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Fulltext Universal coverage in an era of privatisation: can we guarantee health for all?

Allotey P, Yasin S, Tang S, Chong SL, Cheah JC, Reidpath DD

BMC Public Health, 2012;12 Suppl 1:S1.
PMID: 22992275
Matched MeSH terms: Privatization*
Hybrid Organizations in Health Systems: The Corporatization of Malaysia's National Heart Institute

Virk A, Croke K, Mohd Yusoff M, Mokhtaruddin K, Abdullah Z, Nadziha Mohd Hanafiah A, et al.

Health Syst Reform, 2020 12 01;6(1):e1833639.
PMID: 33314988 DOI: 10.1080/23288604.2020.1833639

Health system reforms across high- and middle-income countries often involve changes to public hospital governance. Corporatization is one such reform, in which public sector hospitals are granted greater functional independence while remaining publicly owned. In theory, this can improve public hospital efficiency, while retaining a public service ethos. However, the extent to which efficiency gains are realized and public purpose is maintained depends on policy choices about governance and payment systems. We present a case study of Malaysia's National Heart Institute (IJN), which was created in 1992 by corporatization of one department in a large public hospital. The aim of the paper is to examine whether IJN has achieved the goals for which it was created, and if so, whether it provides a potential model for further reforms in Malaysia and other similar health systems. Using a combination of document analysis and key informant interviews, we examine key governance, health financing and payment, and equity issues. For governance, we highlight the choice to have IJN owned by and answerable to a Ministry of Finance (MOF) holding company and MOF-appointed board, rather than the Ministry of Health (MOH). On financing and payment, we analyze the implications of IJN's combined role as fee-for-service provider to MOH as well as provider of care to private patients. For equity, we analyze the targeting of IJN care across publicly-referred and private patients. These issues demonstrate unresolved tensions between IJN's objectives and public service goals. As an institutional innovation that has endured for 28 years and grown dramatically in size and revenue, IJN's trajectory offers critical insights on the relevance of the hybrid public-private models for hospitals in Malaysia as well as in other middle-income countries. While IJN appears to have achieved its goal of establishing itself as a commercially viable, publicly owned center of clinical excellence in Malaysia, the value for money and equity of the services it provides to the Ministry of Health remain unclear. IJN is accountable to a small Ministry of Finance holding company, which means that detailed information required to evaluate these critical questions is not published. The case of IJN highlights that corporatization cannot achieve its stated goals of efficiency, innovation, and equity in isolation; rather it must be supported by broader reforms, including of health financing, payment, governance, and transparency, in order to ensure that autonomous hospitals improve quality and provide efficient care in an equitable way.

Matched MeSH terms: Privatization/trends*
Fulltext Sustainable development goals, universal health coverage and equity in health systems: the Orang Asli commons approach

Wong YS, Allotey P, Reidpath DD

Glob Health Epidemiol Genom, 2016;1:e12.
PMID: 29868204 DOI: 10.1017/gheg.2016.8

Universal health coverage is a key health target in the Sustainable Development Goals (SDGs) that has the means to link equitable social and economic development. As a concept firmly based on equity, it is widely accepted at international and national levels as important for populations to attain 'health for all' especially for marginalised groups. However, implementing universal coverage has been fraught with challenges and the increasing privatisation of health care provision adds to the challenge because it is being implemented in a health system that rests on a property regime that promotes inequality. This paper asks the question, 'What does an equitable health system look like?' rather than the usual 'How do you make the existing health system more equitable?' Using an ethnographic approach, the authors explored via interviews, focus group discussions and participant observation a health system that uses the commons approach such as which exists with indigenous peoples and found features that helped make the system intrinsically equitable. Based on these features, the paper proposes an alternative basis to organise universal health coverage that will better ensure equity in health systems and ultimately contribute to meeting the SDGs.

Matched MeSH terms: Privatization
Managed care storms Malaysia. Fears are brewing that consumers will be hurt in the transition to privatized U.S.-style HMOs

Rauber C

Mod Healthc, 1999 Nov 15;29(46):50, 52, 55.
PMID: 10662048
Matched MeSH terms: Privatization/trends
Effect of privatization of the drug distribution system on drug prices in Malaysia

Babar ZD, Izham MI

Public Health, 2009 Aug;123(8):523-33.
PMID: 19665741 DOI: 10.1016/j.puhe.2009.06.011

Previous studies on anti-infective and cardiovascular drugs have shown extraordinary price increases following privatization of the Malaysian drug distribution system. Therefore, it was felt that there was a need to undertake a full-scale study to evaluate the effect of privatization of the Malaysian drug distribution system on drug prices.

