HSM479 Topic 3 Health Financing
Page 1
HSM479 National Healthcare System
Health Financing: Overview of health finance principles critical for understanding the healthcare system.
Page 2
Topic Objectives
Learning Outcomes:
Discuss the sources of revenue and financial flows in healthcare.
Explain statutory financing.
Identify various financing mechanisms in the healthcare context.
Page 3
True Statement Quiz
Health Finance Understanding: Choose the correct interpretation:
A. Health finance is about managing hospital expenses.
B. Health finance involves the distribution of healthcare resources.
C. Health finance concerns calculating healthcare service costs.
Page 4
Today's Learning Topics
Agenda:
Sources of revenue and financial flows.
Overview of the statutory financing system.
Out-of-pocket payments.
Voluntary health insurance.
Other financing mechanisms.
Payment mechanisms in healthcare.
Page 5
Subtopic 1
Sources of Revenue and Financial Flows: Introduction to the different sources and how funds flow in the healthcare system.
Page 6
Public vs Private Hospitals
Key Differences:
Comparison of operational structures and financing sources in public and private hospitals.
Page 7
Scenarios for Discussion
Scenario 1: Assessing the potential to expand mother and child health service activities by 10% with available funding.
Scenario 2: Evaluating the feasibility of opening a new trauma department along with staffing needs.
Page 8
Importance of Health Financing
Core Functions:
Keeps healthcare organizations operational.
Allocates resources effectively for service delivery.
Involves understanding healthcare operations influenced by political, economic, and environmental factors.
Basic model of healthcare comprises input, process, and outcomes.
Page 9
Basic Model of Underlying Healthcare
Three Components: Overview of the foundational model pertaining to healthcare.
Page 10
Basic Model of Underlying Healthcare
Input, Process, and Outcomes: Key elements in the healthcare delivery system.
Page 11
Input
Resources Used for Healthcare Production:
Examples include staff, assets, facilities, medical equipment, and consumables.
Can be measured financially.
Page 12
Process
Operational Activities: Tasks required to achieve health outcomes:
Includes managing payments, rentals, supplies, number of procedures (e.g., X-rays, vaccinations).
Emphasis on the need for accuracy, relevance, and timeliness in these processes.
Page 13
Outcomes
Measuring Patient Health Status:
Assessment of changes in health following service delivery.
Metrics used include quality of life and survival rates.
Involves economic evaluations to gauge input versus healthy life outcomes.
Page 14
Health Expenditure
Current Trends:
Considerations regarding sustainability of health expenditure amidst rising costs.
Comparative analysis of operating versus development expenditures.
Public vs private spending insights: Public healthcare spends more yet higher out-of-pocket expenses observed.
Sharp increase in pharmaceutical costs—from MYR 891 million to MYR 1.5 billion.
Page 15
Sources of Revenue
Public Funding:
Revenue sources include general taxation, non-tax revenue, and allocation based on historical values.
Emergency funding models for public health crises (pandemic/endemic).
Key providers identified as MOH & MOHE.
Page 16
Statutory Financing
Coverage and Accessibility:
Overview of the dual healthcare system, highlighting public healthcare access from primary to tertiary levels.
Focus on urban vs rural health service distribution.
Revenue Collection Methods:
Public revenues from taxes and development plans, private sources from out-of-pocket payments and health insurance.
Page 17
Private Financing Sources
Components:
Out-of-pocket payments (OOP).
Voluntary health insurance models such as employer-sponsored insurance and personal policies.
Role of private managed care organizations in the system.
Page 18
Payment Mechanisms
Healthcare Practitioner Payments:
General practitioners and private practitioners' fees regulated under the 1998 Private Health Care Facilities and Services Act.
Public practitioners compensated based on civil service rates, with notes on locum payments.
Issues regarding unregulated oral services and fee scheduling noted as a concern.
Page 19
Key Considerations
Critical Questions in Healthcare Financing:
Sustainability of financing methods?
Evaluation of healthcare access and equity?
Discussion on the effectiveness of payment mechanisms.
Page 20
References
Citations:
Al-Sanaani et al. (2022). Health insurance status and determinants, Plos One.
Gruen & Howarth (2005). Financial management in health services, McGraw-Hill.
Jaafar et al. (2013). Malaysia health system review, WHO.
Other scholarly references addressing health care reforms and financing in Malaysia.