Strengthen primary health care by connecting private and public sectors
Chee Heng Leng
Citizens' Health Initiative/ People's Health Forum
Malaysia’s well-distributed primary healthcare system has served our population well for maternal and child health, and for acute infectious diseases. However, we now face epidemics of non-communicable diseases (NCDs)—heart disease, diabetes, hypertension, strokes, cancers. This is shown by Malaysia’s widening gap in life expectancy in late adulthood, and high prevalence of risk factors such as overweight and obesity (highest rates in Southeast Asia). It is expensive to treat NCDs at late stages in hospitals. It is necessary to improve prevention by (1) expanding effective health promotion, and (2) increasing screening and treatment at the primary health care level so that people with NCDs will be identified and treated at an earlier stage. Currently, there is no coordination in primary care services between the private sector (GPs) and public sector (government clinics). There is also no system whereby individuals can be followed by the same doctor for continuity of care, which is crucial for NCDs.
Value(s) and Belief(s):
PHF affirms a policy of healthcare on the basis of need, not on the ability to pay. We believe, in line with WHO’s Constitution, that the state has the responsibility to create the enabling environment for “the highest attainable standard of health as a fundamental right of every human being.”
Proposal of Solution:
Improve primary health care in both private and public sectors, and strengthen the connection between them. Incorporate the general practitioners into the public health care service, and provide tax incentives for those who serve in rural areas. This can be done, for example, by a system in which the MOH contracts with GPs under a capitation payment system that covers a certain number of patients over a particular period of time. The capitation system offers to GPs ‘guaranteed patients’, and has an inbuilt mechanism to incentivise doctors to keep their patients healthy and does not incentivise them to over-medicate. Bonuses can be given to doctors to encourage regular medical screening for preventive health for their patients. Patients who now cannot afford to go to private GPs and who are overloading the government hospital out-patient clinics will be given medical care free at the point of service, in exchange for ‘tying’ themselves to a doctor or a group practice. There is scientific evidence that continuity of care provided by seeing the same doctor is beneficial for patients. This is a more holistic system that will include chronic disease management (follow up treatment, regular medication, blood tests and other tests, for example, eye test for diabetic retinopathy).
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