Challenges of aged care in the Malaysian health care system For many people in Malaysia, the first point of contact in the public health care sector is the primary health care provider. The primary health care system, both public and private, focuses on the care of acute, episodic illnesses. This means that older patients only seek treatment when symptoms develop, while complex and multiple chronic conditions of older people are sidelined. Preventive and other specialised programmes for older people in the community have only been implemented sporadically. The main impediment remains the shortage of a trained primary care workforce, such as trained family medicine specialists and allied health personnel. There is an urgent need for multidisciplinary primary care teams to manage long-term care and treat complex health problems in the aged community. The main challenge for the provision of comprehensive, coordinated and continuous care for the aged with multiple chronic conditions and complex health care needs is a fragmented primary health care system. Malaysia does not as yet have a universal funding mechanism, which means that there is still inequitable access to health care for many segments of society. The public primary care sector is often over-burdened and highly subsidised, especially for vulnerable groups such as older patients. The costs of health care in the private sector for older patients with multiple and complex conditions are often prohibitive, and out-of-pocket payments can be debilitating. The current fee-for-service payment to private general practitioners by private health insurance companies and employers places limits on the type of health care services that are available. For segments of society such as the aged, who often require longer consultations and home visits, private health insurance schemes are virtually inaccessible. Often, comprehensive care packages such as these are not even covered by private health insurance. Conclusion In designing a more responsive health care system that takes into consideration the needs of the aged, useful lessons can be learned from the health care systems of other Commonwealth member countries. These include conducting annual health checks for older populations in primary care. There is also a need to set up community-based aged care assessment teams to assess the elderly C h a l l e n g e s o f a g e i n g a n d g o o d h e a l t h who may require special assistance, since many are homebound. Comprehensive service packages for preventive care, selfmanagement support, chronic disease care and rehabilitative care for older people should be developed under Malaysia’s proposed health care restructuring, funded by the national health financing scheme. As well as this, older patients and their families must also have access to adequate information and the skills to manage their health problems. Patient self-management has been shown to reduce severity of symptoms and is cost effective. Patients and families must therefore be empowered with skills to manage their health to enable them to work in partnership with their health care providers. There are also advances in information and communications technology, medical diagnostics and interventions that are promising. Devices that can be worn on the body to continuously monitor physical activity may assist in assessing the functional capacities of the aged, and older people can access IT applications that measure physical health indicators, such as blood pressure, ECG, urine sugar and so on, remotely. Data collection systems in most public hospitals in Malaysia are outdated and inefficient. Efficient clinical information systems that use electronic medical records would ensure long-term, coordinated care of older people in the community. In addition, integration of evidence-based guidelines into patient care will be fundamental to translating evidence into practice. There is also a need to develop a collaborative network with community resources. SHILA KAUR trained as a biochemist and public health specialist. She has worked with various local, regional and international CSOs such as the Consumers Association of Penang, Consumers International and the International Federation of Red Cross and Red Crescent Societies. She has worked as an Epidemiologist Analyst with the Department of Human and Health Services, County of Los Angeles, California. She lectured at the School of Pharmacy, Universiti Sains Malaysia while assuming full time co-ordinatorship of Health Action International’s Regional Office for Asia and the Pacific (HAIAP). She is currently a health consultant at the Third World Network Penang and continues co-ordinating HAIAP. Commonwealth Health Partnerships 2015 31
Commonwealth Health Partnerships 2015
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