Expectations of healthcare professionals and patients

1
Expectations of healthcare professionals and
patients

• SP Chan
• Professor of Medicine
• MBBS (Malaya), FRCP (Edinburgh)
• Consultant Endocrinologist
• University Malaya Medical Centre, Malaysia

2
Malaysia today

• Introducing Malaysia
• Disease burden causes of mortality
• Healthcare standards, facilities, funding
• Major changes in healthcare
• Drug registration, timing, availability
  limitations
• Expectations healthcare community, population
  at large

3
Malaysia today...

• Population 27, 170, 000
• GDP (RM in Million 165,155)

Department of Statistics Malaysia Updated 13th
July 2007
4

• Introducing Malaysia
• Disease burden causes of mortality
• Healthcare standards, facilities, funding
• Major changes in healthcare
• Drug registration, timing, availability
  limitations
• Expectations healthcare community, population
  at large

5
Expected burden of disease points to shift in
favour of chronic diseases AsiaPacific forecast
to show an increasingly Western disease profile

Source WHO Global Burden of Disease, November
2006 Update. Excludes Injury related DALYs
6
10 Principal causes of Death in MOH hospitals
7
Cardiovascular Disease Admission Government
Hospital 1985 - 2000
Cerebrovascular Disease
Hypertensive Disease
Disease of Arteries, Veins, Lymphatic Vessels
Unspecified Disorders of the Circulatory System
Ischaemic Heart Disease
Disease of Pulmonary Circulation other Forms of
Heart Disease
Rheumatic Fever Rheumatic Heart Disease
8
Trend of Diabetes Prevalence in Malaysia
Based on IGT Based on IFG
9
3rd NHMS (2006) Prevalence of Hypertension
age gt 30 yrs (N24,796)
BP gt 140/90 mmHg
Ministry of Health Epid Stats, 2007
10
3rd NHMS (2006) Prevalence of Overweight /
Obesity
19961 20062 Obesity /
Overweight 24.1 43.1
Relative increase of 78 over 10 years
WHO criteria Overwt 25 30 Obese gt 30 kg/m2
Ministry of Health Epid Stats, 2007
11

• Introducing Malaysia
• Disease burden causes of mortality
• Healthcare resources, facilities, funding
• Major changes in healthcare
• Drug registration, timing, availability
  limitations
• Expectations healthcare community, population
  at large

12
Healthcare Resource (2006)
Health Facts, 2006. Planning and Development
Division, MOH, Jul 2007)
13
Health Facilities 2006

• 
  Hospitals Beds
• Ministry of Health 128 30,969
• Special Medical Institutions (MOH) 6
  4,770
• Non-MOH Government Hospitals 6 2,886
• Private Hospitals/Mat/Nursing Homes 233 11,637
• MOH Rural Clinics (Klinik Desa) 1,919
• MOH Maternal Child Health Clinics 88
• MOH Mobile Clinics 151

14
Financial Allocation 2006

• Total MOH Budget - RM 8,660,200,000
• Operating Budget - RM 7,369,430,000
• Development Budget - RM 1,296,770,000
• Per Capita Allocation - RM 327
• Per Capita GNI - RM 19,739
• of total MOH Allocation to - 6.33
• National Budget

15

• Introducing Malaysia
• Disease burden causes of mortality
• Healthcare standards, facilities, funding
• Major changes in healthcare
• Drug registration, timing, availability
  limitations
• Expectations healthcare community, population
  at large

16
Major changes in Healthcare last 5-10 yrs

• Advanced Healthcare system
• Gradual improvements from 1995 to 2003
• 1995 2003 (/1000
  livebirths)
• infant mortality rate 10.4 5.8
• perinatal mortality rate 9.8 6.3
• toddler mortality rate 0.8 0.5
• Maternal mortality ratio increased slightly from
  1995 to 2003, from 20 to 30 per 100 000 live
  births
• NHFS (National Healthcare Financing Scheme)

17

• Introducing Malaysia
• Disease burden causes of mortality
• Healthcare standards, facilities, funding
• Major changes in healthcare
• Drug registration, timing, availability
  limitations
• Expectations healthcare community, population
  at large

18
New drugs in Malaysia 2004-2008

• Registration process by the Malaysian DCA - has
  improved their approval timelines
• Extensive number of KOLs (from the Institutions,
  MOH) co-opted to assist in giving feedback for
  the various medicines / new modalities
• While awaiting official approval for use - DCA
  has also been very supportive in approving
  individual applications - with an efficient and
  rapid approval for specific drugs for use on
  Name-patient basis - if supported by the
  appropriate indications and documentation

19
Major changes in Healthcare last 5-10 yrs
Clinical Trials

• Malaysia Region Maturing, increasingly
  recognized as centres of excellence for Clinical
  Trials
• Phase 3 clinical trials
• Phase 2 and even 1 Phase 1
• KOLs - first-hand knowledge of drugs being
  developed - hands-on experience with the new
  molecules / therapeutic agents - starting from
  very early on in development of these drugs and
  up to registration
• Provides in-depth knowledge that can never be
  obtained from 2nd-hand or 3rd-hand information
  culled from journals / international meetings.

20
New drugs (Malaysia) 2006-7 vs Benchmark Approval
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Limitations

• Major limitations of obtaining appropriate
  therapies in a timely manner to those who require
  it - remain (sadly)
• Issue of funding / economic capabilities at an
  individual / personal level, societal /
  governmental level (responsibility?)
• Remains the main stumbling block to getting
  access to the newer (more expensive) treatments.

22

• Introducing Malaysia
• Disease burden causes of mortality
• Healthcare standards, facilities, funding
• Major changes in healthcare
• Drug registration, timing, availability
  limitations
• Expectations healthcare community, population
  at large

23
Expectations of healthcare community (1)
We need new drugs

• which demonstrate real innovation
• meet a previously unmet need
• better efficacy
• better safety
• easier compliance
• save on surgery/hospital stays
• with minimum of delay not years after other
  markets
• to be appropriately used and well-monitored so
  their value can be regularly assured

24
Expectations of healthcare community (2)
We need,

• appropriate information on new drugs at time of
  first availability
• the information to be kept up-to-date, in real
  time, especially new safety information
• help to ensure patients expectations can be
  managed (nothing is 100 risk-free)
• drugs with acceptable assured quality, from good
  quality sources and procedures for ensuring no
  break in supply
• to rid the market of counterfeits

25
FUTURE
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9th Malaysian Plan 2006-2010

• Ministry of Health Allocated 5.4 of budget
  (RM10.2 billion) RM3.3 billion - public health
  care,
• RM5.4 billion - patient care services
• - incl building new hospitals and renovation
• RM1.4 billion - other healthcare services, incl
  training of staff
• Broad plan Greater efforts in development - 10
  and 20 prevention improving efficiency of
  delivery. Shows greater sensitivity towards a
  more equal distribution of healthcare services -
  with aims to improve healthcare services delivery
  to rural areas
• Primary care, 10 and 20 prevention which often
  utilises out-patient services are less pronounced
  and less successful in terms of implementation -
  involving long term management dealing with
  numerous chronic medical conditions

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Summary of expectations

• New, innovative drugs
• Speedy availability
• Strong control processes
• Ready access to the latest information
• Responsible promotion