Estimating and projecting direct healthcare cost and expenditure for non-communicable diseases (NCDs) in Malaysia
Background
The prevalence of lifestyle-related chronic diseases such as diabetes mellitus, obesity, cardiovascular disease and several forms of cancer has been on a continual upward trend in most developed nations as well as in developing nations in recent decades. NCDs and their related complications also pose a real and significant threat to Malaysia. This can be attributed to rapid changes in diets and lifestyles due to the inevitable forces of urbanization, industrialization, globalization, and ageing population. Facts and figures from our latest population-based health surveys, known as the National Health and Morbidity Survey (NHMS) in 2015, showed that the prevalence of NCD risk factors continues to rise. Malaysia now has an estimated 3.5 million (17.5%) adult Malaysians living with diabetes, 6.1 million (30.3%) with hypertension, 9.6 million (47.7%) with hypercholesterolemia and 3.3 million (17.7%) with obesity.
The increasing prevalence of NCDs causes higher demand for the use of health services, which results in the rising costs of treating NCD patients. With a view to reducing people suffering disabilities due to poorly controlled NCDs, more investment in health promotion and early detection is crucial. The Ministry of Health (MOH) Malaysia had already developed the National Strategic Plan for NCD (NSP-NCD) 2016-2025 and complementary national strategies to control risk factors associated with NCDs. However, the public healthcare system is constrained by insufficient fund allocation to address the increasing burden of NCDs and population ageing. In 2018, the total health expenditure was 60,147 million RM, which was only 4.2 percent of gross domestic product. Slightly more than half of the total health spending was financed through the Government while the rest was derived from private financing schemes, mostly from out-of-pocket spending from households. Due to the lack of linkage between expenses and beneficiaries, Malaysian national health accounts system is unable to capture health spending by disease categories.
The 12th Malaysia Plan, a sector-wide midterm national strategy for the years 2021-2025, is expected to give more emphasis on the importance of scaling up these efforts. In this regard, it is critical for the MOH to convene relevant ministries and stakeholders to strengthen multi-sectoral actions to address NCDs. To communicate with stakeholders with non-health background, translating the burden of NCDs into monetary value helps the MOH to convince the necessity of prioritizing and allocating more resources on NCDs. In 2019, the MOH and WHO Country Office in Malaysia implemented a project to estimate the economic costs attributed to the burden of NCDs in Malaysia. As a next step, the MOH hopes to estimate direct healthcare cost to control NCDs in accordance with the System of Health Accounts 2011 and project health expenditures attributed for NCDs, which take into account the uncertainties around epidemiological and demographic transition. At the end of the study, the MOH Malaysia will be able to assess total healthcare cost (both direct and indirect) for NCDs and anticipate the additional resources required to combat NCDs in Malaysia. It will also allow the MOH to compare the national health expenditure for NCDs with other counties in OECD or with similar income statuses. The results will be incorporated into the country’s policy and strategic paper and disseminated to relevant stakeholders to reinforce the whole Government’ commitment to tackle NCDs.
Purpose/Specific Objective of the Activity
a) To undertake an economic analysis to estimate direct healthcare costs (in both public and private providers) for the prevention, control and management of NCDs in accordance with the System of Health Accounts 2011.
b) To estimate and project Malaysia’s health expenditure attributed to NCDs by taking into account the future epidemiological and demographic transition.
Description of activities to be carried out
Production of the research paper with the estimation of health expenditure attributed for NCDs in Malaysia
Output/s
Output 1: To conduct a desk review on existing background documents related to health financing system, health accounts, health spending and the potential budgetary impact of NCDs in Malaysia.
• Deliverable 1.1: Produce a draft report on the desk review.
Output 2: Facilitate consultation with relevant stakeholders to examine the availability and limitation of existing data. This refers to meeting with relevant divisions/sections in the MOH or other ministries/departments/agencies being involved with data collection and analysis in Malaysia. Invitations may include Malaysia National Health Accounts Section, Health Informatics Centre, National Institute of Health.
• Deliverable 2.1: Produce a meeting report to summarize the discussion by using the WHO template.
Output 3: Based on the best available data, conduct an economic study to estimate:
- To undertake an economic analysis to estimate direct healthcare costs (in both public and private providers) for the prevention, control and management of NCDs in accordance with the System of Health Accounts 2011.
- To estimate and project Malaysia’s health expenditure attributed to NCDs by taking into account the future epidemiological and demographic transition.
• Deliverable 3.1: Produce a technical report including background information, methodology applied for the study, results of the analysis and limitations/discussion points of the results.
Method(s) to carry out the activity
The work with the MOH on estimating healthcare cost for NCDs in Malaysia requires:
- Preparatory work by emails, video conferencing, meetings and discussions
- Conduct virtual? workshops and facilitate discussions among government officials, academicians and other relevant stakeholders
- Develop guidelines, tools and training materials to be used offline/online
- Collect and analyze data to produce technical/research reports including policy implications and recommendations
Description of the tasks/process involved in carrying out the activity
Institution with demonstrated experience and capacity to conduct health financing analysis with staff that fulfil the below criteria.
Education
Essential: An advanced university degree (master level or above) in economics, health economics, public health or related field.
Desirable: PhD in economics, health economics or related field. Training in NCDs would be advantageous.
Experience
Essential: A minimum of ten years’ experience in economic research focusing on health, health systems and service research, and analysis of health accounts and health financing system.
Desirable: Research experience related to NCDs would be advantageous. Experience of analysing health accounts data would be an asset.
Skills
- • Possess relevant publication in health economics, health service and systems research, health financing and economic implications of NCDs
- • Possess skills in applying available econometric methods to meet the research objectives
- • Knowledge of the System of Health Accounts 2011
- • Basic knowledge of NCDs
- • Advanced skills in using statistical and econometric software
- • Expert reading and writing in English
Additional information
Able to complete the task within the given time frame.
Please submit following documents to the Supply Officer (WPRO) at <wproungm@who.int> by 30 June 2020
- • Expression of interest (cover letter) that includes proposed method of working, description of how to produce deliverables, consultancy fee (per day) and availability
- • WHO personal history form or CV
- • Please note that the application may be closed before the indicated closing date if a sufficient number of applications are received
- • Only the successful candidates will be contacted
Please use Tender Notice No. 108376 as subject to all submission.