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Malaysia Health System Review Health Systems in Transition Vol Health Systems in Transition Vol. 2 No. 1 2012 Vol. in Transition Health Systems Health Systems in Transition Vol. 3 No.1 2013 Malaysia Health System Review The Asia Pacific Observatory on Health Review Malaysia Health System Systems and Policies is a collaborative partnership which supports and promotes evidence-based health policy making in the Asia Pacific Region. Based in WHO’s Regional Office for the Western Pacific it brings together governments, international agencies, foundations, civil society and the research community with the aim of linking systematic and scientific analysis of health systems in the Asia Pacific Region with the decision- makers who shape policy and practice. Asia Pacific Observatory on Health Systems and Policies Health Systems in Transition Vol. 3 No. 1 2013 Malaysia Health System Review Written by: Safurah Jaafar, Ministry of Health, Malaysia Kamaliah Mohd Noh, Ministry of Health, Malaysia Khairiyah Abdul Muttalib, Ministry of Health, Malaysia Nour Hanah Othman, Ministry of Health, Malaysia Judith Healy, Australian National University, Australia Other authors: Kalsom Maskon, Ministry of Health, Malaysia Abdul Rahim Abdullah, Ministry of Health, Malaysia Jameela Zainuddin, Ministry of Health, Malaysia Azman Abu Bakar, Ministry of Health, Malaysia Sameerah Shaikh Abd Rahman, Ministry of Health, Malaysia Fatanah Ismail, Ministry of Health, Malaysia Chew Yoke Yuen, Ministry of Health, Malaysia Nooraini Baba, Ministry of Health, Malaysia Zakiah Mohd Said, Ministry of Health, Malaysia Edited by: Judith Healy, Australian National University, Australia WHO Library Cataloguing in Publication Data Malaysia health system review. (Health Systems in Transition, Vol. 2 No. 1 2012) 1. Delivery of healthcare. 2. Health care economics and organization. 3. Health care reform. 5. Health systems plans – organization and administration. 6. Malaysia. I. Asia Pacific Observatory on Health Systems and Policies. II. World Health Organization Regional Office for the Western Pacific. ISBN 978 92 9061 584 2 (NLM Classification: WA 540 ) © World Health Organization 2012 (on behalf of the Asia Pacific Observatory on Health Systems and Policies) All rights reserved. Publications of the World Health Organization can be obtained from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: [email protected]). Requests for permission to reproduce or translate WHO publications – whether for sale or for noncommercial distribution – should be addressed to WHO Press, at the above address (fax: +41 22 791 4806; e-mail: permissions@who. int). For WHO Western Pacific Regional Publications, request for permission to reproduce should be addressed to the Publications Office, World Health Organization, Regional Office for the Western Pacific, P.O. Box 2932, 1000, Manila, Philippines, (fax: +632 521 1036, e-mail: publications@wpro. who.int). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Contents Preface ................................................................................................................. viii Acknowledgements ................................................................................................ x List of abbreviations ............................................................................................. xi Executive summary............................................................................................. xiii 1. Introduction .................................................................................................... 1 1.1 Section summary ............................................................................................ 1 1.2 Geography and sociodemography .................................................................. 1 1.3 Economic context ............................................................................................ 4 1.4 Political context ............................................................................................. 6 1.5 Health status .................................................................................................. 7 2. Organization and governance ...................................................................... 15 2.1 Section summary .......................................................................................... 15 2.2 Overview of the health system ..................................................................... 15 2.3 Historical background .................................................................................. 15 2.4 Organization .................................................................................................. 18 2.5 Decentralization and centralization ............................................................. 19 2.6 Planning ....................................................................................................... 21 2.7 Intersectoral relationships ........................................................................... 22 2.8 Health information management ................................................................. 22 2.9 Regulation ..................................................................................................... 24 2.10 Patient empowerment .................................................................................. 30 3. Financing ...................................................................................................... 35 3.1 Section summary .......................................................................................... 35 3.2 Health expenditure ....................................................................................... 35 3.3 Sources of revenue and financial flows ........................................................ 42 3.4 Overview of the statutory financing system ................................................. 43 3.5 Out-of-pocket payments .............................................................................. 44 3.6 Voluntary health insurance .......................................................................... 45 3.7 Other financing ............................................................................................. 46 3.8 Payment mechanisms .................................................................................. 46 iii 4. Physical and human resources ................................................................... 48 4.1 Section summary .......................................................................................... 48 4.2 Physical resources........................................................................................ 48 4.3 Human resources ......................................................................................... 53 5. Provision of services .................................................................................... 63 5.1 Section summary .......................................................................................... 63 5.2 Public health ................................................................................................. 63 5.3 Patient pathways .......................................................................................... 70 5.4 Primary/ambulatory care ............................................................................ 71 5.5 Specialized ambulatory care/inpatient care ................................................ 72 5.6 Emergency care ............................................................................................ 75 5.7 Pharmaceutical care .................................................................................... 75 5.8 Rehabilitation/intermediate care ................................................................ 76 5.9 Long-term care ............................................................................................. 77 5.10 Services for informal carers ......................................................................... 77 5.11 Palliative care .............................................................................................. 78 5.12 Mental health care ....................................................................................... 78 5.13 Oral health care ............................................................................................ 78 5.14 Complementary
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