An insight into the top five trends redefining the way healthcare stakeholders look at long-term healthcare access sustainability
Southeast Asia’s healthcare landscape has evolved considerably over the last decade, led by shifts in disease patterns, population trends, and an improvement in universal healthcare plans as well as a rise in scientific breakthroughs. Yet, there are glaring gaps in terms of access.
In Malaysia, despite the country’s dual-tiered healthcare services system (comprising a government-led and funded public sector as well as a thriving private sector), more can be done to improve synergy between healthcare stakeholders and provide sustainable healthcare access to the population. The government spends nearly three to four per cent of GDP on national healthcare expenditure; however, this may not be enough as the stakes have been raised by the country’s economic and population growths, as well as the difficulties put forth by the ongoing COVID-19 pandemic.
To meet the ever escalating healthcare needs of Malaysians, public and private stakeholders must collaborate and address access as one of the key components to enhance the country’s healthcare landscape. The following five trends influencing healthcare access across greater Southeast Asia might be useful to consider:
Access is being reconceptualised from a short-term solution to a long-term strategy
Access to treatment used to be a short-term solution comprising reimbursement for patients paying out-of-pocket. Over 65 million people in the region have been pushed into poverty because of direct, out-of-pocket health expenditure and this was made worse by the pandemic – making long-term and sustainable access more crucial than ever.
Recognising that access is the continual enjoyment of healthcare services and products in expectation of the same in the future, there have been calls from Malaysian healthcare professionals and research organisations for the wider implementation and streamlining of the case-mix system, which classifies types of patients and treatments in public facilities in highly urbanised areas.
One such way is through payments which are pre-determined and synchronised with full paying patient (FPP) arrangements. FPP then serves as a “cross-subsidy” to cover any shortfalls in projections. This expansion would improve universal access and catalyse digitalisation of the healthcare system, further enhancing access. This builds on the Malaysian Health Ministry’s Strategic Framework of the Medical Programme and improves costs for inpatient as well as outpatient care in the public healthcare system.
There is also a role for the private sector to play. For instance, the Patient Financial Eligibility Tool (PFET) is a unique confidential assessment tool that Axios International has developed and we use it across all the Asian countries we operate in to assess the true financial capability of patients. Working with pharmaceutical companies and other healthcare stakeholders, we assess how much financial help patients require for their full treatments, and we offer cost-sharing programmes so that patients can have long-term access to healthcare solutions.
Access not only includes affordability, but long-term adherence
Access solutions have evolved from being unidimensional, focusing on affordability to multidimensional including treatment adherence support. Accessing treatment is only half the equation – health outcomes are 30 to 50 per cent affected by behaviour, so adherence is especially important.
The non-adherence rates in Malaysia are up to 56 per cent with studies showing communication as a major factor. It was found that pharmacists versed in pharmaceutical counselling skills or behavioural intervention and physicians skilled at communication were effective in increasing treatment adherence. Also, modified labelling for less literate Malaysians and text-messaging reminders to address unintentional medication non-adherence (forgetfulness or carelessness) made a difference as well. The latter could be automated as a sustainable solution; however, costs could be a deterrent for the public sphere, placing the onus on private stakeholders to fill the gap.
Each patient journey is unique and thus holistic Patient Support Programmes should aim to address patients’ real needs in a personalised way rather than through a ‘one-size-fits-all’ approach.
There is a growing focus on reaching patients outside the hospital
Malaysia’s public healthcare sector caters to about 65 per cent of the population but is served by just 45 per cent of all registered doctors, with even fewer specialists (25 to 30 per cent). Already facing capacity challenges, the sector is likely to be strained in providing further infrastructure or networks to communicate with patients.
Yet, the private sector is well-positioned to expedite this change, especially via digitalisation. Private sector stakeholders can collaborate with the wider healthcare ecosystem to offer products or services outside of hospitals or clinics that are facing increasing capacity burdens.
One way is by offering digital tools to complement Patient Support Programmes (PSP). An example is the tools our organisation developed to give patients greater agency in tracking and managing their treatment. They can also help facilitate and expedite the PSP referral process for physicians and the medication dispensing process for pharmacists.
Malaysia’s government is already prioritising the digitalisation of healthcare access. This includes the landmark launch of its Malaysian Health Data Warehouse (MyHDW), a national healthcare information gathering and reporting system that includes a patient treatment information system (SMRP) and patient registry information system (PRIS). MyHDW enables a person’s medical records to be shared among all public health institutions, thus simplifying the overall patient journey. More recently, the government introduced the MySejahtera app to assist in COVID-19 monitoring nationwide. Its key features include COVID-19 health guidelines, information on the nearest health facilities, a COVID-19 hotspot tracker as well as a vaccine registration portal.
While digital solutions are certainly helping Malaysia’s healthcare stakeholders to streamline operations and optimise resources, they wouldn’t work as efficiently, or as effectively, if they were a standalone solution. Human intervention is highly crucial – it helps maximise health outcomes by proactively triggering a response based on the data entered. And therefore, there’s a need to lay equal emphasis on technological interventions as well as the human factor behind it.
Companies are exploring new ways to engage with governments on access
The role of the private sector in improving healthcare access is more vital than ever. However, sustainability cannot be achieved without governments.
To bridge this gap, access stakeholders must not only engage, but also work closely with governments on collaborative solutions. The DoctorOnCall programme and existing cost-sharing programmes that allow for co-funding between the government and pharmaceutical companies are an example of the Malaysian government’s willingness to collaborate and innovatively explore ways of improving access. Private stakeholders must consider these initiatives seriously and participate in them to make a real difference in improving healthcare access.
More relevant data is needed to inform access decision-making
Even before the pandemic, technology was facilitating the evolution of societies, industries and governments, so the healthcare sector must do more to adapt to the rapidly changing environment. One way the ecosystem can do this is by leveraging more data to improve decision-making processes.
As broader access becomes more integral across therapeutic areas, the need for systematic, robust data informing access decisions has increased. This can be different from the data collected via clinical trials or post-marketing studies providing breakthrough insights on areas like disease evolution, treatment, patients’ perceptions, outcomes and cost.
For this reason, there is a need to capture access-related real-world insights to gauge the impact of access interventions and their effectiveness. Our organisation uses this data to understand how to ensure optimum treatment access, affordability, and adherence amongst patients and how PSPs should be designed in the first place to support patients comprehensively.
Access is no longer “a good to have”
Today, access to healthcare solutions is being increasingly integrated with the business models of private sector stakeholders. The key difference as compared to previous efforts is that there is a more concerted effort to develop sustainable models, rather than short-term solutions. There is the recognition that true sustainability only happens via a multi-sectoral, multi-dimensional response.
In a fast-developing country such as Malaysia, the healthcare system is no longer able to quickly adapt to the evolving needs of patients. Unless the access gaps are addressed, healthcare for patients will gradually become less effective with sub-optimal outcomes and more seriously, will impact the country’s ability to respond to future public health challenges.
The onus is hence on Malaysia’s access specialists and stakeholders, in addition to civil society groups, to instil real, long-term change. Each has its part to play in collaborating with the government to close access gaps, but effectiveness rests on them working in concert with each other.
Roshel Jayasundera is Director, Global Consulting, at Axios International.