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Med J Malaysia 67:363-368.
Ministry of Health, Kangar Health Clinic, Jalan Kolam, Kangar, Perlis, Malaysia
Allocation of funding within the Ministry of Health of Malaysia has traditionally been dependent on previous utilisation with some consideration of population coverage through burden of workload. A more appropriate distribution would be based not only on the volume of patients, but also on the morbidity profiles of these populations through casemix.1 Johns Hopkins Adjusted Clinical Groups® System (ACG), developed by Johns Hopkins University was selected to study case-mix in the Malaysian primary care setting, in view of its wide use and its applicability within primary care.2
ACG is used to determine the morbidity profile of patient populations in order to assess provider performance fairly, to reimburse providers based on the health needs of their patients, and to allow for more equitable comparisons of utilisation or outcomes across two or more patient groups.3,4 Perlis is one of the states in Malaysia, located in the north of Peninsular Malaysia. It has a population of 240,000. Health care is provided by both public and private facilities. The public sector is delivered through the Ministry of Health’s facilities, comprising of a hospital, 9 primary care clinics with doctors and 29 community clinics without doctors. These are complemented by 34 private general practice clinics, the majority of them organised as solo practices.
As part of the Government’s initiative on telehealth, three public clinics in Perlis were equipped with Teleprimarycare® System (TPC), an electronic clinic management and clinical information system. TPC in Perlis was initiated in 2006 at Kangar Health Clinic (HC), the biggest clinic with the full complement of supporting services and located in the state’s capital city. This was followed by Beseri HC and Simpang Empat HC in 2008. The population coverage of these clinics was 54,248 for Kangar HC, 27,546 for Beseri HC and 27,714 for Simpang Empat HC. The availability of a rich electronic database, which was easily accessible from TPC, presented an opportunity to study the possibility of applying ACG for the development of a morbidity-based resource allocation for primary care providers in Malaysia.
The aim of this report is to describe the morbidity profiling of patients in three public primary care clinics in Perlis and its variation in morbidity patterns. This exercise also had the beneficial effect of determining the quality of TPC data pertaining to diagnostic coding.
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