1. Introduction1.1. Background of Ministry of Health, MalaysiaThe Ministry of Health (MoH) Malaysia is one of the largest ministries in Malaysia. The history of MoH dated back to British colonial era.
The flourishing tin mining industry in Perak in late 1800s catalysed the expansion of public health care facilities in then Malaya. Across the South China Sea, the first hospital in Sarawak was founded in 1870 during the White Rajah era and health care facilities were built in North Borneo (now Sabah) by the North Borneo Company. Following the formation of the Federation of Malaysia in 1963, the Ministry of Health (Malaysia) were founded to oversee health care in the country. (Official Portal for Ministry of Health Malaysia, 2014)MoH structure is divided into 52 sub-entity which consists of 45 divisions/units, 7 programmes and 7 institutions. MoH employs more than 200,000 staff, second largest in public sector after Ministry of Education (MoE). Contrary to popular belief, MoH manages both the public and private health care matters in Malaysia. For public health care, MoH manages the facilities as well as policy governing its facilities. As of 2016, MoH has 144 hospitals and special medical institutions, 2869 health clinics, 1689 dental clinics, 586 dental mobile teams, 368 1Malaysia clinics and 24 1Malaysia dental clinics under its care.
(MoH, 2017) Collectively, these facilities recorded admissions and outpatients services to 95.26 million attendance in 2016. (MoH, 2017)1.
2. Problem backgroundDuring the tabling of 2018 Budget by Prime Minister, Dato’ Sri Mohd Najib in November 2017, RM26.58 billion or 9.5% of national expenditure. This shows a RM 1.
78 billion increase of allocation compared to 2017 allocation. Comparison of three-year budget allocation for MOH is shown in Figure 1. (MoH, 2016, 2017) Figure 1: Financial allocation for MoH (2016-2018)The ever-increasing budget allocated is attributed to the increasing attendance recorded by MoH health care facilities over the years. However, despite the increasing budget injected by the government for health care expenditure, MoH is continually receiving complaints from the public due to these reasons (Pelan Strategik KKM 2016-2020, 2016):• delays in service delivery or no action were taken after complaints were lodged• failure to comply with standard operating procedure (SOP)• civil servants misconduct • lack of public facilitiesThe comparison between allocated budget (in % of national budget) versus complaints received by MoH (in % over total complaints received by Public Complaints Bureau (PCB) in respective years) is shown in Figure 2. Data from MoH Health Facts and PCB statistics were presented in the figure. (‘Main MOH Publications’, 2017, ‘Statistik Mengikut Tahun’, 2017) Figure 2: Comparison of Financial Allocation to MoH (% of National Budget) against Number of Complaints Received by MoH (2012-2017) The government is working to transform the current healthcare systems.
Transformation in health systems is needed due to changing socio-demographic and disease pattern as well as higher quality expectation from the citizens. (Saleh, 2011) MoH is mulling to provide more autonomy to public hospitals. Autonomy in public hospitals management are found to improve performance of health services.
(Harding & Preker, 2000)1.3. Research questionsa. How ASEAN nations practices public hospital autonomy?b.
What were the outcomes of the policy towards public healthcare in their respective country?c. What were the threats and challenges faced by the institution in relation to their autonomous nature?1.4. Research objectivesa. To understand current practices of autonomy among public hospitals in selected ASEAN countries.
b. To recognise the outcomes of public hospital autonomy towards public healthcare in selected ASEAN countries. c. To identify the threats and challenges faced by autonomous public hospitals and to recognise whether similar threats and challenges are applicable for Malaysian setting. 1.5. Conceptual framework1.
6. Significance of the studyThe study will be an initial research of autonomous public hospitals in terms of its advantages, disadvantages and challenges faced by the institution. Since the idea is novel in Malaysia, the findings of the study will be helpful for the policy makers to outline the policy to implement the idea. 2.
Literature review2.1. Definition and the concept of public hospital autonomyAutonomy is defined as “the ability to act and make decisions without being controlled by anyone else” by the Oxford Dictionary.
Decentralisation of public organisations is not a recent idea, being mooted since 1960s to 1970s in Western Europe and eventually adapted by developing countries in 1980s. (Harding & Preker, 2000)