Healthcare System In Malaysia
- Healthcare Financing
Health Finance
• The use of financial resources to make sure the health system can
appropriately meet the collective health needs of every person is
referred to as health finance.
• It is a fundamental element that affects the operation of the overall
health system, including the provision and accessibility of basic
healthcare.
Principles Of Healthcare Finance
• Consider the various ways that money is raised for healthcare. A low-
or middle-income nation that has financed its public health system
mostly through taxes.
• Moreover, a nation that has primarily utilised social health insurance.
Collection, pooling, purchasing, and payment are the four basic
principles of health care financing or the financing functions
Healthcare Funded In Malaysia
1. Tax payments, and
2. Contributions to EPF (Employee Provident Fund) and
3. SOCSO (Social Security Organization)
Important Health Care Financing
• Health system performance in terms of equality, effectiveness, and
health outcomes are significantly influenced by health financing,
which provides the funding and financial incentives necessary for the
operation of health systems.
Managed Health Care
• Managed care, to put it simply, is a system that combines the funding
and provision of appropriate medical treatment with a wide range of
services.
• Any strategy of coordinating healthcare providers to accomplish the
twin objectives of reducing healthcare costs and enhancing quality of
service is referred to as managed care.
Managed Care Concept
• Managed Care is a health care delivery system organized to manage
cost, utilization, and quality.
Role Of Managed Care Organization (MCO)
• An organisation that controls the finance, insurance, delivery, and
payment of healthcare services is known as a managed care
organisation.
• In terms of financing, the MCO and employer agree on a set premium
for each enrollee as well as the health care covered by the
agreement.
Types Of Managed Care Plans
1. Health Maintenance Organizations (HMO)
• Is a type of health insurance plan that limits coverage to doctors who
work for or contract with the HMO.
• It generally won't cover out-of-network care except in an emergency.
An HMO may require you to live or work in its service area to be
eligible for coverage.
2. Preferred Provider Organizations (PPO)
• You pay less if you use providers in your health insurance plan's
network. You can use doctors, hospitals, and providers outside of the
network without a referral for an additional cost.
• Usually pay more if you get care within the network; still pay part of
the cost if you go outside the network.
3. Point of Service (POS)
• A "managed care" plan is an integrated system that manages health
care services for an enrolled population rather than simply providing
or paying for them.
• Point of Service (POS) plans require you to get a referral from your
primary care doctor in order to see a specialist.
• Plans let you pay less if you use doctors, hospitals, and other health
care providers that belong to the plan's network.
Managed Care Improve Quality?
• Managed care plans have significantly lower rates of inpatient
hospitalisation, lower rates of more expensive and discretionary
tests, higher rates of preventive services utilisation, and mixed results
on quality as measured by outcomes when compared to indemnity
plans.
Managed Care Affect Quality Of Care
• There has been extensive research on whether managed care
delivery systems are more effective than traditional fee-for-service
(FFS) models, but it is still unclear if managed care increases or
decreases beneficiaries' access to or the quality of their care.
Issues and concerns MCOs attempt to
manage
• Managed care organisations (MCOs) try to accomplish their
objectives by limiting patient access to specialised care and
eliminating unnecessary services, integrating health care delivery and
payment systems through prepaid member fees, and limiting
provider fees by setting fixed rates for doctors' and hospitals'
services.
Student Activity
• Explain public healthcare funding in Malaysia.
• Explain the mechanism for paying healthcare in Malaysia
• Describe the role of Manage Care Organisations (MCO) in controlling
healthcare cost
