A conversation with To’ Puan Dr Safurah Jaafar, Panel Advisor to Aged Care Group and Head of Sub-Specialty for Family Health in the Academy of Medicine’s Public Health Medicine Chapter, discussing the definition of integrated care and how its gaining importance in the future delivery of continuum care.
Trends are the sort of thing that comes and goes. Yet, they typically capture the moment and represent the times we live in. As of late, integration is a hot topic and buzz word in health care. With an ageing population and a growing number of people living with chronic or complex health conditions, alongside changing health needs and increasing demands on the healthcare system, it comes as no surprise that integrated care is the future in the provision of care.
Achieving integrated care requires that those involved with planning, financing and providing services have a shared vision, employ a combination of processes and mechanisms, and ensure that the patient’s perspective remains a central organising principle throughout.
Based on her vast experience in Health Services Management and Primary Healthcare, we interviewed To’ Puan Dr Safurah Jaafar, the esteemed former director of the Ministry of Health’s (MOH) Family Health Development Division, to take a closer look at what exactly is integrated care, what makes it an important element for the delivery of care moving forward and where it stands today in Malaysia.
Integration in Care Defined
As a buzz word being thrown around, integrated care as a term has been used loosely on various occasions. So, what exactly is the concept of integrated care, apart from an intangible impression? Globally, the term refers to the systematic coordination of general and behavioural healthcare to produce the best outcomes when caring for people with multiple healthcare needs.
“Integrated care would mean medical and social care provided as real-time as possible to members or individuals of a population needing such services at point of care across physical, mental and social health needs rendered through an efficient and effective orchestrated approached by all care providers within a country” says To’ Puan Dr Safurah.
To put it in perspective, the elements of integrated care consist of four components of care:
|· promotive care||Refers to the process of enabling people to improve and increase control over their health. It moves beyond a focus on individual behaviour towards a wide range of social and environmental interventions.|
|· preventive care||Refers to the care you receive to prevent illnesses or diseases. It also includes counselling to prevent health problems.|
|· curative care||Refers to health care practices that treat patients with the intent of curing them, not just reducing their pain or stress.|
|· rehabilitative care||Refers to the restoration of patients to functional health and allow their return to useful and productive life|
Likewise, establishing these four components requires the involvement of four parties; namely the public, private, non-governmental organisations and the Malaysian population itself. Each party must be unanimous in sharing the objectives and values to achieve together positive ageing and ageing with adequate financial and social support, whilst the provision of friendly and warm services observes dignity and respectfulness.
Putting all of these components together will require the medical and non-medical sectors; from the medical fraternity to architects, engineers, interior decorators and chefs – to name a few examples – need to envision and fit into the big picture and play their roles effectively.
“There should not be differences, instead there should be synchronization between all these players” says To Puan Dr Safurah.
However, she also notes that the outcome of care in Malaysia will differ from our neighbours. As resources in middle-income countries differ from their rich-income counterparts, the outcome of integrated care cannot be compared apple to apple with mature countries – such as Japan, Australia and Germany – that have the opportunities of the lead time to improve their care framework.
Integrated Care in Malaysia
In terms of delivery of care, To Puan Dr’ Safurah stated Malaysia – despite being fairly young in the aged care industry and not having earned an ‘integrated care model for the aged’ yet – has begun taking steps towards developing its’ resources to address the growing need for integrated care.
“The Ministry of Health has begun increasing the training of geriatricians and gerontologists together with their allied healthcare providers, while the Ministry of Women and Community Development has provided various facilities, shelters and assistance to support the needing elderlies.”
She also stated that the Ministry of Local Government is currently reviewing various standards and policies in the logistics requirements of city planning. Meanwhile the Economic Planning Unit is forming various committees to develop options that would best optimise and harmonise various efforts within delivery of care, both presently and in the future.
On the other hand, thousands of care providers and facilities have mushroomed to accommodate the growing needs of the ageing population. A fact made evident in the growth of hundreds of private hospitals that are well governed by the prevailing Private Healthcare Facilities & Services Act and patronized by growing communities that can afford it.
However, the needs are ballooning to proportions that Malaysia’s current healthcare system – with its’ fragmented delivery of care and social services – will be unable to sustain.
It is projected that with the coming of the Private Aged Health Care Facilities Act, the standards of care can be gradually aligned to improve the standards of delivering care, management of nursing homes and ensure sustainable development to benefit the aged.
Financial Affordability is a Two-way Road
Another immediate challenge facing public and private hospitals in implement integrated care lies not only in the area of financial affordability of the aged population seeking care. The sustainability of the facilities to maintain and provide the appropriate care while having a sound financial balance is also of concern.
According to To’ Puan Dr Safurah, the Economic Planning Unit and the Ministry of Finance are aware of this concern and are looking into developing various policies and financial plans.
“These plans are crucial as it will have bearing on the incentive and dis-incentive system. This is critical as it will be the principal factor that accelerates the advancement of aged care in Malaysia.”
The structure of public and private hospitals in Malaysia raises unique challenges. On one hand, public hospitals are governed by the MOH, while on the other, the Association of Private Hospitals of Malaysia (APHM) represents private hospitals. Hence, collaborative efforts to deliver integrated care are thus hindered.
So how can public and private hospitals – with different challenges arising from different settings – overcome these challenges together?
“The public and private hospitals have their unique objectives and clientele. Each aspire to do their best for the aged population within the policies and resources they have assembled. What the can do is find common areas in which they can share resources such as human resource, professional expertise, equipment, beds or training. Many have already started sharing but can be further expanded.”
However, with each party having different models, To’ Puan Dr Safurah stated that seamless delivery of integrated care – the free flow of patients between private and public hospitals – may not develop the way we envisioned it unless the financial models are changed.
Currently many “green areas” exist in Malaysia’s delivery of integrated care, with many gaps to be filled in both medical and non-medical fields. Our infrastructure; from training, facilities, nutrition, food & beverage to our architectural, engineering, interior and technological designs, alongside communication and many other fields crucial to an aged care ecosystem – has yet to be fully developed and established.
However, while integrated care is a relatively new game to Malaysia, as a country ranked as the 6th best place to retire in 2017 by International Living – with our healthcare noted as excellent, we aren’t doing too shabby. We do have the foundation, resources and potential to evolve our healthcare system. It’s only a matter of time.
“Every seminar and meeting we attend, we will always find opportunities to work together to improve or offer more competitive ideas to enhance the development of care to provide the best care and survivability possible” said To’ Puan Dr Safurah.