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. •
•