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Seksyen Malaysia NationalHealth Accounts (MNHA)
Cawangan Perancangan Pembiayaan, Informatik dan AkaunKesihatan
Bahagian Perancangan
Kementerian KesihatanMalaysia
MESYUARAT JAWATANKUASA PEMANDU MNHA
2018SHA 2011 MIGRATION
Seksyen MNHA, Bahagian Perancangan- 2018 1
MALAYSIA NATIONAL HEALTH ACCOUNTS
Migration to SHA 2011
Note : This presentation was prepared for the MNHA Steering Committee Meeting on 22nd November 2018.
For further information, please contact us at mnha@moh.gov.my
Seksyen MNHA, Bahagian Perancangan- 2018
OUTLINE
• Introduction
• Changes in SHA2011
• In i t ia l plan
• Methodology
• Outputs
• Future plans
Seksyen MNHA, Bahagian Perancangan- 2018 3
INTRODUCTION
Seksyen MNHA, Bahagian Perancangan- 2018 4
National HealthAccountsTri-Axial Concept
DIMENSIONS OF NATIONAL HEALTH ACCOUNTS: SHA 2000 (SHA 1.0) – TRI AXIALCONCEPT
Seksyen MNHA, Bahagian Perancangan- 2018 5
SOURCESof
funding
Who Pays?
FUNCTIONS of Health
Care Services
For What?
PROVIDERSof
Health Care
To Whom?
SHA2011
framework
Consumer health
interface
Provision
interfaceFinancing
interface
Characteristics of beneficiaries (ICHA-HB)
(Diseases, age, gender, income,etc.)
Revenues of health
care financing schemes
(ICHA-FS)
Financing agents (ICHA-FA)
Gross capitalformation
(ICHA-HK)
Factors of provision (ICHA-FP)
External trade
Health care
financing schemes
ICHA-HF
Healthcare
Providers
ICHA-HP
DIMENSIONS OF SHA 2011 FRAMEWORK (CORE & EXTENDED)
Healthcare
functions
ICHA-HC
5
Source: IHAT for SHA 2011
Seksyen MNHA, Bahagian Perancangan- 2018
• The System of Health Accounts (SHA) 2011 framework is aninternationally recognized methodology that tracks all healthspending in a given country over a defined period of timeregardless of the entity or institution that financed and managedthat spending. It ensures comparability of health expenditureacross countries and over time.
• The purpose of the SHA 2011 is to generate consistent andcomprehensive data on health spending in a country, which inturn can contribute to evidence-based policy-making in thecountry.
SHA 2011-INTRODUCTION
Seksyen MNHA, Bahagian Perancangan- 2018 7
GLOBAL IMPLEMENTATION OF SHA2011
Seksyen MNHA, Bahagian Perancangan- 2018 8
CHANGES IN
SHA 2011
Seksyen MNHA, Bahagian Perancangan- 2018 9
CHANGES IN SHA 2011(1)
Revised terminologies & boundaries to addressambiguity on certain concepts,definitions
• public & private => compulsory &voluntary
• Reporting from Total Health Expenditure to Current Health Expenditure
• Total Health Expenditure = Health & Health Related Items (Capitalformation, Research & Development, And Education & Training)Current Health Expenditure = Health Expenditure Excluding HealthRelated Items (National health expenditure values will now belower)
• Capital formation is reportedseparately
Note: Health Related items includes Capital formation, Research & Development,
And Education & Training
Seksyen MNHA, Bahagian Perancangan- 2018 10
HEALTH CAREPROVIDERS
• Minor changes - refinement of classification for better clarity
HEALTH CAREFUNCTIONS
• More complete & detailedclassifications
• HC.6 (preventive care) is completely re-categorized
• Updated HC.7 classification (governance) into 2 sub-codes - governance & health system administration (HC.7.1) and health financing administration(HC.7.2)
• Memorandum items added to track policy relevantexpenditures
• Health-related items – e.g. social component of long termcare
• Reporting Items – TCAM, Total Pharmaceutical Expenditure
