KUALA LUMPUR, Oct 26 — A newly released white paper on cancer care in Malaysia calls for a replication of systemic Covid-19 data collection for cancer to coordinate a coherent response to reduce disease burden.
The “Cancer Care: Challenges, Gaps And Opportunities In Malaysia” White Paper, issued by the Galen Centre for Health and Social Policy, stated that data, including real-world evidence, should be used to monitor, measure, and evaluate progress towards achieving objectives set out under the National Strategic Plan for Cancer Control Programme (NSPCCP).
It added that reporting of new cancer cases should be made mandatory across all health care settings, including non-Ministry of Health (MOH) facilities, such as hospitals under the Ministry of Higher Education, Ministry of Defence, and private hospitals to increase representation of the cancer registry to track incidence and survival outcomes.
The Malaysian Health Data Warehouse’s (MHDW) resources should also be utilised for the analysis and application of cancer control data.
“Apart from the registration of cases and periodic updates to the National Cancer Registry, it is also vital to strengthen information systems to capture the patient journey throughout treatment and survivorship.
“As Malaysia is moving towards digitalisation of health care by using Electronic Medical Records (EMR) systems and to futureproof cancer care, main hospitals and health care facilities should be linked via a robust interoperability online platform. This will improve hospital coordination, personalised cancer treatments, and prescriptions leading to better patient outcomes,” the report said.
MOH currently presents data on Covid-19 cases, tests, deaths, hospitalisation, ventilation, intensive care unit (ICU) utilisation rates, positive rates, and vaccination in live graphics, broken down on the state level and by time period on the CovidNow website.
The site also features the vaccination status, gender, age group, and nationality of Covid-19 cases and fatalities. Separately, MOH releases raw data on the epidemic on GitHub.
The use of real-time data allows the government to decide instantly on policies to curb the spread of Covid-19 such as mass testing, tracing, lockdowns, border closures, ventilation, vaccination, and the procurement of new medicine.
Apart from data, the Galen Centre’s white paper also suggested the introduction of innovative cancer care financing in anticipation of cancer becoming the most expensive disease for the country’s health system, as cancer was given a lower budget priority during the Covid-19 health emergency.
“There is a need to transition from the annual budget-based financing framework to public financing or community-based health insurance (CBHI) schemes that enable prepayment and pooling of risks and costs.
“Health insurance schemes can be designed to cater to innovative therapies provided by MOH. They could be subsidised at different tiers to accommodate different household income levels. This would allow the government to have more funding flexibility for different population groups,” the Galen Centre said.
Based on the National Health and Morbidity Survey 2019, only 22 per cent of Malaysians are covered with at least one type of health insurance.
Out-of-pocket (OOP) spending on health over the past decade has increased and resulted in households facing financial catastrophe, the Galen Centre’s report read. More than 80 per cent of households utilised their current income as a source for payment for health services.
The World Health Organization (WHO) has previously recommended reducing the country’s OOP from 35 per cent to between 15 and 20 per cent.
The Galen Centre’s report further noted that new sources of financing should also be explored to increase the budget for cancer care, such as interim tax and non-tax mechanisms.
“One such mechanism involves earmarking at least 5 per cent of annual revenue from tobacco and alcohol excise duties (so-called ‘sin taxes’) for cancer treatment. The proposed quantum could potentially contribute an additional RM290 million annually to a cancer care budget that could be allocated to provide coverage of molecular diagnostics and innovative treatment, complementing the existing public funding for cancer.”
The white paper also recommended the establishment of a multi-sectoral central governance body for the implementation of the NSPCCP.
“It should be populated by representatives of health and non-health stakeholders, as well as representatives from the government, private sector, professional organisations, civil society organisations and patient groups.
“What would be critical for this central governance body is to have senior representation from the government such as the Deputy Minister of Health. This would empower the body, provide clear key performance indicators, and allow decisions made to be followed through with a high level of accountability,” the report stated.
This is akin to the Greater Klang Valley Special Task Force (GKVSTF) that was established in July under MOH to tackle the Covid-19 crisis that overwhelmed hospitals in the commercial region.
The task force was headed by Health deputy-general Dr Chong Chee Kheong, and was given the mandate to make swift decisions at ground level to alleviate stress on Klang Valley hospitals. This included the procurement of equipment and mobilisation of resources such as manpower, oxygen supply, and ICU beds.
The GKVSTF saw the inclusion of the private sector, university hospitals, civil societies, and individual experts under the same structure to deal with the Klang Valley’s health crisis.
“Strong government support within such a body would have the potential for stronger collaborations, and more opportunities for meaningful, quality public-private partnerships to improve patient care,” the Galen Centre’s white paper stated in relation to cancer care.