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Fulltext Western impressions of the Hong Kong health care system

Bennett CL, Pei GK, Ultmann JE

West. J. Med., 1996 Jul-Aug;165(1-2):37-42.
PMID: 8855683

Hong Kong, Taiwan, Singapore, and Malaysia are initiating health care reform to meet the changing demands of populations with improved socioeconomic status and access to modern technologies and who are living longer than in previous generations. Hong Kong, in particular, is facing a unique set of circumstances as its people prepare for the transition in 1997 from a British colony to a Special Administrative Region of China. While spending only 4% of its gross domestic product on health care, it has a large and regulated public hospital system for most inpatient medical care and a separate, loosely regulated private health care system for most outpatient medical care. In 1993 the Secretary for Health and Welfare of Hong Kong initiated a year-long process to debate the pros and cons of 5 fundamental programs for health care reform. After a year of open consultation, options were chosen. We describe the Hong Kong health care system, the fundamental changes that have been adopted, and lessons for reformers in the United States.

Matched MeSH terms: Health Care Reform/organization & administration
Fulltext Developing the Malaysian health system to meet the challenges of the future

Merican MI, Rohaizat Y, Haniza S

Med J Malaysia, 2004 Mar;59(1):84-93.
PMID: 15535341 MyJurnal

The Malaysian health care system is a success story among countries of equivalent socio-economic status. However there are numerous challenges faced by the nation, which create the need for changes and reform. There is rising consumer demands and expectations for high technology and high cost medical care due to improved standards of living, changing disease patterns and demographic changes, inadequate integration of health services, maldistribution of resources and the threats as well as opportunities of globalisation and liberalisation. The changes in health policy, priorities and planning for the country are guided by the country's development policies, objectives and the challenges of Vision 2020, Vision for Health and the goals of the health system in ensuring universal access, improving equity and efficiency and the quality of life of the population. The essential services in the health system of the future are information and education of individuals to empower support for the wellness paradigm. There is also a need to restructure the national health care financing and the health care delivery system. The present roles and responsibilities of MOH also need to be reviewed.

Matched MeSH terms: Health Care Reform
Health sector reform: ethical issues and challenges

Suleiman AB

Med J Malaysia, 2000 Aug;55 Suppl B:5-8.
PMID: 11125522
Matched MeSH terms: Health Care Reform*
Fulltext Mortality from congenital abnormality in Malaysia 1991-1997: the effect of economic development on death due to congenital heart disease

Ho JJ

Med J Malaysia, 2001 Jun;56(2):227-31.
PMID: 11771084

An analysis was done of available data from the Department of Statistics Malaysia, on the type of congenital abnormality contributing to death, to determine whether progress in health care over recent years was associated with any decline in mortality from congenital abnormality. A significant decline in death due to congenital abnormality was observed between 1991 and 1996. This was attributable to a decline in deaths due to congenital heart disease occurring because of improvements in cardiac surgical services for infants. In 1997 death due to congenital heart disease increased significantly. This could be attributed to improvements in the diagnosis of congenital heart disease in the neonate.

Matched MeSH terms: Health Care Reform/economics; Health Care Reform/statistics & numerical data
The business man and the laboratory: standards guarantee profits

Hamer JW

Malays J Pathol, 1997 Dec;19(2):99-103.
PMID: 10879248
Matched MeSH terms: Health Care Reform/economics
Cancer control reform in Nigeria

Fatokun O

Lancet Oncol, 2017 01;18(1):19-20.
PMID: 28049569 DOI: 10.1016/S1470-2045(16)30650-7
Matched MeSH terms: Health Care Reform/legislation & jurisprudence*
Do South Australian pharmacy interns have the educational and behavioural precursors to meet the objectives of Australia's health care reform agenda?

