Reports | Clinical Research Centre

NATIONAL MEDICAL CARE STATISTICS 2010

EDITED BY : LIM

KK, SIVASAMPU S, GOH PP, HISHAM AN

MINISTRY OF HEALTH MALAYSIA

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NATIONAL MEDICAL CARE STATISTICS 2010

National Medical Care Statistics 2010
October 2012
© Ministry of Health Malaysia

Published by:
The National Healthcare Statistics Initiative (NHSI)
Clinical Research Centre,
Ministry of Health
3rd Floor, MMA House

124, Jalan Pahang
53000 Kuala Lumpur
Malaysia
Tel.
Fax
e-mail
Website

:
:
:
:

(603) 40439300 / 400
(603) 40439500
hsu@crc.gov.my
http://www.crc.gov.my/nhsi

This report is copyrighted. Reproduction and dissemination of this report in part or in whole for research, educational or other non-commercial
purposes are authorised without any prior written permission from the copyright holders provided the source is fully acknowledged. Suggested

citation is Clinical Research Centre. National Medical Care Statistics 2010. Kuala Lumpur 2012.

Funding:
The National Healthcare Statistics Initiative is funded by a grant from the Ministry of Health Malaysia (MRG Grant No. NMRR-09-842-4718)

ISSN 2289-1811

9

7722 89

1810 08

Please note that there is the potential for minor corrections of data in this report. Please check the online version at
www.crc.gov.my for any amendments

NATIONAL MEDICAL CARE STATISTICS 2010

PREFACE
With over 800 Klinik Kesihatan (public health clinics) and 5,000 private primary care clinics in Malaysia, primary care serves as the first point

of contact for many of the health needs of Malaysia’s estimated 28 million population. Despite its importance in community healthcare, there
has been little information available on the primary care setting. This vacuum poses a great challenge to the coordination of health services,
collaboration between public and private sector, policy planning and implementation.
It is only with the successful launch of the National Healthcare Establishment and Workforce Survey (NHEWS) Primary Care report in 2009,
that we now have some credible demographic data of primary care facilities available in the country. Two reports (Year 2009 and 2010)
derived from the annual survey have also been published. The next step forward would be to look at the data on disease burden and treatment
modalities used in the primary care setting. It is with this objective that the National Medical Care Survey (NMCS) was carried out to fill the
information gap as it explores the morbidity pattern and treatment being given in the primary care setting.
Thus, I am convinced that this maiden report will be a very useful reference for many stakeholders of the healthcare sector, including
the general public, practitioners, policy makers as well as the industry. In addition, I hope that this report will create more awareness on
the importance of primary care in safeguarding the health of the population and that this would later translate into more support for the
development of primary care in Malaysia.
Last but not least, it is my pleasure to convey my appreciation to all the participants of the survey and the staff from Healthcare Statistics Unit,
Clinical Research Centre who have contributed towards the successful completion of the first National Medical Care Statistics (NMCS) 2010.
I sincerely hope that the primary care practitioners, particularly those from the private sector, would continue to render us your support in the
coming NMCS survey.
Thank you.

…………………………………
Dato’ Sri Dr. Hasan Abdul Rahman

Director General of Health, Malaysia

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NATIONAL MEDICAL CARE STATISTICS 2010

CONTENTS
PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i
TABLE OF CONTENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ii
LIST OF TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii
ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
NATIONAL MEDICAL CARE SURVEY 2010 PROJECT TEAM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
ABBREVIATIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
CHAPTER 1
1.1
1.2
1.3

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INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
About National Healthcare Statistics Initiative (NHSI) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
About National Medical Care Survey (NMCS) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
General Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Specific Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1
2
2
2
2
2

CHAPTER 2
2.1
2.2

2.3
2.4
2.5
2.6
2.7
2.8
2.9

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METHODOLOGY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Survey Tool . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Sampling Frame & Recruitment Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Study Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Data Collection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Data Entry & Data Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Identification of Private Primary Care Clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Data Coding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Data Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Limitations of the Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3
3
3
5
5
5
5
6
6
6

