This chapter of the paper would explain on the introduction to this study and issues background. It would consist of problem statement, objectives, research questions, scope, significant of the study, limitations and some important terms that will be use in this research.
Healthcare system in Malaysia is one of the crucial sector focus by the government. The healthcare services can be divided into public and private sector. There are many efforts done by the government to increase country healthcare quality such as by including healthcare aspects in formulating 10th Malaysia plan strategies that are:
Strategy 1 : Establish a comprehensive healthcare system & recreational infrastructure
Strategy 2 : Encourage health awareness & healthy lifestyle activities.
Strategy 3 : Empower the community to plan or implement individual wellness programme (responsible for own health)
Strategy 4 : Transform the health sector to increase the efficiency and effectiveness of the delivery system to ensure universal access
It showed government really concern in improving and fulfilling people healthcare necessity. The public healthcare in Malaysia consist of government public hospital and clinics. public and private sector has spend billion of money in providing better healthcare and it will continuing increase align with the increase of Malaysia population. According to country health plan in 10th Malaysia plan for 2011-2015, population of Malaysia has increase till 28.3 million and 2.32 million of it was immigrant and foreign workers. Moreover, 24.4 % from the total immigrants residing in Sabah. It means the number population will keep increasing from year to year. The more higher population would need the more good healthcare providers.
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The public and health sector has invest lot of money in ensuring the current healthcare availability is enough in fulfilling people high demand. The table below shown total expenditure on health from 1997 to 2008. Therefore, in 23rd October 2009, prime minister YAB Dato Sri Najib Tun Razak established 1Malaysia clinics under 1Care programme of 1 Malaysia concept. According to the prime minister 1Malaysia concept is define as “â€¦provide a free and open forum to discuss the things that matter deeply to us as a Nation. It provides a chance to express and explore the many perspectives of our fellow citizens. What makes Malaysia unique is the diversity of our peoples. 1Malaysia’s goal is to preserve and enhance this unity in diversity which has always been our strength and remains our best hope for the future. I hope this Website will initiate an open and vital dialogue exploring our Malaysian identity, purpose, and direction. I encourage each of you to join me in defining our Malaysia and the role we must play in its future. Each of us despite our differences shares a desire for a better tomorrow. Each of us wants opportunity, respect, friendship, and understanding” (1Malaysia Booklet). The definition of 1Care Malaysia is national health restructuring system that provide more choice of quality health care, better healthcare coverage that require by the population based on solidarity and equity. This new system should improve old system by providing new effort in enhancing people healthcare quality (Maimunah binti A hamid, 2010).
1Malaysia clinics objective is to provide affordable and quality healthcare treatment to the local residents especially for middle and local income group. It manage by medical assistance and only applicable in handling minor treatment and limited medicine prescription. Currently, there are 100 clinics with additional RM 17.2 Million budget (Nes strait times, 2012). In sabah only there are 20 clinics and 2 (Sulaman sentral kota kinabalu and Bandar Leila, Sandakan) of it has been upgraded to Klinik Kesihatan. The upgraded of 1Malaysia clinic to become Klinik Kesihatan is because the positive response from loal residents and the clinic received more than 100 patients per day. The upgraded is hope to provide better services to the people with extra expertise (Utusan, 2012).
TOTAL EXPENDITURE ON HEALTH, 1997-2008
(RM, NORMINAL VALUE)
Expenditure on Health (RM million)
Expenditure on Health as % of GDP
Total GDP (nominal value) (RM million)
Source: Malaysia National Health Accounts 2007
Malaysia government has established lot of healthcare effort in order to increase public health quality for example 1Malaysia clinic and klinik kesihatan. These two clinic is related to each other and offer almost the same system of service delivery and purpose. This study conduct to identify the comparison between these two clinics based on certain aspects of effectiveness. There are a few issues arise related to these government healthcare program. The first issues is related to the reliability of 1Malaysia clinics services, the concern shows by president of the Malaysian medical association (MMA), Dr. David Quek. He said that the establishment of 1malaysia clinic provides low healthcare standard system because it operates by medical assistance and nurses only. He also reminded the ministry, the limitation of knowledge among medical assistance and nurses in giving medical advices and medicines would affect the healthcare services in Malaysia (the sun, 2010). It not aligns with the modernization of Malaysia and this kind of system similar with healthcare system during world war. He also showing concern related to 1malaysia legality, according to Medical Act 1971 its illegal for a medical assistance to manage a clinic (the star online, 2009). The provision referred by Dr David Quek is Medical Act 1971 Section 33. (1) (f), the section stated:
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“33(1) Any person not registered or exempted from registration under this Act who – (f) uses the term “clinic” or “dispensary” or “hospital” or the equivalent or any of there terms in any other language in the signboard over his place of practice in purported practice of medicine or surgery as a person registered under this Act; shall be guilty of an offence against this Act.”
