0.07,2005=0.08, 2006=0.06 ,2007=0.01 & 2008=0.003
Cross Classification of Private Sector Expenditure by Provider of
                      Health Services, 2008

• In the private sector, by Provider of Services, the highest
  spending was for hospitals. The total amount spent was
  RM9.84 billion (52.0%), followed by providers of ambulatory
  care (non-hospital setting), RM6.33 billion (33.5%), retail
  sale and providers of medical goods, RM1.38 billion (7.3%),
  general health administration and insurance, RM1.15 billion
  (6.1%), and others, RM0.23 billion (1.1%).
Diagram 11: Cross Classification of Private Sector Health Expenditure by
                  Providers of Health Services, 2008


                                                        6.08     0.72

                                            7.28




                                                                                       51.98
                                                           Private
                                                           sector
                                                        expenditure :
                                                          53.84% of
                                                             TEH
                              33.47




            HOS PITA L S                                                Providers of ambulatory health c are

            Retail s ale and other providers of medic al goods          General health adminis tration and ins uranc e

            Ins titution providing health related s ervic es
Cross Classification of Private Sector Expenditure by Function of
                      Health Services, 2008

• In the private sector, by Functions of Services the highest
  health spending was for services of curative care. The TEH
  for services of curative care was RM12.19 billion (64.4%),
  followed by ancillary services to health care RM3.48 billion
  (18.4%), medical goods dispensed to outpatients, RM1.84
  billion (9.7%),health administration and health insurance
  RM1.15 billion (6.1%) and others, RM0.26 billion (1.3%).
Diagram 12: Cross Classification of Private Sector Health Expenditure by
                  Functions of Health Services, 2008




                                                          0.72% 0.62%
                                                  6.09%

                                        9.74%




                                                            Private
                                                            sector
                               18.39%                    expenditure :
                                                           53.84% of

                                                                                  64.41%




         S ervic es of c urative c are                                   A nc illary s ervic es to health c are
         Medic al goods dis pens ed to out-patients                      Health adminis tration and health ins uranc e
         E duc ation and training of health pers onnel                   P revention and public health s ervic es
 Cross Classification of Private Household OOP Expenditure by
                 Provider of Health Services 2008

• Cross-classification of the private household OOP by
  Provider of Health Services shows that the highest health
  spending from OOP was at the providers of ambulatory care
  whereby RM5.93 billion (54.9%) was spent, followed by
  hospitals, RM3.39 billion (31.4%), retail sale and other
  providers of medical goods, RM1.36 billion (RM12.6%) and
  institutions providing health related services, RM0.12 billion
  (1.1%).
               Diagram 13: Expenditure by
            Providers of Health Services, 2008



                                                    1.09%



                                         12.63%



                                            Private sector
                                             expenditure :
                                            30.74% of TEH          54.92%
                                31.36%
                                            (RM11 billion)




Providers of am bulatory health care                        HOSPITALS
Retail sale and other providers of m edical goods           Institution providing health related services
       TEH by Provider of Health Services, 2008

• The TEH by Providers of Health Services (public and private
  combined) showed that the highest spending was at the
  hospitals whereby the amount spent was RM19.33 billion
  (55.0%), followed by provider of ambulatory care (non-
  hospital setting), RM7.13 billion (20.3%), provision and
  administration of public health programs, RM3.25 billion
  (9.3%), general health administration and insurance, RM3.03
  billion (8.6%), retail sale and other providers of medical
  goods, RM1.48 billion (4.2%) and others, RM0.92 billion
  (2.6%).
Diagram 14: TEH by Providers of Health Services, 2008

    60.00
            54.99


    50.00



    40.00



    30.00


                    20.30
    20.00



                                     9.26               8.63
    10.00
                                                                          4.20
                                                                                 2.36

     0.00
                                  P roviders of health s ervic es

                    HO S P ITA L S
                    A mbulatory health c are
                    P ublic health
                    Health adminis tration
                    R etail s ale and other providers of medic al goods
                    Ins titution
Cross-Classification of Hospital Expenditure by Source
                   of Financing, 2008

• Cross-classification of hospital expenditure by Source of
  Financing (public and private sector combined) showed that
  the highest spending was incurred by MOH. It spent RM7.53
  billion (39.0%), followed by all corporations (other than
  health insurance), RM4.53 billion (23.4%), private household
  OOP, RM3.39 billion (17.5%), private insurance enterprise,
  RM1.92 billion (9.9%), MOHE, RM1.05 billion (5.5%) and
  others, RM0.93 billion (4.7%).
Diagram 15: Cross Classification of Hospital Expenditure by
               Sources of Financing, 2008