Mak VS, March G, Clark A, Gilbert AL

Int J Pharm Pract, 2014 Oct;22(5):366-72.
PMID: 24428202 DOI: 10.1111/ijpp.12090

OBJECTIVE: To explore South Australian (SA) pharmacy interns' values, beliefs and motivations to study pharmacy and their assessment of how well their pharmacy education has prepared them for activities required of all health professionals under Australia's health care reforms.
METHODS: A postal questionnaire was sent to all 136 SA pharmacy interns enrolled in SA intern training programmes in February 2010 (second month of the intern training programme).
KEY FINDINGS: Sixty (44%) of SA pharmacy interns responded; 75% selected pharmacy as a career because of an interest in health-related sciences and 65% valued working with patients. Respondents believed their pharmacy education prepared them for patient care (80%), providing medicine information (72%) and primary health care delivery (68%), but 51% indicated that they were not prepared for multidisciplinary team care.
CONCLUSIONS: The positive values, beliefs and motivations expressed by respondents are significant behavioural precursors to meet the requirements of health professionals in Australia's health care reforms. Respondents indicated that their pharmacy education provided appropriate training in a number of relevant professional areas.
KEYWORDS: behaviour; career choice; education; pharmacy interns; preparedness

Matched MeSH terms: Health Care Reform*
Bank accounts for public primary health care facilities: Reflections on implementation from three districts in Tanzania

Kuwawenaruwa A, Remme M, Mtei G, Makawia S, Maluka S, Kapologwe N, et al.

Int J Health Plann Manage, 2018 Nov 20.
PMID: 30461049 DOI: 10.1002/hpm.2702

Health care financing reforms are gaining popularity in a number of African countries to increase financial resources and promote financial autonomy, particularly at peripheral health care facilities. The paper explores the establishment of facility bank accounts at public primary facilities in Tanzania, with the intention of informing other countries embarking on such reform of the lessons learned from its implementation process. A case study approach was used, in which three district councils were purposively sampled. A total of 34 focus group discussions and 14 in-depth interviews were conducted. Thematic content analysis was used during analysis. The study revealed that the main use of bank account revenue was for the purchase of drugs, medical supplies, and minor facility needs. To ensure accountability for funds, health care facilities had to submit monthly reports of expenditures incurred. District managers also undertook quality control of facility infrastructure, which had been renovated using facility resources and purchases of facility needs. Facility autonomy in the use of revenue retained in their accounts would improve the availability of drugs and service delivery. The experienced process of opening facility bank accounts, managing, and using the funds highlights the need to strengthen the capacity of staff and health-governing committees.

Matched MeSH terms: Health Care Reform
Equity in access to health care in a rural population in Malaysia: A cross-sectional study

Lim KK, Sivasampu S, Mahmud F

Aust J Rural Health, 2017 Apr;25(2):102-109.
PMID: 27377781 DOI: 10.1111/ajr.12298

OBJECTIVE: To examine the extent of equity in access to health care, their determinants and reasons of unmet need of a rural population in Malaysia.
DESIGN: Exploratory cross-sectional survey administered by trained interviewers among participants of a health screening program.
SETTING: A rural plantation estate in the West Coast of Peninsular Malaysia.
PARTICIPANTS: One hundred and thirty out of 142 adults above 18 years old who attended the program.
MAIN OUTCOME MEASURE: Percentages of respondents reporting realised access and unmet need to health care, determinants of both access indicators and reasons for unmet need. Realised access associated with need but not predisposing or enabling factors and unmet need not associated with any variables were considered equitable.
RESULTS: A total of 88 (67.7%) respondents had visited a doctor (realised access) in the past 6 months and 24.8% (n = 31) experienced unmet need in the past 12 months. Using logistic regression, realised access was associated with presence of chronic disease (OR 6.97, P health status (OR 6.03, P RM 2000 per month) (OR 51.27, P health status and income. Despite not being generalisable, the findings highlight the need for a national level study on equity in access before the country reforms its health system.

Matched MeSH terms: Health Care Reform
Fulltext Remission of symptoms among schizophrenia patients receiving assertive community treatment (ACT) in Malaysia: one year follow-up

Rahima Dahlan, Marhani Midin, Hatta Sidi

Sains Malaysiana, 2013;42:389-397.

