Saturday, March 20, 2010

The Star: DGH Ismail Merican: Ensuring access to healthcare

Ensuring access to healthcare
The Star, Saturday March 20, 2010

In responding to ‘Serving 1Malaysia’, especially towards ensuring equitable healthcare, the ministry has boldly moved towards initiating a major reform of the delivery of healthcare

The saying “health is wealth” holds true in every sense. Indeed, being the director-general of health, it is my responsibility to set the direction and course for the entire health system.

Having been both a healthcare professional and administrator, it has always been my priority to ensure equity (in health) by eliminating disparities in its provision. Our goal is for every individual to get the highest quality of care possible. Prudent investments in health are vital for national growth, human development and poverty reduction. The importance of a healthy population cannot be more strongly emphasised. It will improve the quality of life and increase productivity.

Equity in health implies that everyone should have a fair opportunity to attain his or her full health potential and that no one should be deprived of care when it is needed. In 2007, the London School of Economics reported that Malaysia’s public health sector has been relatively successful in providing equitable healthcare. To a large extent, access to healthcare is dependent on how healthcare is organised.

Historically, after Malaysia gained independence in 1957, the system was largely funded by the government. Patients only had to pay a nominal sum for access to outpatient and hospital admissions. In the 1980s, the service transformed from a system that depended heavily on the government to a dichotomous parallel system – the other player being the sizable and thriving private sector, for whom the Government has given strong encouragement for growth.

The private sector is, in fact, playing an ever-increasing role in the provision of healthcare for the country. However, as in most countries, the private sector, responding to market forces, has been concentrating its facilities in the more economically-developed regions. This contributes little to equity and social justice as such services mainly cater for patients who are able to afford them.

Nevertheless, the country’s health system has continued to perform relatively well over the years, despite the expanding dichotomy. The World Bank World Development Report published in 1993 stated that Malaysia was one of the countries where public health spending was biased towards the poor.

Truly, the government health services have benefited all. There is a strong consensus that subsidised public healthcare, if it continues to be properly tailored and targeted, can further the goal of promoting equity. Nevertheless, inequalities exist for many reasons such as distance, socio-demography, cost and transport problems. Therein lies the future challenges for our health system.

Based on current economic circumstances, the government is concerned about its ability to continue sustaining such levels of expenditure towards ensuring fairness in financing and the continued protection of the general population, and more so, the disadvantaged and vulnerable groups.

Demographic and epidemiological changes continue to alter demand for new healthcare services, whilst increasing affluence heightens expectations for care of even better quality. It is the primary objective of the government to have an efficient system that maximises well-being at the lowest cost to society.

The Health Ministry is in the process of examining reform options to ensure healthcare remains accessible, affordable and relevant. The role of the ministry must shift towards a stronger stewardship function – focusing on policy-making and enforcing regulations across both the public and private health sectors to ensure continued targets of equity, affordability and appropriateness of care are met.

In addition, the ministry will continue to set and monitor standards to ensure suitable quality of care. The fundamental step towards achieving better equity will be to strive for maintaining and enhancing universal access to healthcare. Although the concept of universal access has been well entrenched over the years, more needs to be done. This can be pursued by introducing a more structured and integrated health system, with greater participation of the private sector, underpinned by a comprehensive governance framework.

The plan for a big and bold transformation of the healthcare sector seeks to integrate both the public and private sectors, initially, in the provision of primary healthcare (PHC) services. This is a logical step since the majority of patient contacts occur at this level. If we are serious in our philosophy to provide healthcare based on the principles of needs, solidarity and equity, and in a cost-effective manner, it is prudent to pool resources. This is very much in line with the call of the Prime Minister towards serving 1Malaysia aspiration.

Focusing on PHC has received very strong support from the World Health Organisation. The latter calls for all member states to strengthen this strategy, as PHC can provide a stronger sense of direction and unity in the current context of fragmented health systems.

Specifically for Malaysia, strengthening the capacity and capability of the primary care physician and the multi-disciplinary team of allied health personnel will go a long way towards undertaking a “gatekeeper’s role”.

The overall effects of such a move on health are positive. Over-reliance on specialists and hospitalisation can be reduced by filtering out unnecessary uptake. As a result, the costs of hospital care can be reduced, the duration of hospitalisation shortened and the quality of post-hospitalisation follow-up improved.

The issue of equity is challenging but not insurmountable. Pressures are building for health reforms but these need to be managed in line with the development of a comprehensive strategy, tailor-made for the country.

In responding to “Serving 1Malaysia”, especially towards ensuring equitable healthcare, the ministry has boldly moved towards initiating a major reform of the delivery of healthcare. In this transformation, the ministry will develop and foster a system which is wide-ranging, in terms of scope and delivery, yet equitable, affordable, effective and efficient.

By laying a stronger foundation, involving greater collaboration with the private sector, the ministry will be able to pool scarce skilled resources and share high-tech equipment towards ensuring greater fairness in patient services. Given the right environment and political support, adhering to the principles of solidarity and social responsibility, and embracing the ethos “Rakyat didahulukan, Pencapaian diutamakan” will enable Malaysia to provide equitable and quality health services for all.

Tan Sri Dr Ismail Merican is the Health Director-General

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