                                            3.91% 0.79%
                                 5.45%


                         9.91%


                                                                                    38.96%

                                               Hospital
                                            expenditure :
                                             55% of TEH
                17.53%
                                            (RM19 billion)




                                                 23.44%

                           Minis try of Health (MO H)

                           A ll C orporations (other than health ins uranc e)

                           P rivate hous ehold out-of-poc ket ex penditures

                           P rivate ins uranc e enterpris es (other than s oc ial
                           ins uranc e)
                           Minis try of E duc ation (MO E )

                           O ther federal agenc ies (inc luding s tatutory bodies )

                           O thers
 Cross-classification of MOH Hospital Expenditure by
          Function of Health Services, 2008

• The Cross-classification of MOH hospital
  expenditure by Function of Health Services showed
  that the highest spending was for out-patient
  services, RM3.51 billion (47.3%), followed by in-
  patient services which was RM3.47 billion (46.8%),
  and day care services, RM0.40 billion (5.9%).
Diagram 16: Cross Classification of MOH Hospital Expenditure
            by Function of Health Services, 2008



                                               5.93%




                                              MOH Hospital
                                               expenditure :            47.28%
                                              21.13% of TEH
                                 46.78%        (RM7 billion)




            O ut-patient c urative c are   In-patient c urative c are    Day c as es of c urative c are
  Cross-classification of Ambulatory Care Expenditure by Source of
                    Financing (Non Hospital Setting)
                        (Public vs Private), 2008

• Cross-classification of ambulatory care expenditure by
  Source of Financing (public versus private) showed that the
  spending was predominantly by the private sector. In 2007,
  it spent RM6.60 billion (80.0%) compared to RM1.69 (20.0%)
  by the public sector. In 2008, at RM6.33 billion (88.8%), the
  proportion is has increased, whereby the public sector spent
  only RM0.80 billion (11.2%).
         TEH by Function of Health Services, 2008

• The TEH by Function of Health Services (public and private combined)
  showed that the highest spending was for the services of curative care.
  The amount spent was RM21.05 billion (59.9%), followed by Ancillary
  Services to Health Care RM3.60 billion (10.2%), Health Administration
  and Health Insurance, RM3.08 billion (8.8%), Prevention and Public
  Health Services, RM2.73 billion (7.8%), Medical Goods Dispensed to
  Outpatients, RM2.22 billion (6.3%), Capital Formation of Health Care
  Provider Institutions, RM1.67 billion (4.8%) and Others, RM0.80 billion
  (2.2%).
Diagram 17: Total Expenditure on Health by Function of Health
                       Services, 2007

       70.00

               59.88
       60.00


       50.00


       40.00


       30.00


       20.00

                       10.24
                                      8.75           7.78
       10.00                                                        6.32
                                                                                   4.75
                                                                                           1.72   0.50
        0.00
                                                   F unc tion of financ ing

                               S ervic es of c urative c are
                               A nc illary s ervic es to health c are
                               Health adminis tration and health ins uranc e
                               P revention and public health s ervic es
                               Medic al goods dis pens ed to out-patients
                               C apital formation of health c are provider ins titutions
                               E duc ation and training of health pers onnel
                               R es earc h and development in health
Diagram 18: Cross Classification of Preventive and Promotive
   Public Health Expenditure by Source of Financing, 2008

    80.00   75.82

    70.00

    60.00

    50.00

    40.00

    30.00

    20.00
                    15.55

    10.00
                                     2.45              2.25              1.83              1.58   0.45
     0.00
                                               S ourc e of financ ing

                     Minis try of Health (MO H)
                     O ther federal agenc ies (inc luding s tatutory bodies )
                     L oc al authorities
                     P rivate ins uranc e enterpris es (other than s oc ial ins uranc e)
                     Minis try of Defenc e (MO D)
                     P rivate hous ehold out-of-poc ket ex penditures
                     Non-profit organis ations s erving hous eholds
Diagram 19 : Cross Classification of Education and Health Training
                          Expenditure by
                    Source of Financing, 2008




                         22.50%



                                    Public sector
                                    expenditure :
                                    1.72% of THE        54.18%
                                    (RM6 million)

