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Received Mar 2; Accepted May This article has been cited by other articles in PMC. Abstract Since , there has been major reorganization of health care services in Malaysia. Health care system in Malaysia Human capital and health improvement programmes are of central importance towards sustainable development and economic growth in any country. Open in a separate window. Table 1 Health facilities of the Ministry of Health, Malaysia in , and Adapted from Merican and bin Yon 2 ;.
Table 2 Health care facilities in Malaysia Changes and challenges Equitable health care Equity is an assessment of fairness. Health care financing Health care financing is a key concern all over the world today. Champions Concluding remarks Multidisciplinary interventions are required to promote health financing, health care and disease prevention. Equity in health care financing: Int J Equity Health. Merican MI, bin Yon R. Health care reform and changes: Asia Pac J Public Health. Public health care provisions: Amar Current challenges in health and health care. Text speech by Minister of Health at: National Conference on Primary Health Care.
The private health sector and public policy objectives: Department of Health Selangor.
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Ministry of Health Malaysia. Report of the Director-General of Health Malaysia. Ministry of Health Malaysia; Malaysian health care system. Global Health Care Markets: Towards a comparative analysis of health systems reforms in the Asia-Pacific Region. Health system reforms — toward a framework for international comparisons.
Binns C, Boldy D. The burden of disease in the Asia-Pacific region — challenges to public health.
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Healthcare financing in Malaysia. A journal for public health issues in the Asia Pacific: Community-based health practices and their challenges in the future.enter
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The inverse care law. That study also has important implications for the size of the future physician resident workforce Physician Payment Review Commission, Table E-2 presents staffing data for each HMO plan. I also analyzed staffing for and and found that staffing patterns in each plan had been fairly stable over a 3-year period. Furthermore, approximately 12 to 15 percent of HMO 1 physicians are retained by contract. I assumed that these contract physicians were distributed among the practice categories in the same way as employed physicians, since actual counts of contract physicians by specialty were not available.
Adjustments for demographic differences between HMO 1's population and the entire U. As of January 1, , , U. HMO 2 uses a variety of other nonphysician health professionals and para-professionals, including psychologists, social workers, audiologists, occupational therapists, and optometrists. Also absent from most of this literature is any discussion of how to educate health professionals in team-building skills.
As Schneller and Ott observe, health professionals often have difficulty adapting to the team concept, and interprofessional conflicts are common. Although it is beyond the scope of this discussion, it should be noted that nonpayment incentives such as utilization review and selective contracting can also affect outcomes Robinson, The "force-field paradigm" developed by Henrik Blum of the University of California, Berkeley , influenced my thinking in this area.
Researchers also need to consider who reaps the benefits of productivity improvements in a health care system that is increasingly market-driven. This depends on the structure of market competition and the relative bargaining power of providers, payers, consumers, and other actors in the market.
For example, in markets characterized by a surplus of physicians and little or no competition among health plans, plans could realize substantial financial gains from physician productivity improvements but not feel compelled to share these gains with consumers. A current example of a health profession's controversy is the American Medical Association's recent proposal for direct physician supervision of NPs, similar to the traditional relationship of PAs to physicians Rodgers, Turn recording back on.
National Center for Biotechnology Information , U. E Life in the Kaleidoscope: The Impact of Managed Care on the U. Abstract Market forces are producing dramatic changes in health care financing and delivery mechanisms. Introduction In response to the projected excess supply of physician specialists, 1 the rapid growth of managed care, 2 and continued pressure to limit increases in health care costs, the organization of the U. Productivity And Quality Of PAs And NPs Given the economic incentives associated with capitation, health care delivery organizations should employ PAs and NPs to the extent that they improve the competitive position of the organizations: Productivity Simply put, productivity is output per unit of input.
Quality of Care and Patient Satisfaction PAs and NPs have demonstrated that they are able to deliver care in a manner acceptable to patients, and research shows that they deliver more preventive and educational services than physicians. The following appear to be reasonable conclusions regarding quality of care at this time: Nonphysician clinicians who have received training equivalent to that of physicians in a technical procedure can perform the procedure as well as physicians. Nonphysician clinicians can supply high-quality care for simple acute problems and chronic stable ones.
Studies are not adequate to determine whether these providers may occasionally miss a rare diagnosis and fail to seek consultation 12 , nor are they adequate to determine whether nonphysician clinicians can treat complicated cases as well as physicians can. There is no evidence to support the assertion that independent practice by nonphysician clinicians results in quality of care comparable to that of collaborative practice or that of physician-only care. Neither is there evidence against this assertion.
Studies have not been conducted, in part, because of the paucity of such independent practices Scheffler, Results Of Comparison Of HMOs This simple comparison of staffing patterns in two mature HMOs illustrates some important lessons and indicates the need for more research into the underlying causes of staffing variations in managed care organizations. Optimal Production of Health This model begins with three basic premises: Productivity Productivity studies in the BMC world focused primarily on opportunities for physician substitution: Legal Restrictions on NPs and PAs Legal restrictions may adversely affect the ability of NPs, PAs, and other nonphysician clinicians to practice at levels commensurate with their training and skills Sekscenski et al.