Matched MeSH terms: Privatization/economics*; Privatization/statistics & numerical data
Fulltext Assessing the performance of non-specialised private hospitals in Malaysia - an upper-middle-income medical tourism destination country using the Pabón-Lasso model

Samsudin MF, Lim YC, Rochmah TN, Dahlui M

BMC Health Serv Res, 2024 Nov 16;24(1):1414.
PMID: 39548435 DOI: 10.1186/s12913-024-11768-5

BACKGROUND: The government has rapidly promoted the privatisation of healthcare to improve systemic performance, based on the theory that markets improve efficiency. This study aims to measure the efficiency of private hospitals following their expansion and venture into the medical tourism industry through extensive governmental support.
METHODS: Inpatient utilisation of 101 private, non-specialised hospitals in Malaysia in 2014 and 2018 from the Health Informatics Centre, Ministry of Health Malaysia database was studied using paired samples t-test, analysis of variance (ANOVA), and the Pabón-Lasso model.
RESULTS: Better quantitative performance was found among larger hospitals, those with hospital accreditation, and those participating in medical tourism activities. There is a scale effect of efficiency between smaller and larger hospitals. However, when compared within respective size categories, Category 1 (small hospitals with less than 100 beds) has the highest percentage of efficient hospitals (39.3 per cent in 2014 and 35.7 per cent in 2018 in Sector 3 of the Pabón Lasso graphs).
CONCLUSION: This study has found that a higher bed occupancy rate (BOR) and longer average length of stay (ALoS) are associated with larger private hospitals, hospital accreditation, and participation in medical tourism activities in Malaysia. There is a need to expedite strategic hospitals partnership for resource optimisation and capacity pooling towards producing better performance.

Matched MeSH terms: Privatization
Trends in sustainable landfilling in Malaysia, a developing country

Fauziah SH, Agamuthu P

Waste Manag Res, 2012 Jul;30(7):656-63.
PMID: 22455994 DOI: 10.1177/0734242X12437564

In Malaysia, landfills are being filled up rapidly due to the current daily generation of approximately 30,000 tonnes of municipal solid waste. This situation creates the crucial need for improved landfilling practices, as sustainable landfilling technology is yet to be achieved here. The objective of this paper is to identify and evaluate the development and trends in landfilling practices in Malaysia. In 1970, the disposal sites in Malaysia were small and prevailing waste disposal practices was mere open-dumping. This network of relatively small dumps, typically located close to population centres, was considered acceptable for a relatively low population of 10 million in Malaysia. In the 1980s, a national programme was developed to manage municipal and industrial wastes more systematically and to reduce adverse environmental impacts. The early 1990s saw the privatization of waste management in many parts of Malaysia, and the establishment of the first sanitary landfills for MSW and an engineered landfill (called 'secure landfill' in Malaysia) for hazardous waste. A public uproar in 2007 due to contamination of a drinking water source from improper landfilling practices led to some significant changes in the government's policy regarding the country's waste management strategy. Parliament passed the Solid Waste and Public Cleansing Management (SWPCM) Act 2007 in August 2007. Even though the Act is yet to be implemented, the government has taken big steps to improve waste management system further. The future of the waste management in Malaysia seems somewhat brighter with a clear waste management policy in place. There is now a foundation upon which to build a sound and sustainble waste management and disposal system in Malaysia.

Matched MeSH terms: Privatization
Ownership, control, and contention: challenges for the future of healthcare in Malaysia

Chee HL

Soc Sci Med, 2008 May;66(10):2145-56.
PMID: 18329149 DOI: 10.1016/j.socscimed.2008.01.036

The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.

Matched MeSH terms: Privatization
Public health care provisions: access and equity

Bin Juni MH

Soc Sci Med, 1996 Sep;43(5):759-68.
PMID: 8870140

Within the current exercise of reforming the health care system, underlying all issues, is the reassessment of the role of government. It is a government's responsibility and concern that the health sector be accessible and equitable to the population, and more important that the health sector be more efficient and affordable. Many governments in the world attempt to provide universal health care services to their population through public health care provisions. This paper reviews and analyses the experience of the Malaysian health system, focusing on the performance of the system in relation to access and equity. The performance of the Malaysian health system has been impressive. At minimum cost it has achieved virtually accessible and equitable health care to the entire population. This is evident by analysing almost all the commonly used indicators. These clearly show that when matched to comparable countries, health outcome is even better than predicted value.