                     23.32%




                  Minis try of Health   Non-Moh     P rivate s ec tor
                   Diagram 20: OOP Expenditure Vs Per Capita Health
                                Spending, 1997-2008

                                                  OOP Vs Per Capita Total Health Expenditure, 1997 - 2008

                   12,000.0                                                                                                                               1400
                                                                                                                                                  1,268
                                                                                                                                     1,112                1200
                   10,000.0                                                                                     839




                                                                                                                                                                 Per Capita Spending (%)
                                                                                                                            930
                                                                                                       836                                    10,803.0    1000
OOP (RM Million)




                    8,000.0                                                                                                         9,374.7
                                                                                               765
                                                                                  560                                    10,050.5                         800
                    6,000.0                                                                          8,036.5   9,178.4
                                                                         529
                                                               501                                                                                        600
                                           406       432                                   6,250.3
                                 381
                    4,000.0
                                                                                 4,443.3                                                                  400
                                                                       4,045.2
                                        3,269.2    3,540.9   4,109.2
                    2,000.0   3,151.8                                                                                                                     200

                         -                                                                                                                                0
                              1997      1998       1999      2000      2001      2002      2003      2004      2005       2006      2007      2008

                                                                                        Year
                                        OOP (RM Million)                 Per capita
• Kesemua hospital dikelompokkan ke dalam 6
  jenis kategori iaitu;
1. Kategori 1 – Hospital Kuala Lumpur
2. Kategori 2 – Hospital Negeri (18 buah)
3. Kategori 3 – Hospital dengan 9-12 kepakaran
    (12 buah)
4. Kategori 4 – Hospital dengan 1-8 kepakaran
    (25 buah)
5. Kategori 5 – Hospital tanpa kepakaran (77
    buah)
6. Kategori 6 – Hospital Psikiatri (4 buah)
PERBANDINGAN KOS HOSPITAL KATEGORI 1-6 BAGI
                  2008
0.80
                  0.74
                                             0.70
0.70                                                                                         0.68
                         0.65


0.60

                                                                          0.52
                                                                                 0.50 0.50
0.50                                                           0.48



0.40                                                                                                           Inpatient
                                    0.35
                                                                                                               Outpatient
                                                                                                        0.32
                                                        0.30
0.30
       0.26


0.20



0.10



0.00
              1                 2                   3                 4             5               6


                                       MNHA/MOH2009
   PECAHAN PERBELANJAAN HOSPITAL KATEGORI 1
                    dan 2
0.80
           0.75

0.70                    0.68
                                        0.65
                                                                                                         0.63
                                                                         0.61
                                                        0.59
0.60

                                                                                         0.50
0.50                                                                                         0.47


0.40                                                                        0.37                                          Inpatient
                                                            0.36
                                            0.31                                                            0.32          Outpatient
                            0.29
0.30                                                                                                                      Daycare

        0.22
0.20


0.10


0.00
       Hospital Kuala   Hospital Alor   Hospital Ipoh Hospital Kangar / Hospital Kota   Hospital Pakar Hospital Kuantan
         Lumpur            Setar                       Tengku Fauziah      Bharu            Kuala       / Tg Ampuan
                                                                                         Terengganu         Afzan
             PECAHAN PERBELANJAAN HOSPITAL
                     KATEGORI 1 & 2
0.80
                0.74
                          0.71
                                         0.69                                                             0.68
0.70
                                                          0.64            0.64

0.60
                                                                                          0.53

0.50                                                                                             0.47


0.40                                                                             0.36
                                                                 0.36                                                     Inpatient
                                                0.31                                                             0.32
                                 0.29                                                                                     Outpatient
0.30     0.26


0.20


0.10


0.00
       Hospital Kuala   Hospital Alor   Hospital Ipoh Hospital Kangar / Hospital Kota   Hospital Pakar Hospital Kuantan
         Lumpur            Setar                       Tengku Fauziah      Bharu            Kuala       / Tg Ampuan
                                                                                         Terengganu         Afzan
              PECAHAN PERBELANJAAN HOSPITAL
                        KATEGORI 3
0.80

                                                                    0.72                                     0.71
                              0.69
0.70
                                                                                              0.65
                                                        0.63
       0.60       0.60                       0.61
0.60                                                                              0.58


