THE ENC RESPONSE RATE

34 National Medical Care Statistics 2014

CHAPTER 4: THE PRACTICES

This chapter reports the characteristics of public and private primary care clinics. The data was obtained through the healthcare provider profile form Appendix 2, which was completed by the healthcare providers during data collection. Information captured included the practice characteristics and the sociodemographic characteristics of the healthcare providers, the latter of which will be reported in the next chapter.

4.1 PRIMARY CARE CLINICS IN MALAYSIA

Primary care services in Malaysia exist in two parallel systems — a heavily subsidised public sector and a private sector largely funded by out-of-pocket payments. According to data from the Ministry of Health Malaysia, there were 911 public clinics and 5,646 private clinics in Malaysia in 2012 see Chapter 2, corresponding to a public-to-private ratio of 1:6. With a population of about 29.2 million, the density of primary care clinics in Malaysia was 2.2 clinics per 10,000 population in 2012 Figure 4.1.1, with the highest density recorded in WP Kuala Lumpur 4.1 clinics per 10,000 population. Majority of the more urbanised West Coast states Selangor, Pulau Pinang, Negeri Sembilan, Melaka, Perak and Johor had a density of 2.3–2.8 clinics per 10,000 population. In comparison, Singapore reported a density of 2.8 general practitioner practices per 10,000 population in 2013, 1,2 whereas Australia had 3.3 general practitioner practices per 10,000 population in 2011. 3,4 Figure 4.1.1: Number primary care clinics per 10,000 population in 2012

2.2 4.1

2

2.7 2.6

2.6 2.5

2.3 1 1 1 1

1.7 1.6

1.6 1.1

1.1 1 2 3 4 5 Malaysia WP Kuala Lumpur Selangor Pulau Pinang Negeri Sembilan Melaka Perak Johor Pahang Kedah Terengganu WP Putrajaya Sarawak Perlis Kelantan Sabah WP Labuan N + • • • • 35 Chapter 4 : The Practices In the NMCS 2014 survey, a total of 129 public clinics out of 139 sampled 92.8 and 409 private clinics out of 1,002 sampled 40.8 responded to the healthcare provider profile questionnaire. These clinics were nationally representative by sector with regard to facilities, services and workforce, and survey data were weighted to produce unbiased national estimates.

4.2 ATTENDANCES

Private clinics outnumber public clinics in quantity nationwide. However, data from NMCS 2014 show that more patients were seen in the public clinics, which reported a median attendance rate of 111.5 presentations per day IQR: 71.9–264.3, compared to 33.0 per day IQR: 25.0–50.0 in private clinics. These findings extend our previous results from 2012, which showed similar patterns of primary care attendances in all five states studied. 5

4.3 OPERATING DAYS AND HO

U - . Public clinics Table 4.3.1 shows the operating days and hours of public clinics in 2014. • As with other government establishments in Malaysia, a large majority 82.8 of public clinics operated five days in a week Monday to Friday. • About one-eighth 12.6 of the public clinics reported operating seven days per week, while the remaining 4.7 had a six-day-per-week operation. • Slightly more than half 52.1 of the public clinics operated during the standard office hours between 8.00 a.m. to 5.00 p.m. only. • The remaining 47.9 of public clinics also provided after-hours services in addition to the standard-hour operation. On-call services at least one healthcare provider could be called to help in cases of emergency were provided in 39.6 of clinics, while extended-hours services regular clinic operation beyond the standard office hours were available in 8.5 of the clinics. Table 4.3.1: Operating days and hours public clinics in 2014 Clinic operation 3 nweighted count n 4 56 7 9 Weighted count n 4 : :; 9 Percent = clinics 95 CI n 4 : : ;9 Operating days 5 daysweek 110 550 82.8 75.4–90.2 6 daysweek 8 31 4.7 1.1–8.2 7 daysweek 11 83 12.6 5.8–19.3 Operating hours Office hours 77 346 52.1 42.5–61.7 Office hours on call services 37 262 39.4 30.3–48.5 Office hours extended hours 14 55 8.3 3.5–13.1 Office hours extended hours on call services 1 1 0.2 0.0–0.4 36 National Medical Care Statistics 2014 Private clinics The operating days and hours of private clinics are shown in Table 4.3.2. Note that private clinics which operated less than five days in a week were excluded from NMCS 2014. As a result, the operating days and hours of these clinics were not captured by the survey. • More than half 54.0 of the clinics in the private sector operated six days per week. • Clinics which operated Monday through Sunday represented 40.2 of all private clinics, while only 5.8 of the private clinics operated five days in a week. • Only 5.0 of the clinics in the private sector provided 24-hour services. Table 4.3.2: Operating days and hours A B private clinics in 2014 Clinic operation C nweighted count n D EF G H Weighted count n D E I JKF H Percent L M clinics 95 P CI n D EI JK F H Operating days 5 daysweek 24 280 5.8 3.6–8.0 6 daysweek 222 2,597 54.0 49.3–58.7 7 daysweek 163 1,933 40.2 35.5–44.9 Operating hours 24 hoursday 390 4,570 95.0 92.9–97.1 24 hoursday 19 240 5.0 2.9–7.1

4.4 TYPE OF PRACTICE

• All public clinics were collaborative practices staffed with multiple healthcare providers who worked under salaried employment with the government. • About a quarter 24.7 of the private clinics operated as group practices, while the remaining were solo practices Table 4.4.1. A similar figure has been reported in our previous report. 5 Table 4.4.1: Typ e A B practic e B or private clinics in 2014 Typ Q L M practice C nweighted count n D E F G H Weighted count n D E I JKF H Percent L M clinics 95 P CI n D 4, J K F H Group 98 1,188 24.7 20.6–28.8 Individual 311 3,622 75.3 71.2–79.4

4.5 PROVIDER WORKLOAD

• Overall, the median number of patients seen per full-time-equivalent FTE doctor in the private sector was 25.9 IQR: 17.1–40.0 patients per day. • The public clinic attendances were recorded at the clinic level and could not be disaggregated by healthcare providers. Hence, the patient volume per FTE doctor could not be calculated for the public clinics. • •