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THE HEALTH | MAY-JUNE , 2022
| Opinion |
Bridging healthcare access in Malaysia
There needs to be greater synergy between the various healthcare stakeholders within the government , private sector and civil society groups
BY ROSHEL JAYASUNDERA
CONTINUOUS improvements within Malaysia ’ s healthcare ecosystem mean more people in the country now have better access to quality healthcare and are therefore living longer . However , maintaining this quality is becoming a larger healthcare burden , testing the limits of healthcare system capacity in the longer term . Concurrently , more patients are opting to receive care outside of hospitals and clinics due to overcapacity issues and the fear of contracting Covid-19 .
These issues pose a challenge for healthcare systems as ensuring continuity is important for generating positive healthcare outcomes . For instance , patients with critically fatal diseases such as cancer require specialised treatment , but many are often unable to access the medication they need in time – especially if they come from more vulnerable population groups .
Healthcare systems are then at risk of collapse as they cannot successfully address specific threats such as brain cancer . Although not currently one of the largest contributors to cancer cases in the country , they still often present a high incident-todeath ratio .
For Malaysia to build a more resolute and accessible healthcare future , there needs to be greater synergy between the various healthcare stakeholders within the government , the private sector and civil society groups . These players must work more closely together – particularly outside of purely clinical settings – to understand the real needs of patients and how to best tackle perennial issues across multiple dimensions such as access and affordability .
Multi-sectoral collaboration
Today , healthcare systems must go beyond the long-standing top-down models typically associated with state-provided healthcare . This is because healthcare needs in Malaysia are growing but so are its costs , placing more demand on government budgets .
Ultimately , this means the responsibility for treatment and other medical costs is increasingly falling on the patient , who must now take a more active role in treatment decisions – particularly those related to pursuing , paying for and staying on treatment outside of clinical settings .
Even so , broadening healthcare access is not a one-size-fits-all approach that happens only in clinical settings ; it requires one that is personalised and tailored to the specific needs of the patient and their country . This is especially for specialty treatments in Malaysia , such as oncology treatment which may be too costly for patients and still lack universal coverage .
With more money needing to be paid out of the patient ’ s pockets , there can be a late presentation of the disease , leading to more expensive treatment and poorer outcomes .
This means that healthcare stakeholders outside government – including the private sector and civil society groups – are wellpositioned to support the country ’ s broader healthcare system improvement efforts . However , they must venture outside of their siloes and work more closely to explore better ways for patients to adhere to their treatment regimens .
But before doing so , they must understand the various dimensions of factors that affect a patient ’ s healthcare decision-making .
Harnessing insights across dimensions
To improve the effectiveness of multisectoral approaches in addressing growing burdens such as cancer , they must first understand in detail how a complex set of factors guides a patient ’ s healthcare decisions . As these factors cut across multiple dimensions , the factors can be determined through a comprehensive assessment of the patient ’ s needs and affordability .
A complex set of considerations guides patient decisions ( see Figure 1 ). These considerations can be measured to understand how specific patient requirements vary across treatment adherence dimensions , which then helps to inform customised adherence and support plans that maximise treatment benefits .
To ensure accuracy of these plans , there must also be a detailed assessment and understanding of the risk factors which may impact the patient ’ s adherence to treatment . A Patient Needs Assessment Tool ( PNAT ) facilitates this assessment , helping to understand better the patient ’ s unmet needs across the five dimensions of adherence proposed by the World Health Organisation ( WHO ). They are :
• Social and economic : i . e ., patient ’ s socioeconomic status ; literacy and education levels ; culture ; age ; and availability of social support
Figure 1 : Considerations behind a patient ’ s decision-making .
• Therapy-related : i . e ., treatment regimen complexity ; treatment duration ; the immediacy of beneficial treatment effects ; and side effects from treatment
• Patient-related : i . e ., resource availability ; knowledge ; attitudes ; motivation ; expectations ; and beliefs
• Healthcare team and system : healthcare coverage availability ; relationships between patients and clinicians ; and skill and training of clinicians
• Condition-related : symptom severity ; disability levels ; rate of disease progression ; and comorbidities After considering a patient ’ s unique needs , a Patient Financial Eligibility Tool ( PFET ) can assess how much assistance an individual patient needs to afford their full treatment course . This tool must measure three different indicators of a patient ’ s wealth – indicated by income , assets and living standards . These are then used to develop a plan that details how much of the treatment course a patient must pay based on their ability to pay .
The insights obtained from tools such as PNAT and PFET can then help inform multi-sectoral healthcare efforts . For instance , with more detailed information on hand , healthcare providers and ecosystem stakeholders can then develop cost-sharing models that help widen access to specialised medications – namely how much will be covered by other parties , such as pharmaceutical companies , insurers , and the government .
By splitting the cost of treatment across multiple parties , cost-sharing makes it possible for patients to afford their entire course of treatment . Patients then maximise their treatment ’ s medical benefits , whereas physicians have a viable alternative for patients experiencing access issues .
This can also help minimise demand on government healthcare budgets , while NGOs and civil society groups helping more vulnerable societal segments pay for treatment will have more clarity on how to raise and / or disburse financial support more accurately .
Multiplying efforts to transform patient outcomes in Malaysia
If its access needs remain unaddressed , Malaysia ’ s national healthcare system will be strained in its ability to adapt to the ever-evolving needs of patients in the country . We are already seeing healthcare transformation efforts being driven by the government and private sector to overcome existing access hurdles – particularly in terms of digitalisation .
However , multisectoral initiatives must reinforce such efforts that can accurately determine the multi-dimensional factors behind a patient ’ s access limitations . Doing so will help generate better health outcomes and scale it , thus raising the quality of healthcare access in Malaysia and sustaining it . — The Health
Roshel Jayasundera is Senior Director , Global Consulting at Axios International , a global healthcare access company