Assertive community treatment (ACT) is one of the most important elements of mental health care reform in Malaysia. Many studies worldwide have reliably found that ACT has positive impact on several outcome domains such as reduced hospitalization rate, improvement of symptoms and quality of life. This study aimed to assess the outcome of ACT in the aspect of symptom remission and its influencing factors among patients with schizophrenia in the urban city of Kuala Lumpur. A cross sectional study was conducted on 155 patients with schizophrenia who received ACT in Hospital Kuala Lumpur (HKL). The selection was made by simple random sampling. The abbreviated Brief Psychiatric Rating Scale (BPRS) was used to determine the status of symptom remission. The socio demographic and relevant clinical data were also assessed. A total of 76% (118) was noted to be in remission. According to logistic regression, the strongest predictor of patients receiving ACT with symptom remission was having good social support (p<0.001) and with higher educational level (p=0.024). The study revealed the effectiveness of ACT in terms of high prevalence of patients with symptom remission. This was despite the model of ACT being studied not fulfilling all fidelity measurements of the standard version of the service. The finding would hopefully act as a propeller for further development in this service area. However, the study
needs to be replicated through studies with better designs and involving more psychiatric centers.

Matched MeSH terms: Health Care Reform
Fulltext Unlocking Access To Novel Medicines In China-A Review From A Health System Perspective

Diao Y, Li M, Huang Z, Sun J, Chee YL, Liu Y

Risk Manag Healthc Policy, 2019;12:357-367.
PMID: 31908552 DOI: 10.2147/RMHP.S226379

China's healthcare reform aims to provide affordable and equitable basic healthcare for all by 2020. Access to medicines is an essential part of the healthcare. The efforts of promoting access to medicines have been moving from meeting the needs of the basic healthcare, towards increasingly dedicated resources to offer breakthrough therapies. Looking at access to novel medicines from a health system perspective, and placing the changes China has made into that system context, this paper makes a comprehensive review of the progress of access to novel medicines in China. The review drew on two sources of information, which included desk review of published and grey literature, and key informant interview. Five hurdles were identified which create barriers of access to novel medicines, ranging from regulation and financing of medicines, intellectually property rights protection, and development of innovation capacity, to other health system components. Multiple policies have been implementing in China to remove the multiple access barriers gradually. Universal access to medicines has been moving from towards the basic common conditions to the world breakthrough technologies. We see cause for optimism, but recognize that there is a long way to go. Achieving broader and better access to modern medicines for Chinese patients will require multiple and coordinated government efforts, which would need to target the whole lifecycle regulation of novel medicines with a health system perspective, from balancing IP protection, strengthening R&D and public health, to appropriate regulatory approach and financing mechanism, and to supply chain management, as well as smart use.

Matched MeSH terms: Health Care Reform
Fulltext Healthcare in Asia: a perspective from primary care at the gateway to a continent

Jiwa M, Othman S, Hanafi NS, Ng CJ, Khoo EM, Chia YC

Qual Prim Care, 2012;20(5):317-20.
PMID: 23113999

Malaysia has achieved reasonable health outcomes even though the country spends a modest amount of Gross Domestic Product on healthcare. However, the country is now experiencing a rising incidence of both infectious diseases and chronic lifestyle conditions that reflect growing wealth in a vibrant and successful economy. With an eye on an ageing population, reform of the health sector is a government priority. As in other many parts of the world, general practitioners are the first healthcare professional consulted by patients. The Malaysian health system is served by public and private care providers. The integration of the two sectors is a key target for reform. However, the future health of the nation will depend on leadership in the primary care sector. This leadership will need to be informed by research to integrate care providers, empower patients, bridge cultural gaps and ensure equitable access to scarce health resources.

