In 2006, the Ministry of Health Malaysia was looking for more effective approaches to resource allocation. They engaged John Hopkins University Consultants and ACG® International to apply the ACG® System to the data obtained from electronic clinical information systems in both government clinics and the private sector, to monitor and improve the quality and efficiency of primary health care delivery in Malaysia.
Particular emphasis was given to improving data quality, increasing understanding of the morbidity profile of individual clinics and regions, and developing the necessary underlying infrastructure to support adjustments to the funding formula for the development of risk adjusted capitation schemes.
The successful completion of the first evaluation project in 2007 resulted in an appreciation of the value of the database as well as increased knowledge of the morbidity profile of the Malaysian population. It was established that morbidity patterns are influenced by age, gender, region and ethnicity. The profiling of providers on a regional basis was successful, and served as a first step to evaluate the viability of a morbidity based capitation formula. Moreover, it was determined that in order to give a national capitation scheme further consideration, a better understanding of the differences in service delivery between the public and the private sector is necessary.
Subsequent studies in 2008 and 2009 furthered the process by validating new micro-costing information and increasing the quality of the diagnostic information recorded. Furthermore, clinic profile reports and high-risk patient identification lists were developed, and Rx information was added to the mix.
Next steps in Malaysia include studies to predict high-risk patients for inclusion in care management, and to address equitable allocation of resources and efficient provider practices. Additionally, plans are in place to develop fair provider payment mechanisms.