0.50


0.40                                                                                0.37
                    0.36                                                                                                   Inpatient
         0.33                                  0.34
                                                                                                 0.33
                                                                                                                           Outpatient
0.30                             0.27                     0.26         0.27
                                                                                                                0.25       Daycare

0.20


0.10


0.00
       Hospital   Hospital   Hospital Batu   Hospital    Hospital Hospital Miri    Hospital    Hospital       Hospital
       Ampang     Selayang      Pahat         Muar /    Kuala Krai                 Taiping    Teluk Intan    Temerloh
                                             Sultanah                                                        (Sultan Hj.
                                             Fatimah                                                        Ahmad Shah)
              PECAHAN PERBELANJAAN HOSPITAL
                        KATEGORI 3
0.80
                                                        0.74                                                 0.75
                               0.73                                  0.73

0.70   0.67                                                                                   0.67
                  0.64                       0.65
                                                                                  0.63

0.60


0.50


0.40                                                                                 0.37
                     0.36                       0.35
          0.33                                                                                    0.33                    Inpatient
0.30                               0.27                                 0.27                                              Outpatient
                                                            0.26                                                0.25

0.20


0.10


0.00
       Hospital   Hospital   Hospital Batu   Hospital    Hospital Hospital Miri   Hospital    Hospital       Hospital
       Ampang     Selayang      Pahat         Muar /    Kuala Krai                Taiping    Teluk Intan    Temerloh
                                             Sultanah                                                       (Sultan Hj.
                                             Fatimah                                                       Ahmad Shah)
       PECAHAN PERBELANJAAN HOSPITAL
                 KATEGORI 4
0.90

0.80

0.70

0.60

0.50

0.40

0.30                                   Inpatient
                                       Outpatient
0.20
                                       Daycare
0.10

0.00
       PECAHAN PERBELANJAAN HOSPITAL
                 KATEGORI 4
0.90                               0.84

0.80

0.70             0.64

0.60

0.50
          0.39
0.40

0.30
                                          Inpatient
0.20                             0.16     Outpatient

0.10

0.00
       PECAHAN PERBELANJAAN HOSPITAL
                 KATEGORI 5
0.70


0.60


0.50


0.40


0.30
                                       Inpatient
                                       Outpatient
0.20
                                       Daycare


0.10


0.00
        PECAHAN PERBELANJAAN HOSPITAL
                  KATEGORI 5
0.70    0.66   0.66             0.65   0.65

0.60


0.50


0.40
       0.34

0.30
                                              Inpatient

0.20                                          Outpatient


0.10


0.00
       PECAHAN PERBELANJAAN HOSPITAL
                 KATEGORI 6
1.00
        0.91
0.90


0.80


0.70


0.60
                                              0.55
                                                                  Inpatient
0.50
                                  0.45                            Outpatient
                                                                  Daycare
0.40


0.30


0.20

                    0.09
0.10


0.00
               Hospital Bahagia    Hospital Mesra, Bukit Padang
  PERBELANJAAN HOSPITAL KATEGORI 1 & 2
   MENGIKUT UNIT KOS BAGI TAHUN 2008
RM2,000.00

RM1,800.00

RM1,600.00

RM1,400.00

RM1,200.00

RM1,000.00
                                                                                                         unit costs for inpatient/day

 RM800.00                                                                                                Unit costs for outpatient/visit
                                                                                                         unit costs for daycare/visit
 RM600.00

 RM400.00

 RM200.00

   RM0.00
               Hospital Hospital Alor Hospital Ipoh   Hospital   Hospital Kota Hospital     Hospital
             Kuala Lumpur  Setar                      Kangar /      Bharu     Pakar Kuala Kuantan / Tg
                                                      Tengku                  Terengganu    Ampuan
                                                      Fauziah                                Afzan
  PERBELANJAAN HOSPITAL KATEGORI 1 & 2
   MENGIKUT UNIT KOS BAGI TAHUN 2008
RM2,500.00
                                                                                           RM2,328.52



RM2,000.00




RM1,500.00                                                                                                  unit costs for
                                                                                                            inpatient/day


                                                                                                            Unit costs for
RM1,000.00                            RM950.73                                                              outpatient/visit
                                                                   RM898.89
             RM780.99                                                           RM753.69
                         RM617.63
                                                      RM539.46
 RM500.00       RM449.27
                                                                       RM371.99
                                                                                   RM310.37
                             RM207.82    RM203.54        RM217.02                               RM199.29