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Quality of Care As noted above, a significant body of research shows that the quality of care provided by NPs and PAs appears to be comparable to that provided by physicians in terms of clinical outcomes and is often superior in terms of patient satisfaction and process methods. In addition to problems with nonrandom assignment and the possible confounding effects of gender, the following methodological issues should be addressed by future research comparing the quality of care provided by physician and nonphysician clinicians: Adequate sample size of patients and clinicians, with use of power analysis to determine sample size and use of statistical significance testing.
Use of a representative sample of settings and clinicians, not just academic medical center-related sites and providers. Allowance for the time factor: Calculation of the percentage of a population of patients for whom nonphysician clinicians seek physician consultation over time, not simply the percentage of visits for which such consultation is requested. Conclusions As this paper has shown, the AMC world will demand much more cooperation between physicians and other health professionals, beginning with the teaching of team skills, as well as research into the new methods of professional collaboration.
Some of the more important topics for a new health workforce research agenda are identified below: What federal and state policies will promote an effective market response to the team provision of primary care? How will the team delivery of primary care affect funding for and training of health professionals?
How do micro workforce policies team composition and macro workforce policies training and funding interrelate? How will the composition of a team vary by patient demographics, culture, and case mix severity? What types of payment and incentive programs can be designed and tested to promote the team delivery of primary care? To what extent do federal and state laws and regulations impede the evolution of innovative health care teams?
What data and information should we collect and disseminate in order to monitor performance and to promote effective decisionmaking? Acknowledgments This paper was supported in part by the Bureau of Health Professions. The System of Professions: An Essay on the Division of Expert Labor. University of Chicago Press. Advanced Practice Nursing Education: Center for Health Services and Policy Research. Physician Characteristics and Distribution in the U.
Bureau of Health Professions, U. Department of Health and Human Services. Strategic Adaptation in the Health Professions. Nurse Practitioner 20 3: Nurse Practitioner 19 1: Nurse Practitioners and Certified Nurse-Midwives: Health Care Financing Review 11 3: PMC ] [ PubMed: Physician Assistants in the Health Workforce: HMO Practice 5 4: HMO Practice 8 4: Employee Benefit Plan Review 49 8: Archives Pediatric and Adolescent Medicine Physician Assistants in the Health Care Workforce.
Clawson, editor; and M. Nurses' Liability in Doctor-Nurse Relationships. Contemporary Nurse 2 1: Heart and Lung 12 3: Financing Health Care for the Poor. In Health Services Research: Key to Health Policy. Paying the Physician's Fee: Blue Shield and the Reasonable Charge. The New England Journal of Medicine The Health Care Economy in the U. Prospects for the Future. Performance Reports on Quality: Prototypes, Problems, and Prospects. The New England Journal of Medicine 1: Managed Care on the March: Will Physicians Meet the Challenge? Health Affairs 14 2: Annual Review of Public Health Health Manpower and Health Policy.
The Coming Physician Surplus: In Search of a Policy. Medical Care Research and Review 52 3: American Journal of Public Health 82 2: Journal of the American Academy of Nurse Practitioners 7 1: Health Resources Administration, U. Removing Practice Barriers of Nonphysician Providers: Association of Academic Health Centers. The InterStudy Competitive Edge 5. Definition of Primary Care: Donaldson, editor; , K. Yordy, editor; , and N. Physician Assistants and Health System Reform: Journal of the American Medical Association The Robert Wood Johnson Foundation.
Academic Medicine 67 7: Updated Projections for Selected Specialties. Its Manpower Forecasting Framework. American Journal of Public Health 71 Methodology and Findings on Productivity.
Medical Care 18 6: Nurse Practitioner 18 2: The Registered Nurse Population: Efficiency, Incentives and Reimbursement for Health Care. In Improving Health Policy and Management: Nine Critical Research Issues for the s. Shortell, editor; and U. Managing Physician Incentives in Managed Care: The Role of For-Profit Ownership.
Medical Care 28 The Nurse Practitioner 19 1: Physician Payment Review Commission. Reforming Graduate Medical Education Chapter 4. In Annual Report to Congress, Nonphysician Practitioners Chapter Provider-Driven Integration Chapter Delegation, Productivity, and Costs in Primary Care. Journal of Health, Politics, Policy and Law 5 3: Physician Productivity and the Demand for Health Manpower.
The Case of Physician Supply. Key Findings and Lessons Learned: National Committee for Quality Assurance. Nonphysician Providers and Limited License Practitioners: Scope of Practice Issues. Bulletin of the American College of Surgeons 79 2: Medicine, Money, and Morals: Physicians' Conflicts of Interest. A Death Knell for Private Practice?
Characteristics, Workload and Training Needs. British Journal of General Practice 44 Results from the Medical Outcomes Study. If you add this item to your wish list we will let you know when it becomes available. American health care has made great strides in the past hundred years.
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Life expectancy has increased dramatically and advances in medicine and treatments have eradicated many life-threatening diseases. However, in today's health care arena there is divergence between our health needs, the structure of our health care system, and how health care is delivered and funded. In "Forces of Change," David A. Shore has collected the leading thinking from experts in the field on how our health care system can benefit from important lessons from other industries and effect transformational change that truly serves all stakeholders well.
Glaser of Siemens Healthcare; Ashish K.
Related Forces of Change: New Strategies for the Evolving Health Care Marketplace (Jossey-Bass Public Health)
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