HEALTH CARE FINANCING SCHEMES & REVENUESOF HEALTH CARE FINANCING SCHEMES
• Completely new classifications
CHANGES IN SHA 2011(2)
Seksyen MNHA, Bahagian Perancangan- 2018 11
Total Vs Current Health Expenditure (SHA1)
SHA1.0Code CoreFunctions
HC.1 Services of curativecare
TotalHealth
Expenditu
re
Current
Health
Expenditu
re
HC.2 Services of rehabilitative care
HC.3 Services of long-term nursingcare
HC.4 Ancillary services to healthcare
HC.5 Medical goods dispensed to out-patients
HC.6 Prevention and public health services
HC.7 Health administration and health insurance
Code Health- RelatedFunctions
HC.R.1 Capital formation of health care providerinstitutions
HC.R.2 Education and training of healthpersonnel
HC.R.3 Research and development in health
HC.R.4 Food hygiene and drinking water control
HC.R.5 Environmental health
HC.R.6Administration and provision of social services in kind toassist
living with diseases andimpairment
HC.R.7 Administration and provision of health relatedcash-benefits
TOTAL VS CURRENT HEALTH EXPENDITURE (SHA1.0)
Seksyen MNHA, Bahagian Perancangan- 2018 12
SHA 2011 Current HealthExpenditure
SHA2011
Code Functions
HC.1 Curative care
CurrentHealth
Expenditure
HC.2 Rehabilitative care
HC.3 Long-term care(health)
HC.4 Ancillary services (non- specified by function)
HC.5 Medical goods (non- specified by functions)
HC.6 Preventive care
HC.7 Governance, and health system and financingadministration
HC.9 Other health care services not elsewhere classified(n.e.c)
SHA 2011- CURRENT HEALTHEXPENDITURE
Seksyen MNHA, Bahagian Perancangan- 2018 13
13
PREVENTIVE CARE FUNCTION: SHA 1.0 VS SHA2011
Seksyen MNHA, Bahagian Perancangan- 2018
SHA 1.0
HC.6PREVENTION ANDPUBLIC
HEALTHSERVICES
HC.6.1 Maternal and child health,family
planning and counselling
HC.6.2 School health services
HC.6.3 Prevention ofcommunicable
diseases
HC.6.4 Prevention of noncommunicable
diseases
HC.6.5 Occupational health care
HC.6.9 All other miscellaneouspublic
health services
SHA 2011
HC.6 PREVENTIVE CARE
HC.6.1 Information, education and
counselling programmes
HC.6.2 Immunization programmes
HC.6.3 Early diseasedetection
programmes
HC.6.4 Healthy condition monitoring
programmes
HC.6.5 Epidemiological surveillanceand
risk and disease control
programmes
HC.6.6 Preparing for disasterand
emergency response programmes
INITIAL PLAN
Seksyen MNHA, Bahagian Perancangan- 2018 14
SHA2011
framework
Consumer health
interface
Provision
interfaceFinancing
interface
Characteristics of beneficiaries (ICHA-HB)
(Diseases, age, gender, income,etc.)
Revenues of health
care financing schemes
(ICHA-FS)
Financing agents (ICHA-FA)
Gross capitalformation
(ICHA-HK)
Factors of provision (ICHA-FP)
External trade
Health care
financing schemes
ICHA-HF
Healthcare
Providers
ICHA-HP
DIMENSIONS OF SHA 2011 FRAMEWORK (CORE & EXTENDED)
Healthcare
functions
ICHA-HC
15
Source: IHAT for SHA 2011
Seksyen MNHA, Bahagian Perancangan- 2018
Research & Development
Education & Training
PH components:Food
safety, drinkingwater,
fogging, etc.MNHA FRAMEWORK
SHA 1.0FRAMEWORK
NEW CHALLENGE SHA 2011MIGRATIONNEW CHALLENGES SHA 2011MIGRATION
Seksyen MNHA, Bahagian Perancangan- 2018 17
MNHA FRAMEWORK
MNHA vs SHAFRAMEWORKS
SHA 1.0FRAMEWORK
SHA2011
Framework
NEW MNHAFRAMEWORK
SHA 1.0 vs SHA 2011FRAMEWORK
Seksyen MNHA, Bahagian Perancangan- 2018 18
SHA2011
framework
Consumer health
interface
Provision
interfaceFinancing
interface
Characteristics of beneficiaries(ICHA-HB)
(Diseases, age, gender, income,etc.)