CHAPTER 3 : THE RESPONSE RATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
CHAPTER 4 : THE ENCOUNTERS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
CHAPTER 5 : THE REASONS FOR ENCOUNTER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
CHAPTER 6 : MANAGEMENT OF MORBIDITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6.1
: Prescribed Medication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
ATC Classification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Types of Drugs Prescribed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
6.2
: Continuity of Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
APPENDIX 1 : PARTICIPANTS OF NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Public/Ministry of Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Private . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
APPENDIX 2 : NMCS 2010 SURVEY FORM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

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NATIONAL MEDICAL CARE STATISTICS 2010

LIST OF TABLES
Table 1.1

: Healthcare surveys under the NHSI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Table 3.1

: Number of respondent public and private clinics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Table 4.1

: Characteristic of encounters by age group in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Table 4.2

: Characteristic of encounters by sector, sex, nationality and ethnicity in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Table 4.3

: Characteristic of encounters by source of payment in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Table 5.1

: Number of patients’ reasons for encounter in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Table 5.2

: Reasons for encounter by ICPC-2 chapter in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Table 5.3

: Top 50 reasons for encounter in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Table 6.1

: Distribution of prescribed medications by ATC level 1 in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Table 6.2

: Distribution of prescribed medications by ATC level 2 in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Table 6.3

: Top 100 most prescribed medications in NMCS 2010, in descending order . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22

Table 6.4

: Follow up proposed by primary care practitioners in NMCS 2010 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

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NATIONAL MEDICAL CARE STATISTICS 2010

ACKNOWLEDGEMENTS
The National Healthcare Statistics Initiative team would like to thank the Director General of Health Malaysia for his continuous support towards
this survey and for permission to publish this report.
Also, our sincere appreciation to the following for their participation, assistance, support and contribution:
•฀ Deputy Director General of Health (Research and Technical Support), Ministry of Health (MOH)
•฀ Deputy Director General of Health (Medical), MOH
•฀ Deputy Director General of Health (Public Health), MOH
•฀ Director, Planning and Development Division, MOH
•฀ Director, Family Health Development Division, MOH
•฀ Director, Medical Practice Division, MOH
•฀ Director, Clinical Research Centre, National Institutes of Health, MOH
•฀ Director, Health Informatics Centre, MOH
•฀ State level Private Medical Practice Control Unit (Unit Kawalan Amalan Perubatan Swasta or UKAPS)
•฀ All participating public and private clinics and other institutions that provided data to the National Medical Care Survey (NMCS)
•฀ Malaysian Medical Council, Malaysian Medical Association, Family Medicine Specialists Association of Malaysia, National Specialist Register,
Academy of Medicine Malaysia
•฀ All who have supported or contributed to the success of the NMCS and this report

Thank you.

National Healthcare Statistics Initiative (NHSI)
Ministry of Health Malaysia

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NATIONAL MEDICAL CARE STATISTICS 2010

NATIONAL MEDICAL CARE SURVEY 2010 PROJECT TEAM

PRINCIPAL INVESTIGATOR

PRINCIPAL CO-INVESTIGATORS

CO-INVESTIGATORS

PROJECT LIAISON OFFICERS

PROJECT MANAGERS

SURVEY COORDINATOR

RESEARCH OFFICERS

DATA ANALYSTS

DATABASE DEVELOPER / ADMINISTRATOR

DATUK DR NOOR HISHAM ABDULLAH

DR. SHEAMINI SIVASAMPU
DR. GOH PIK PIN

DR. NOORAINI BABA
DR. MD KHADZIR SHEIKH AHMAD

DR AFIDAH ALI
DR. ZAKIAH MOHD SAID

DR. NADIA FAREEDA GOWDH (JULY 2009 – JANUARY 2011)
DR. SHARON CHONG (JANUARY 2011 – AUGUST 2011)
MR. LIM KA KEAT (SEPTEMBER 2011 – SEPTEMBER 2012)

LEON HO LIP MAN

MR. SHANTHA KUMAR CHANDRASEKARAN
MR. POOVANESVA RAO YANG KETTER RAHMAN

MR. LIM KA KEAT
MR. SHANTHA KUMAR CHANDRASEKARAN
MS. NORAZIDA BT AB RAHMAN

ALTUS SOLUTIONS SDN. BHD.