Matched MeSH terms: Health Care Reform
Fulltext 40 years of Alma Ata Malaysia: targeting equitable access through organisational and physical adaptations in the delivery of public sector primary care

Fadzil F, Jaafar S, Ismail R

Prim Health Care Res Dev, 2020 02 24;21:e4.
PMID: 32090729 DOI: 10.1017/S146342362000002X

This paper illustrates the development of Primary Health Care (PHC) public sector in Malaysia, through a series of health reforms in addressing equitable access. Malaysia was a signatory to the Alma Ata Declaration in 1978. The opportunity provided the impetus to expand the Rural Health Services of the 1960s, guided by the principles of PHC which attempts to address the urban-rural divide to improve equity and accessibility. The review was made through several collation of literature searches from published and unpublished research papers, the Ministry of Health annual reports, the 5-year Malaysia Plans, National Statistics Department, on health systems programme and infrastructure developments in Malaysia. The Public Primary Care Health System has evolved progressively through five phases of organisational reforms and physical restructuring. It responded to growing needs over a 40-year period since the Alma Ata Declaration in 1978, keeping equity, accessibility, efficiency and universal health coverage consistently in the backdrop. There were improvements of maternal, infant mortality rates as well as accessibility to health services for the population. The PHC Reforms in Malaysia are the result of structured and strategic investment. However, there will be continuing dilemma between cost-effectiveness and equity. Hence, continuous efforts are required to look at opportunity costs of alternative strategies to provide the best available solution given the available resources and capacities. While recognising that health systems development is complex with several layers and influencing factors, this paper focuses on a small but crucial aspect that occupies much time and energies of front-line managers in the health.

Matched MeSH terms: Health Care Reform/history*
Contribution of pharmacy education to pharmaceutical research and development: critical insights from educators

Nouri AI, Hassali MA, Hashmi FK

Perspect Public Health, 2020 Jan;140(1):62-66.
PMID: 31165671 DOI: 10.1177/1757913919832927

AIMS: This article examines the outputs of pharmaceutical education with the development of the pharmacy profession and how that affects pharmaceutical innovation. It also discusses different models of collaboration between the academic and pharmaceutical industry in order to achieve a healthy collaboration between the stakeholders.
METHODS: The perspective, experiences and insights of educators from various backgrounds, origin and educational levels were sought regarding the role of pharmacy education in providing pharmaceutical research and development workforce.
RESULTS: Many countries around the world are currently undertaking major reforms in pharmacy education due to the changing landscape of health and healthcare delivery. These reforms must be accompanied by robust systems to assure that the quality of educational structures, processes and outcomes will produce competent pharmacy graduates in the future. It is also considered imperative that pharmacy academic institutions should establish collaboration with the drug development units, the pharmaceutical industry and government agencies for sustainability and positive research outcomes.
CONCLUSION: Shortcomings in pharmacy curricula need to be addressed and the authors have proposed the 'TARGET' approach for the development of integrated pharmacy curriculum to substantially contribute to pharmaceutical research and development.

Matched MeSH terms: Health Care Reform
Fulltext Health system reform from the people's point of view: development of reliable and valid questionnaire

Saad Ahmed Ali Jadoo, Syed Mohamed Aljunid, Seher Nur Sulku, Sami Abdo Radman Al-Dubai, Sharifa Ezat Wan Puteh, Zafar Ahmed, et al.

Malaysian Journal of Public Health Medicine, 2013;13(2):65-76.
MyJurnal

Health system reform has been a major concern for different countries. The aim of this research was to develop a reliable and valid questionnaire suitable to assess the consequences of health reform process from people's perspective. An extensive literature review used to extract a set of statements as possible indicators for health system reform. Expert panel used to determine the content validity rate (CVR) and the content validity index (CVI). The first version produced in Turkish language and pre-piloted with 20 heads of household. Qualified committee used to translate the Turkish version to English version. Group of eighteen academics and graduate students recruited to tests both versions for parallel test validity. The construct validity of the questionnaire was determined using principal components analysis with Varimax rotation method (PCA). Internal consistency and questionnaire's reliability were calculated by Cronbach's alpha and the test–retest reliability test. A 17- items questionnaire was developed through the qualitative phase. The Bartlett's test was significant (p < 0.001), and the KMO value (0.842) showed that using principal component analysis (PCA) was suitable. Eigenvalues equal or higher than 1 were considered significant and chosen for interpretation. By PCA, 4 factors were extracted (accessibility, attitude and preference, quality of care and availability of resources) that jointly accounted for 85.2% of observed variance. The Cronbach's alpha coefficient showed excellent internal consistency (alpha=0.97), and test-retest of the scale with 2-weeks intervals indicated an appropriate stability for the scale (Intra-class coefficient = 0.96). The findings showed that the designed questionnaire was valid and reliable and can be used easily to assess the consequences of health reform process by comparing the situation before and after the reform from people's perspective.

