Primary Health Care and Health Information Needs In Malaysia Syed Aljunid
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1 UNU- International Institute For Global Health (UNU-IIGH) Primary Health Care and Health Information Needs In Malaysia Syed Aljunid MD (UKM) MSc Public Health (Singapore) PhD (Health Econs and Financing) (London) FAMM Professor of Health Economics and Senior Research Fellow UNU-International Institute For Global Health Kuala Lumpur
2 OUTLINE Background of Malaysia Overview of PHC in Malaysia Health Information in PHC Teleprimary Care Disease Classification System Use of Health Information Conclusion
3 Malaysia Population: 27 Millions Two main areas: West Malaysia (Peninsular Malaysia) East Malaysia (Sabah & Sarawak) Size: 329,000 sq. km GNP per capita: US 6,146 (RM 22,420) (Upper-middle-income) Urban population: 56% Literacy rate: 86% Elderly population: 5.7% (> 60 years) Access to safe water: 89%
4 Primary Care Facilities (2008) Numbers Public Health Centres 802 Community Clinics 1,927 Maternal and Child Health Clinics 95 Mobile Health Clinics 193 Dental Clinics 1,707 Mobile Dental Clinics 493 Private Private Medical Clinics 6,371 Private Dental Clinics 1,435
5 UTILISATION OF HEALTH SERVICES : Out-patient Visits
6 UTILISATION OF HEALTH SERVICES - Admissions
7 Three Tier System ( ) MCQ HSC MHC (50,000 people)
8 Three Tier System Three levels of health care facilities Main Health Centre 50,000 people Health Subcentre 10,000 people Midwife Clinic 2,000 people
9 Three Tier System One Rural Health Unit One Main Health Cente Four Health Sub-Centre 20 Midwife Clinics Population coverage 50,000
10 Three Tier System Operational research carried out funded by World Bank from More than 10% of the population underserved by Three Tier System Underserved in Sabah is 41% and Sarawak 68% 1973 in Mid-term review of Second Malaysia Plan decision made to convert Three Tier to Two Tier system Should be completed by 1985
11 Two Tier System Two types of Facilities Health Centre For 15,000 20,000 people Community Clinic For 3,000 4,000 people Run by two Community Nurses (Jururawat Masyarakat) Specially trained midwife who can provide simple out-patient care
12 TWO TIER SYSTEM KD HC (15,000-20,000 People
13
14 Primary Care Facilities in Malaysia
15 Health Centre in Malaysia
16 Primary Care Facilities In Rural Area: Staff Quarters
17 PRIVATE CLINICS Main provider of primary care in Malaysia For every 10 primary care visits, 6 visits in private clinics and 4 in public health facilities Estimated number 6,000 7,000 Owner has to registered with MMC Annual Practice Certificate Must be owned by Doctors Medical Assistants, Nurses and other staff cannot own the facilities
18 PRIVATE CLINICS Ownership Single Owner (Solo-practitioner) Small size and numbers of clinics Small Capital Short operating hours May have very limited facilities/equipment Group Practice Has chain of clinics Bigger capital Longer operating hours May have more expensive equipment Portable Blood Analyser X-ray machine Ultrrasound machine
19 Private Clinic
20 PRIVATE CLINICS Mostly in urban areas Some has gone into rural areas and small towns because of competition in cities Provide Services: General Out-patient Care Specialist Services If it is owned by a specialist Drugs Prescriptions Simple procedure Minor Operation Circumcision Incision and Drainage Laboratory Services Blood and Urine Examination
21 Why Patients Prefer Private PHC Facilities? Longer opening hours After office hours Weekends Shorter waiting time No appointment/walk in Easier to get treatment by doctors Public facilities by MA and Nurses Better interpersonal quality Clinics are well equipped
22 HEALTH INFORMATION SYSTEM IN PHC
23 Collection of Health Information Individual Health Records Individual records maintain at each PHC facility No link with other PHC facilities New record created if patient visit to other PHC
24 Collection of Health Information Household Health Records Not routinely maintained Only for Maternal and Child Health Services Compiled at MOH level Household surveys Every 10 years National Morbidity Survey Detail household information on 10% of the population
25 Aggregation of PHC Data Patient level data only available at health care facility level Summary data aggregated at District State National
26 Data Collection Method Public Facilities Paper based in most PHC facilities except for 56 Teleprimary Care Clinics Private Clinics Paper based send to MOH HQ
27
28 Teleprimary Care in Malaysia Bridging Rural Communities to Better Health Care Pilot project started 2 year ago Components: Patient Management System Clinical Management System Clinical Support System Epidemiology and Population Health
29 Teleprimary Care in Malaysia: Objectives To provide a system for storing, archiving and retrieving medical records electronically. To facilitate collection and analysis of data on population health. To provide system for real-time consultation on patient management between the peripheral clinic and the hospital specialist. To allow join management of patient by the health clinic personnel and the hospital specialist consistent with the concept of seamless and borderless health care. To improve the disease surveillance system by providing alert and auto-notification features within the system. Provide more opportunities for specialist care to patients from rural area. Reduce traveling cost to patient.
30 Legal Framework for Information Gathering Government Facilities Routine data collection Private Facilities Private Health Care Facility Act 1998 All private PHC Facilities and hospitals required to send information to MOH Private Health Insurance Companies Regulated under Insurance Division of National Bank No specific requirement to submit patient level information
31 Information Capture and Coding Public PHC Facilities Non-TPC Facilities Coding done by Medical Assistants using ICD 10 Few received basic training in ICD TPC Facilities Coding done by Clinicians (Doctors and MA) Use pull-down menu in the IT System No formal training in ICD.
32 Coding System Diagnosis ICD-10 in all public facilities ICPC in some private clinics using Primacare Health Information System Procedure ICD9-CM for Ambulatory Services in Hospitals Using Case-mix No procedure coding in most public PHC facilities ICPC in some private clinics
33 Use of Health Information Public PHC Medical Record Keeping Facility Activity Monitoring Private PHC Medical record keeping Reimbursement
34 Conclusion PHC system is well developed in Malaysia Curative services in PHC are mainly provided by private clinics Public PHC facilities provide most of the MCH services ICD10 is the main disease classification in PHC Health Information System in PHC is still in development stage Need to coordinate development of information system in TPC with overall PHC system
35 THANK YOU
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