Revenues of health
care financing schemes
(ICHA-FS)
Financing agents (ICHA-FA)
Gross capitalformation
(ICHA-HK)
Factors of provision (ICHA-FP)
External trade
Health care
financing schemes
ICHA-HF
Healthcare
Providers
ICHA-HP
SHA 2011 MIGRATION: INITIALPLAN
BY MNHA SECTION, PLANNINGDIVISION
Healthcare
functions
ICHA-HC
18
Source: IHAT for SHA 2011
Seksyen MNHA, Bahagian Perancangan- 2018
METHODOLOGY
Seksyen MNHA, Bahagian Perancangan- 2018 20
Multiple Trainings (National andInternational)
Studied mapping SHA 1.0 versus SHA 2011
Reviewed boundaries & terminologies MNHA vs SHA2011
Early draft of MNHA 2 framework
Developed draft of MNHA2 with full mapping
TechnicalAdvisory Committee review & inputs for mapping
Planned methodology to migrate withconsultant
Pilot test the methodology
SHA 2011- METHODS OFMIGRATION
Seksyen MNHA, Bahagian Perancangan- 2018 21
Seksyen MNHA, Bahagian Perancangan- 201821
MAPPING–
MNHA 1.0
FRAMEWORK
FORMAT
SHA 1.0 FRAMEWORKSHA 2011
FRAMEWORK
MNHA 2.0
FRAMEWORK
MNHA 1.0
frk code
MNHA
1.0 label
MNHA
dtb codeSHA 1.0
frk code
SHA 1.0
label
SHA 1.0
dtb codeSHA 2011
frk code
SHA 2011
label
SHA 2011
dtb codeMNHA 2.0
frk code
MNHA
2.0 label
MNHA 2.0
dtb code
Note:
frk = framework
dtb =database
EXCEL-11DFORMAT
Internal DatabaseCode
Seksyen MNHA, Bahagian Perancangan- 2018 23
MNHA DatabaseCode
STATA-COMBINEDATASETS
Seksyen MNHA, Bahagian Perancangan- 2018 24
SHA 2011/ MNHA 2 (DATABASE2)
Seksyen MNHA, Bahagian Perancangan- 2018 25
DATA OUTPUTS
Seksyen MNHA, Bahagian Perancangan- 2018 26
For this round- Pilot study SHA 2011 migration for 3 years (2015-2017)
TABLE 1: TOTAL & Current Health Expenditure, 2015-2017
Year Current Health Expenditure(CHE)
2015 45,123
2016 46,772
2017 52,232
Current Health Expenditure,2015-2017 (RM Million, Nominal)
Seksyen MNHA, Bahagian Perancangan- 2018 27
TABLE 1: TOTAL & Current Health Expenditure, 2015-2017Current Health Expenditure,2015-2017
(RM Million, Nominal)
Seksyen MNHA, Bahagian Perancangan- 2018 28
Current Health Expenditure as percentageof GDP,2015-2017
Seksyen MNHA, Bahagian Perancangan- 2018 29
Year
Current Health
Expenditure (CHE),
Nominal
(RM Million)
Current Health
Expenditure (CHE),
Nominal as %of GDP
2015 45,123 3.89
2016 46,772 3.80
2017 52,232 3.86
Current Health Expenditure as percentageof GDP,2015-2017
Seksyen MNHA, Bahagian Perancangan- 2018 30
SHA 2011
codeHealth care financingschemes
2015 2016 2017
RM Million Percent RM Million Percent RM Million Percent
HF.1.1.1
Central governmentschemes
(e.g. MOH, MOHE, MOD, Other federal
agencies)23,159 51.33 22,777 48.7 25,536 48.89
HF.3.1 Out-of-pocket excludingcost-sharing 16,009 35.48 17,584 37.6 19,821 37.95
HF.2.1.2
Complementary/supplementary
insuranceschemes(e.g. Private Insurance & PrivateMCO)
4,353 9.65 4,738 10.13 5,069 9.70
HF.2.3Enterprise financingschemes
(e.g. All corps)684 1.52 702 1.5 799 1.53
HF.1.1.2State/regional/
local governmentschemes538 1.20 520 1.11 560 1.08
HF.1.2.1Social health insuranceschemes
(e.g. SOCSO)261 0.58 310 0.66 329 0.63
HF.2.2NPISH financingschemes
(e.g. NGO)67 0.15 84 0.18 60 0.11
HF.1.3
Compulsory Medical SavingAccounts
(CMSA)(e.g. EPF)
52 0.11 56 0.12 58 0.11
Total 45,123 100 46,772 100 52,232 100
Current Health Expenditure by Health CareFinancing Schemes,2015-2017
Seksyen MNHA, Bahagian Perancangan- 2018 31
Current Health Expenditure by HealthCare Financing Schemes,2017
Seksyen MNHA, Bahagian Perancangan- 2018 32
Year
GeneralGovernment
Health Expenditure
(GGHE)
(RM Million)
GeneralGovernment
Expenditure (GGE)-
Operating*
(RM Million)
GGHE as % GGE-Op
2015 24,010 243,302 9.87
2016 23,663 238,569 9.92
2017 26,483 248,202 10.67
GGHE aspercentage of GGE-Operating , 2015-2017 (Current)
Seksyen MNHA, Bahagian Perancangan- 2018 33
Source: *Treasury Malaysia website Economy Report 2016/2017