   RM0.00
               Hospital Hospital Alor Hospital Ipoh     Hospital    Hospital Kota Hospital     Hospital
             Kuala Lumpur  Setar                        Kangar /       Bharu     Pakar Kuala Kuantan / Tg
                                                        Tengku                   Terengganu    Ampuan
                                                        Fauziah                                 Afzan
         PERBELANJAAN HOSPITAL KATEGORI 3
                MENGIKUT UNIT KOS
RM1,000.00

 RM900.00

 RM800.00

 RM700.00

 RM600.00

 RM500.00
                                                                                                     unit costs for inpatient/day
 RM400.00                                                                                            Unit costs for outpatient/visit
                                                                                                     unit costs for daycare/visit
 RM300.00

 RM200.00

 RM100.00

   RM0.00
             Hospital Hospital Hospital Hospital Hospital Hospital   Hospital   Hospital Hospital
             Ampang Selayang    Batu     Muar / Kuala Krai Miri      Taiping     Teluk Temerloh
                                Pahat Sultanah                                   Intan (Sultan Hj.
                                        Fatimah                                          Ahmad
                                                                                          Shah)
             PERBELANJAAN HOSPITAL KATEGORI 3
                    MENGIKUT UNIT KOS
RM1,600.00
                                                                                                                     RM1,423.44
RM1,400.00                                                       RM1,315.67

RM1,200.00


RM1,000.00                                          RM915.20                                 RM931.54
             RM900.46     RM886.55                                                                        RM901.52
                                      RM784.51                                                                                         unit costs for
 RM800.00
                                                                                                                                       inpatient/day

 RM600.00                                                                                                                              Unit costs for
                                                                                RM503.64
                            RM461.56                                                                                                   outpatient/visit
               RM371.79
 RM400.00
                                        RM272.13
                                                      RM199.11                                 RM228.82
                                                                                                                          RM178.76
 RM200.00                                                           RM133.47      RM121.87                   RM97.13

   RM0.00
               Hospital    Hospital     Hospital      Hospital      Hospital      Hospital     Hospital     Hospital      Hospital
               Ampang      Selayang    Batu Pahat      Muar /      Kuala Krai      Miri        Taiping     Teluk Intan   Temerloh
                                                      Sultanah                                                           (Sultan Hj.
                                                      Fatimah                                                              Ahmad
                                                                                                                            Shah)
      PERBELANJAAN HOSPITAL KATEGORI 4
             MENGIKUT UNIT KOS
RM700.00


RM600.00


RM500.00


RM400.00


RM300.00

                                 unit costs for inpatient/day
RM200.00
                                 Unit costs for outpatient/visit
                                 unit costs for daycare/visit
RM100.00


 RM0.00
     PERBELANJAAN HOSPITAL KATEGORI 4
            MENGIKUT UNIT KOS
RM1,000.00                     RM934.41
 RM900.00

 RM800.00          RM757.45
                                           RM723.99
 RM700.00                RM670.07
                                                                                   RM631.97
                                                      RM581.59                                      unit costs for
 RM600.00                                                        RM538.51
             RM505.99                                                                               inpatient/day
 RM500.00                            RM463.32                                RM468.25
                                                                       RM378.59
 RM400.00                                                                                           Unit costs for
                                                                                                    outpatient/visit
 RM300.00
                                                                                         RM180.88
 RM200.00

 RM100.00

   RM0.00
       PERBELANJAAN HOSPITAL KATEGORI 5
              MENGIKUT UNIT KOS
RM1,000.00

 RM900.00

 RM800.00

 RM700.00

 RM600.00

 RM500.00                                 unit costs for
                                          inpatient/day
 RM400.00

 RM300.00
                                          Unit costs for
 RM200.00                                 outpatient/visit

 RM100.00

   RM0.00                                 unit costs for
                                          daycare/visit
        PERBELANJAAN HOSPITAL KATEGORI 5
               MENGIKUT UNIT KOS
RM1,600.00

                        RM1,399.56
RM1,400.00


RM1,200.00


RM1,000.00

                                      unit costs for
 RM800.00                             inpatient/day

 RM600.00
                                      Unit costs for
                                      outpatient/visit
 RM400.00    RM305.14