Matched MeSH terms: Health Care Reform
Fulltext Health-financing reforms in southeast Asia: challenges in achieving universal coverage

Tangcharoensathien V, Patcharanarumol W, Ir P, Aljunid SM, Mukti AG, Akkhavong K, et al.

Lancet, 2011 Mar 5;377(9768):863-73.
PMID: 21269682 DOI: 10.1016/S0140-6736(10)61890-9

In this sixth paper of the Series, we review health-financing reforms in seven countries in southeast Asia that have sought to reduce dependence on out-of-pocket payments, increase pooled health finance, and expand service use as steps towards universal coverage. Laos and Cambodia, both resource-poor countries, have mostly relied on donor-supported health equity funds to reach the poor, and reliable funding and appropriate identification of the eligible poor are two major challenges for nationwide expansion. For Thailand, the Philippines, Indonesia, and Vietnam, social health insurance financed by payroll tax is commonly used for formal sector employees (excluding Malaysia), with varying outcomes in terms of financial protection. Alternative payment methods have different implications for provider behaviour and financial protection. Two alternative approaches for financial protection of the non-poor outside the formal sector have emerged-contributory arrangements and tax-financed schemes-with different abilities to achieve high population coverage rapidly. Fiscal space and mobilisation of payroll contributions are both important in accelerating financial protection. Expanding coverage of good-quality services and ensuring adequate human resources are also important to achieve universal coverage. As health-financing reform is complex, institutional capacity to generate evidence and inform policy is essential and should be strengthened.

Matched MeSH terms: Health Care Reform/economics*
Fulltext The primary health care performance initiative (PHCPI): Issues and challenges for Malaysia as a trailblazer country

Anis Safura Ramli, Sri Wahyu Taher, Zainal Fitri Zakaria, Norsiah Ali, Nurainul Hana Shamsuddin, Wong Ping Foo, et al.

Journal of Clinical and Health Sciences, 2019;4(1):4-21.
MyJurnal

A strong and robust Primary Health Care system is essential to achieving universal health
coverage and to save lives. The Global Conference on Primary Health Care 2018: from Alma-Ata towards achieving Universal Health Coverage and the Sustainable Development Goals at
Astana, Kazakhstan provided a platform for low‐ and middle‐ income countries to join the
Primary Health Care Performance Initiative (PHCPI). At this Global Conference, Malaysia has
declared to become a Trailblazer Country in the PHCPI and pledged to monitor her Vital Signs
Profiles (VSP). However, the VSP project requires an honest and transparent data collection
and monitoring of the Primary Health Care system, so as to identify gaps and guide policy in
support of Primary Health Care reform. This is a huge commitment and can only be materialised
if there is a collaborative partnership between Primary Care and Public Health providers.
Fundamental to all of these, is the controversy concerning whether or not ‘Primary Care’ and
‘Primary Health Care’ represent the same entity. Confusion also occurs with regards to the role
of ‘Primary Care’ and ‘Public Health’ providers in the Malaysian Primary Health Care system.
This review aims to differentiate between Primary Care, Primary Health Care and Public Health,
describe the relationships between the three entities and redefine the role of Primary Care and
Public Health in the PHCPI-VSP in order to transform the Malaysian Primary Health Care
system.

Matched MeSH terms: Health Care Reform
Fulltext Beyond the crisis: building back better mental health care in 10 emergency-affected areas using a longer-term perspective

Epping-Jordan JE, van Ommeren M, Ashour HN, Maramis A, Marini A, Mohanraj A, et al.