GGHE as percentage of GGE-Op, 2015-2017 (Current)
Seksyen MNHA, Bahagian Perancangan- 2018 34
Current Health Expenditure to Providers of Health Care, 2015-2017
Seksyen MNHA, Bahagian Perancangan- 201834
SHA2011
codeProviders of healthcare
2015 2016 2017
RM Million Percent RM Million Percent RM Million Percent
HP.1 Hospital 26,031 57.69 27,652 59.12 30,953 59.26
HP.3Providers ofambulatory
healthcare10,220 22.65 10,717 22.91 11,614 22.24
HP.5
Retailers andother
providers ofmedicalgoods
3,365 7.46 3,635 7.77 3,886 7.44
HP.7
Providers of healthcare
system administrationand
financing3,571 7.91 2,715 5.81 3,791 7.26
HP.6Providers ofpreventive
care1,509 3.34 1,674 3.58 1,581 3.03
HP.4Providers ofancillary
services267 0.59 211 0.45 235 0.45
HP.8 Rest ofeconomy 144 0.32 152 0.33 160 0.31
HP.9 Rest of theworld 15 0.03 11 0.02 11 0.02
HP.2Residential long termcarefacilities
1 0.00 5 0.01 2 0.00
Total 45,123 100 46,772 100 52,232 100
Current Health Expenditure to Providers of Health Care,2017
Hospital
59%
Providers of
ambulatory healthcare
22%
Retail sale andother
providers ofmedical
goods
8%
Providers ofhealth
care system
administrationand
financing
7%
Providers ofpreventive
care
3%
Providers ofancillary
services
1%
All otherproviders
<1%
Seksyen MNHA, Bahagian Perancangan- 2018 36
SHA
201
1
code
Functions of healthcare
2015 2016 2017
RM
MillionPercent
RM
MillionPercent
RM
MillionPercent
HC.1 Curative care 34,277 75.96 36,204 77.41 40,166 76.90
HC.7Governance,and healthsystemand
financingAdministration4,452 9.87 3,764 8.05 4,770 9.13
HC.5 Medical goods 3,873 8.58 4,236 9.06 4,551 8.71
HC.6 Preventivecare 2,166 4.80 2,264 4.84 2,415 4.62
HC.4 Ancillary services 353 0.78 299 0.64 330 0.63
HC.3 Long-term care(Health) 1 0.00 4 0.01 1 0.00
Total 45,123 100 46,772 100 52,232 100
Current Health Expenditure forFunctions of Health Care,2015-2017
Seksyen MNHA, Bahagian Perancangan- 2018 37
Current Health Expenditure forFunctions of Health Care,2017
Seksyen MNHA, Bahagian Perancangan- 201837
SHA
201
1
code
Functions of healthcare
2015 2016 2017
RM
MillionPercen
t
RM
MillionPercen
t
RM
MillionPercen
t
HC.6.3 Early disease detectionprogrammes 697 32.21 739 32.65 781 32.34
HC.6.4 Healthy condition monitoringprogrammes 524 24.19 558 24.66 615 25.45
HC.6.5Epidemiological surveillance and risk anddiseasecontrolprogrammes
507 23.42 512 22.63 545 22.57
HC.6.1Information, education andcounsellingprogrammes
395 18.24 418 18.45 430 17.80
HC.6.2 Immunizationprogrammes 42 1.94 37 1.62 44 1.83
Total 2,166 100 2,264 100 2,415 100
Preventive Care Expenditure, 2015-2017
Seksyen MNHA, Bahagian Perancangan- 2018 39
Preventive Care Expenditure,2017
Seksyen MNHA, Bahagian Perancangan- 2018 40
FUTURE PLANS
Seksyen MNHA, Bahagian Perancangan- 2018 41
2019 andonwards
MNHA 2.0 new version
• Development of MNHA 2Framework
• Update mapping of MNHA 1.0 - SHA1.0 - SHA2011 -MNHA 2.0 based on recommendations from MNHATechnicalAdvisory Committee & policymakers
• Revise definitions of classifications / categories inMNHA 1.0 with stakeholders (e.g. MOH hospitals,preventive components) for MNHA2.0
• Conduct further updates according to new policydevelopment (e.g. new category of Financing Source/Revenue of financing schemes)
SHA 2011 MIGRATION: FUTURE PLANS(1)
Seksyen MNHA, Bahagian Perancangan- 2018 42
Data analysis and reporting
new questionnaire (e.g. Q on• Development of
Revenue)• Additional analyses for ‘provider’ & ‘function’
dimension
• New analysis for Revenue of healthcare financing
schemes dimension• Strengthening process of data validation
and verification for newdatabase
• Reporting SHA 2011 time series outputs byphase
SHA 2011 MIGRATION: FUTURE PLANS(2)
Seksyen MNHA, Bahagian Perancangan- 2018 43
Seksyen MNHA, Bahagian Perancangan- 2018 44
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