Matched MeSH terms: Privatization
Fulltext Development of unit cost for the health services offered at King FAHD Central hospital Jazan, Saudi Arabia

Ghilan K, Mehmood A, Ahmed Z, Nahari A, Almalki MJ, Jabour AM, et al.

Saudi J Biol Sci, 2021 Jan;28(1):643-650.
PMID: 33424351 DOI: 10.1016/j.sjbs.2020.10.055

Background: Efficiency remains one of the most important drivers of decision making in health care system. Fund allocators need to receive structured information about the cost healthcare services from hospitals for better decisions related to resource allocation and budgeting. The objective of the study was to estimate the unit cost for health services offered to inpatients in King Fahd Central hospital (KFCH) Jazan during the financial year 2018.
Methods: We applied a retrospective approach using a top-down costing method to estimate the cost of health care services. Clinical and Administrative departments divided into cost centres, and the unit cost was calculated by dividing the total cost of final care cost centres into the total number of patients discharged in one year. The average cost of inpatient services was calculated based on the average cost of each ward and the number of patients treated.
Results: The average cost per patient stayed in KFCH was SAR 19,034, with the highest cost of SAR 108,561 for patients in the Orthopedic ward. The average cost of the patient in the Surgery ward, Plastic surgery, Neurosurgery, Medical ward, Pediatric ward and Gynecology ward was SAR 33,033, SAR 29,425, SAR 23,444, SAR 20,450, SAR 9579 and SAR 8636 respectively.
Conclusion: This study provides necessary information about the cost of health care services in a tertiary care setting. This information can be used as a primary tool and reference for further studies in other regions of the country. Hence, this data can help to provide a better understanding of tertiary hospital costing in the region to achieve the privatization objective.

Matched MeSH terms: Privatization
Health care reform and changes: the Malaysian experience

Merican MI, bin Yon R

Asia Pac J Public Health, 2002;14(1):17-22.
PMID: 12597513

Health care reform is an intentional, sustained and systematic process of structural change to one or more health subsystems to improve efficiency, effectiveness, patient choices and equity. Health care all over the world is continuously reforming with time. Health care reform has become an increasingly important agenda for policy change in both developed and developing countries including Malaysia. This paper provides an overview of the Malaysian health care system, its achievements, and issues and challenges leading to ongoing reform towards a more efficient and equitable health care system that possess a better quality of life for the population.

Matched MeSH terms: Privatization
Malaysia's social policies on mental health: a critical theory

Mubarak AR

J Health Soc Policy, 2003;17(1):55-72.
PMID: 14620736

This article aims to review the social policies on mental health and mental illness in Malaysia. Using critical theory, major policy issues pertaining to mental health and mental illness such as mental health legislation, prevalence rates and quality of services available to the people with mental health problems are discussed in detail. Implications of these issues on persons with mental health problems are critically evaluated. The paper highlights that the other countries in ASEAN region also require similar review by policy literature.

Matched MeSH terms: Privatization
Private medical practitioners and managed care in Malaysia: a survey of knowledge and attitudes held by Federal Territory based doctors

Marnoch G, Lian PC

Soc Sci Med, 2002 Mar;54(6):869-77.
PMID: 11996021

This paper considers the subject of managed care in Malaysia, providing a questionnaire-based analysis of the position adopted by private medical practitioners. Managed care is now seen as the dominant health care system in the United States, with many other countries around the world including Malaysia beginning to selectively use component parts to tackle particular health care problems. In this survey it was found that three out of four respondents have concerns regarding the implementation of managed care. The survey was used to identify and categorise these concerns. At the same time, three out of four respondents held the opinion that principles of managed care were already a reality or would be in the next 5 years. This group expressed an eagerness to be trained in managed care principles and be given the opportunity to be part of managed care organisations. It is argued that clinicians' knowledge and interest perceptions are an important influence on the implementation of managed care based systems. The survey-based evidence presented in this article is intended as a measure of current understandings and beliefs, in relation to clinical micro-management process associated with managed care.

Matched MeSH terms: Privatization