Int J Ment Health Syst, 2015;9:15.
PMID: 25904981 DOI: 10.1186/s13033-015-0007-9

BACKGROUND: Major gaps remain - especially in low- and middle-income countries - in the realization of comprehensive, community-based mental health care. One potentially important yet overlooked opportunity for accelerating mental health reform lies within emergency situations, such as armed conflicts or natural disasters. Despite their adverse impacts on affected populations' mental health and well being, emergencies also draw attention and resources to these issues and provide openings for mental health service development.
CASE DESCRIPTION: Cases were considered if they represented a low- or middle-income country or territory affected by an emergency, were initiated between 2000 and 2010, succeeded in making changes to the mental health system, and were able to be documented by an expert involved directly with the case. Based on these criteria, 10 case examples from diverse emergency-affected settings were included: Afghanistan, Burundi, Indonesia (Aceh Province), Iraq, Jordan, Kosovo, occupied Palestinian territory, Somalia, Sri Lanka, and Timor-Leste.
DISCUSSION AND EVALUATION: These cases demonstrate generally that emergency contexts can be tapped to make substantial and sustainable improvements in mental health systems. From these experiences, 10 common lessons learnt were identified on how to make this happen. These lessons include the importance of adopting a longer-term perspective for mental health reform from the outset, and focusing on system-wide reform that addresses both new-onset and pre-existing mental disorders.
CONCLUSIONS: Global progress in mental health care would happen more quickly if, in every crisis, strategic efforts were made to convert short-term interest in mental health problems into momentum for mental health reform.

Matched MeSH terms: Health Care Reform
Fulltext Research and health policy

Suleiman AB

International e-Journal of Science, Medicine & Education, 2013;7(11):2-6.
MyJurnal

Healthcare investment is critically important for the health and well-being of the population, and different health systems are developed to meet the needs and priorities of each country. What has become clear has been that despite major advances in medicine, science and technology, there are major issues related to access and equity as well as quality and patient safety in healthcare services. The issue of patient safety was highlighted by the reports of the Institute of Medicine, USA1,2 and this had received worldwide attention. It is also an irony that despite being in an age of major advances in medicine, science and technology, with the acceptance of evidence-based medicine, so much of medicine and healthcare delivered is of little or no proven value. This poses a major challenge on health policy, and on how this can be addressed in any health reform process that focuses on improving access, equity, efficiency and effectiveness in healthcare services.

Matched MeSH terms: Health Care Reform
Fulltext The political economy of health financing reform in Malaysia

Croke K, Mohd Yusoff MB, Abdullah Z, Mohd Hanafiah AN, Mokhtaruddin K, Ramli ES, et al.

Health Policy Plan, 2019 Dec 01;34(10):732-739.
PMID: 31563946 DOI: 10.1093/heapol/czz089

There is growing evidence that political economy factors are central to whether or not proposed health financing reforms are adopted, but there is little consensus about which political and institutional factors determine the fate of reform proposals. One set of scholars see the relative strength of interest groups in favour of and opposed to reform as the determining factor. An alternative literature identifies aspects of a country's political institutions-specifically the number and strength of formal 'veto gates' in the political decision-making process-as a key predictor of reform's prospects. A third group of scholars highlight path dependence and 'policy feedback' effects, stressing that the sequence in which health policies are implemented determines the set of feasible reform paths, since successive policy regimes bring into existence patterns of public opinion and interest group mobilization which can lock in the status quo. We examine these theories in the context of Malaysia, a successful health system which has experienced several instances of proposed, but ultimately blocked, health financing reforms. We argue that policy feedback effects on public opinion were the most important factor inhibiting changes to Malaysia's health financing system. Interest group opposition was a closely related factor; this opposition was particularly powerful because political leaders perceived that it had strong public support. Institutional veto gates, by contrast, played a minimal role in preventing health financing reform in Malaysia. Malaysia's dramatic early success at achieving near-universal access to public sector healthcare at low cost created public opinion resistant to any change which could threaten the status quo. We conclude by analysing the implications of these dynamics for future attempts at health financing reform in Malaysia.

Matched MeSH terms: Health Care Reform*

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