It showed that there are some doubt by the public related to the 1Malaysia clinic effectiveness. The effectiveness of 1Malaysia clinics is a major corcern to the public because of the high cost of establishment. Government allocated RM 10 million for 50 clinics in 2010 and RM 7.2 Million in 2012 for adding 20 more clinics, it cost lot of country money allocation for established all clinics for the public (Bernama, 2012). The failure of this clinics can cause loss to the country with the high expenses given. After establishment of 1Malaysia clinic, government came with another idea for improving people healthcare quality especially for middle and low income group by upgrading the 1Malaysia clinic into klinik kesihatan. For those 1Malaysia clinic that exceed 100 patients per day, the clinic would be upgraded to klinik kesihatan and 1 doctor would be provided. Klinik kesihatan as a replacement of 1Malaysia clinics guesting to provide better service and medication compare to before the upgraded.
This study will focusing on comparing between 1Malaysia clinics and Klinik kesihatan in a few effectiveness aspects. It also hope to answer a few main questions related to the improvement of services between before and after upgraded. In Malaysia there is limited proper study done related to the evaluation of this healthcare program especially when it related to the 1Malaysia clinics. it also very difficult to find comparison study between government clinics for such as 1Malaysia clinic and klinik kesihatan.
By conducting this study, it may assist in evaluate whether this program that cost RM 10 Millions is resulting good result for the public. In addition, this study also may help in figuring out the relevant of 1Malaysia clinic implementation and service changes happened through the upgrading process.
To identify comparative analysis between 1 Malaysia clinic and Klinik Kesihatan in term of:
Comparative analysis between 1 Malaysia clinics with Klinik Kesihatan:
What is the people preference between 1 Malaysia clinic and Klinik Kesihatan? Why?
What are the rationale the establishment of the new healthcare program, 1Malaysia clinics compare to existed government health clinics?
What are the differences between these two clinics:
Which of the clinics provides better accessibility to the patients?
Which of these clinics better in term of availability?
Which of these clinics provides better health treatment to the patients?
Which of these clinics provides friendlier services to the patients?
Which of these clinics provides a better treatment environment?
Which of these clinics provide better waiting time?
Scope Of Study
This study will be conducted at Klinik kesihatan Sulaman sentral, kota kinabalu sabah. The respondents of this study consist of representative of health ministry, both clinics staffs and patients.
SIGNIFICANT OF STUDY
This study is significant as a feedback to the policy maker. The policy maker is refer to government especially ministry of health that responsible in formulating and implementing any healthcare programs. Result of this thesis can be use as one of the feedback especially to 1Malaysia clinics and Klinik Malaysia implementation. Not only that, policy makers also can beneficial from this study by referring to the findings and it can give them some ideas related to the current service quality provided and from the analysis also it can be use as one way to improvise the healthcare practices in the future.
The other beneficial gain from this study is as a contribution to the body of knowledge in this discipline. In Malaysia, there were very limited past research done related to government healthcare services especially comparative study between two government clinics. Most of the past study only focusing on on customer satisfaction and comparison between public and private clinics only. The study conducted can be as one of the reference and source to the future researchers because it rare to find any comparative study related to the two government healthcare services especially related to 1Malaysia clinics. It is because 1Malaysia clinics is still in progress and new programs that established by the prime minister under 1Malaysia concept in 2009.
Besides that, this comparative study between 1Malaysia clinic and Klinik kesihatan can be as one of the information sources for the public. It because public has lack of information related to these clinics and only a few people notice about the upgrading and changes happened. Through this study, it can provide some understanding to the public about the public clinic system and the reason of upgrading of 1Malaysia clinics. Finally, they can realize the government effort in providing better healthcare to the people especially for the middle and low income group.
The first limitation is difficulty in searching for past research. There lack of study done related to healthcare service in Malaysia especially in comparing between government healthcare services. It can be a challenges to the researcher in finding past research related to the 1Malaysia clinics and Klinik kesihatan because of it a new programs and no focus done related to this topics. Result from the difficulty, it hardly to find strong statement to support details in this research.
The second limitation is in analysis the information. This study is a qualitative research and the information gain from interviewing respondents from ministry of health, clinics staff and patients that experienced the services. It means the information gather from the interview, it can be a limitation to the study to observe the body language of interviewee carefully and at the same time make sure all the interview details taken taken into account.Furthermore, it also a challenge for analysis the information received and make ensure the result is based on the actual interviews. In order to overcome this limitation, the researchers has use another way of recording the conversation so at the interviews conducted all the attention can be given in asking, understanding and observing the respondents.
Limitation also exist in finding the right patient respondents, it because the respondents should be someone who has been received treatment from both 1Malaysia clinic and klinik kesihatan so the information given more reliable and convenient if the patients experiencing both clinics treatment. It would be time consuming for search the right respondents to be interview.
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