 RM200.00


   RM0.00
        PERBELANJAAN HOSPITAL KATEGORI 6
               MENGIKUT UNIT KOS
RM1,000.00


 RM900.00                                       RM858.60

 RM800.00


 RM700.00


 RM600.00
                        RM547.23
                                                                    unit costs for inpatient/day
 RM500.00
                                                                    Unit costs for outpatient/visit
                                                                    unit costs for daycare/visit
 RM400.00


 RM300.00


 RM200.00
             RM146.18                RM142.26

 RM100.00


   RM0.00
                  Hospital Bahagia   Hospital Mesra, Bukit Padang
                 Conclusion
• The TEH consistently increased from RM8.21
  billion in 1997 to RM35.15 billion in 2008. As a
  percentage of GDP, it has also increased from
  2.90% (1997) to 4.75% in 2008. The increase is
  less marked if the GDP deflators are applied.
• The per capita health spending increased from
  RM381 in 2007 to RM1268 in 2008. It increased
  by 14% compared to the previous year.
• The ratio of public to private sector’s cost
  sharing was 46 (public): 54 (private).
                     Conclusion
• At RM13.04 billion (37.1%), MOH was the highest
  contributor to TEH, followed by private household OOP,
  RM10.80 billion (30.7%), all corporations (excluding health
  insurance), RM4.78 billion (13.6%), and others, the
  remaining 18.6%. The contribution from SOCSO increased by
  300% whilst from other federal agencies (including statutory
  bodies), 61% when compared to 2007.
                      Conclusion
• By Provider of Health Services, the highest spending was at
  the hospitals, which amounted to RM19.33 billion (55.0% of
  TEH), followed by providers of ambulatory care (non-
  hospital setting), RM7.3 billion (20.3%), provision and
  administration of public health services, RM3.25 billion
  (9.3%), general health administration and insurance, RM3.03
  billion (8.6%) and the remaining 6.8% by others.
• The pattern of health spending differed between the public
  and private sector. The public sector spent 20.3% of its TEH
  at the providers of public health services whereas it was
  negligible in the private sector. Further, in the public sector,
  11.6% of its TEH went to providers of general health
  administration and insurance but it was only 6.1% in the
  private sector.
                  Conclusion
• By Function of Health Services, the highest
  spending was for curative care which amounted to
  RM21.05 billion (59.9%) of TEH. The ancillary
  services to healthcare and prevention and public
  health services showed an increase of 2.3% and
  1.6% respectively. There was a 1.6% decrease in the
  spending for health administration and insurance
  administration.
                  Conclusion
• In the public sector, by Function of Services, the
  pattern of spending for 2007 and 2008 were similar.
  The proportion spent for prevention and public
  health services increased by 3% (RM0.8 billion)
  compared to the year before, probably due to the
  several communicable disease outbreaks. Over the
  years, the government contributed to more than
  90% of the total expenditure required for public
  health services.
                   Conclusion
• In the private sector, by Function of Health Services,
  services of curative care consumed RM12.19 billion
  (64.4%) of its TEH. Compared to 2007, there was a
  5% increase in the proportion of spending for
  ancillary services to health care, probably due to
  more public patients purchasing these services
  themselves to reduce the waiting time for doctors’
  consultation at the public hospitals.
                   Conclusion
• The private household OOP spending went mostly
  to providers of ambulatory care (54.9%), followed
  by hospitals (31.4%), retail sale and other providers
  of medical goods (12.6%) and institutions providing
  health related services (1.1%).
                  Conclusion
• On average, 47.2% of the public hospitals’
  expenditure was for outpatient curative care, 46.8%
  inpatient curative care whilst only 5.9% for day
  cases. This pattern is markedly different from the
  previous year’s pattern whereby in 2007, it was
  27.6%, 65.9% and 6.6% for outpatient, inpatient
  and day care cases, respectively.
                     Conclusion
• Approximately 97% of the expenditure on prevention and
  public health services was funded by the public sector. The
  private sector contributed less than 3% of the RM2.73 billion
  required for public health services.
• The main contributor for education and training was MOH
  (54.2%0, followed by other government agencies (non
  MOH), 23.3% and the remaining amount was contributed by
  the private sector (22.5%).
                Conclusion
• Further studies is needed and a new
  mechanism of funding designed for
  sustainable financing of the health care
  services.
• There is a need for reformation of health
  service delivery system to ensure that the
  system is cost efficient.
Thank you

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:3
posted:11/19/2012
language:English
pages:71