The Health July 2023 | Page 19

JULY , 2023 | THE HEALTH

“ The Strategic Purchaser will procure healthcare services from the public and private sector through innovative and value-based payment models that drive better outcomes , service coverage , costeffectiveness , quality , and performance from providers . Clear reporting standards and robust regulatory oversight will also govern Strategic Purchaser .”

Effective health spending is also driven by allocative efficiency across different programs within the Ministry of Health ( MoH ) and relevant government agencies and ministries .

The HWP proposal to transform primary healthcare , strengthen public health functions and stimulate promotive and preventive approaches provides the direction towards better allocative efficiency within the health system .

Periodic reviews will assess whether funding to specific programs , units , departments , or divisions is adequate and well spent in achieving the desired outcomes .

Additionally , the HWP intends to scale up digitalisation and increase autonomy for public sector healthcare facilities , contributing to more significant

operational and financial efficiencies .

“ To reduce inefficiencies and wastages further , administrative processes and criteria will be reviewed and revised to reduce bureaucracy and improve responsiveness . Effective and responsible healthcare spending also means recognising the impact of healthcare energy consumption and consumables on planetary health and climate change .

“ The MoH will reduce carbon emissions through increased use of renewable energy . The production of pollutants and non-biodegradable waste will be tackled through continuous improvements in medical waste management initiatives .

“ Improving the effectiveness and cost-effectiveness of health spending will maximise every Ringgit invested into the system to produce continuous improvements in health outcomes amongst the population . The mindset of the health sector will also evolve to be more value-and performance-driven .”

The HWP stated the efforts to systematically and structurally improve the effectiveness of health spending are currently either at the early implementation stage or at the planning stage . – The Health

THE 57-PAGE Health White Paper ( HWP ) outlined the current status , gaps and constraints the country ’ s health system faces and proposed structural and systemic solutions that included reforms in service delivery , financing and governance over 15 years .

The short-term phase will commence in 2024 , the medium-term phase will begin in 2029 , and the long-term phase will run from 2034 to 2039 .

The HWP proposes four pillars and 15 strategies for strengthening the healthcare system . The pillars are :

• Pillar 1 : To transform the delivery of healthcare services in the country by prioritising and restructuring primary healthcare ; optimising hospital care ; granting operational autonomy to public sector providers and increasing partnership with private sector providers ; and harnessing digitalisation and technology for overall service delivery improvement .

• Pillar 2 : To cultivate and ground health promotion and disease prevention approaches at all levels in the nation by improving public health and health emergency preparedness functions ; improving processes to drive shared ownership of health outcomes amongst government agencies ; improving methods for coordination and collaboration with stakeholder groups in communities and society ; and increasing the application of incentives and disincentives to acculturate healthy behaviours and norms .

• Pillar 3 : To place the financing of the health system on a sustainable footing towards progressively increasing health funding under public sector management ; exploring and implementing equitable ways of diversifying sources of health funding ; pooling the population ’ s health risk into a dedicated health fund that ensures affordable coverage over a comprehensive set of services ; and ensuring the cost-effectiveness of health expenditure by instituting a range of organisational and governance reforms including the establishment of value-based payment models and the strengthening of the Strategic Purchaser .

• Pillar 4 : To strengthen the organisational , governance and stewardship foundations of the health system by strengthening the Ministry of Health ’ s ( MoH ) policy-making , regulatory , data stewardship and research functions ; devolving the healthcare provider and purchaser role from the MoH to institute greater check-and-balance as well as performance ; improving policies , legislation and regulations related to health to be relevant to the current situation ; improving the health workforce ecosystem including planning , credentialing , career development , public sector recruitment and deployment ; and stimulating research , innovation and evidence-based approaches . Some of the reform themes contained in the pillars and strategies above gained increased prominence recently , but many others are familiar to Malaysia . Since the 1980s , multiple efforts have addressed the systemic challenges inherent in the country ’ s health system .

While many stakeholders have highlighted the clear need for systemic and structural shifts , long-term change has not been purposefully introduced due to the lack of clear agreement on the direction of reform .

Notably , the HWP was initiated by former Health Minister Khairy Jamaluddin back in January 2022 to reform the country ’ s health system , especially in ensuring that it is future-proof .

This critical component , namely securing broad agreement on the case for change and the path forward for Malaysia ’ s health system , is the purpose of presenting the HWP in Parliament .

The direction of the health system reform pillars proposed by the HWP is sufficiently broad and enduring ; nevertheless , reform efforts need to be able to adapt and course-correct in the face of learnings , improved methods or models and new technologies .

In that regard , the strategies proposed may be refined during the HWP reform period upon the government ’ s recommendation , the health reform monitoring body or Parliamentary Select Committees , after debate and deliberation in Parliament .

Health system reform in Malaysia is necessary and urgent . Reform of the health system is required to prepare the system for the future , enable Malaysians to live in better health , and for the nation to prosper .

Before more time is lost , Parliament , the people and the nation must stand together and begin the journey of health system reform today .