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NATIONAL MEDICAL CARE STATISTICS 2010

ABBREVIATIONS
ATC

WHO Anatomical Therapeutic Chemical Classification system

CRC

Clinical Research Centre

CKAPS

Cawangan Kawalan Amalan Perubatan Swasta

DG

Director General of Health, Ministry of Health, Malaysia

FMS

Family Medicine Specialist

GP

General practice or practitioner

ICPC

International Classification of Primary Care

KK

Klinik Kesihatan

MOH

Ministry of Health, Malaysia

MREC

Medical Research and Ethics Committee, Ministry of Health Malaysia

NHEWS

National Healthcare Establishment & Workforce Survey (Primary Care)

NHSI

National Healthcare Statistics Initiative

NIH

National Institutes of Health

NMUS

National Medicine Use Survey

WONCA

World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians

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NATIONAL MEDICAL CARE STATISTICS 2010

CHAPTER 1

| INTRODUCTION

1.1 ABOUT NATIONAL HEALTHCARE STATISTICS INITIATIVE (NHSI)
The National Healthcare Statistics Initiative (NHSI) is a family of surveys which were conducted with the aim to support evidence-based health
policy making and research in Malaysia. Owing to the support of various stakeholders and recognition of the usefulness of data in bridging the gap
between research and policy, the NHSI has grown in credibility and gained greater participation over the past 4 years. Annual reports are being
published for most of the surveys under the NHSI project based on the respective findings. The NHSI family of healthcare surveys, existing data
sources and survey design are summarised below.

1.

NHSI SURVEYS
(a) NHEWS Hospital

(b) NHEWS Primary Care

2.

NMUS

DESCRIPTION OF SURVEYS

COMPLEMENT DATA SOURCES

National Healthcare Establishments and Workforce
Survey for hospitals

Healthcare facility administrative and registration
database

•฀

Captures data on healthcare services provision,
facilities available and workforce (doctors and
allied health professionals) within hospitals;

Health professional registers

•฀

Includes both public and private hospitals in the
country.

National Healthcare Establishments and Workforce
Survey for primary care clinics

Healthcare facility administrative and registration
database

•฀

Captures data on healthcare services provision,
facilities available and workforce (doctors and
allied health professionals) within clinics;

Health professional registers

•฀

Includes both public and private primary care
clinics in the country.

National Medicine Use Survey
•฀

3.

NMDS

National Medical Device Survey
•฀

•฀

4.

NMCS

Captures data on drug utilisation pattern from
hospitals (procurement records), primary care
clinics (prescription records) and pharmacies
(dispensing records).

Captures data on available medical technology
among registered healthcare establishments in
the country
Used to be a standalone survey. Now incorporated
within the National Healthcare Establishment &
Workforce Survey.

National Medical Care Survey
•฀

•฀

Captures data on morbidity pattern seen in
primary care setting and the process of care
being provided.
The prescription data contributes to the NMUS
survey
1

Healthcare facility administrative records
(procurement, dispensing, etc.)
Pharmaceutical manufacturers’ or distributors’
drugs sales records

Healthcare facility administrative records (asset
inventory, purchasing, etc.)
Medical device manufacturers’ or distributors’
sales records
Radiation device registration data

Routine health service statistics from Health
Informatics Centre MOH, Department of Statistics
and various patient registers
Population mortality data from Department of
Statistics.

1 Introduction

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NATIONAL MEDICAL CARE STATISTICS 2010

1.2 ABOUT NATIONAL MEDICAL CARE SURVEY (NMCS)
According to the American Association of Family Physicians1, primary care is defined as the care provided by physicians specifically trained for and
skilled in comprehensive first contact and continuing care for patients irrespective of the problem origin (biological, behavioral or social) and
diagnosis. In short, primary care is the front line of a healthcare system, making healthcare services accessible to general public.
Malaysia has more than 800 government primary care clinics (termed “Klinik Kesihatan”, the vernacular for Health Clinic) and 5,000 private
primary care clinics (commonly known as GP clinics) nationwide. Yet, little is known about the structure of the primary care setting, the morbidity
pattern seen by primary care practitioners and the process of care being provided. Such information is crucial for the planning and development
of the primary care sector in view of the increasing prevalence of non-communicable diseases.
Therefore, to provide a clearer picture of the primary care system in the country the National Medical Care Survey (NMCS) with a focus on
processes and delivery of care was launched in 2010 to complement the National Healthcare Establishments and Workforce Survey (NHEWS)
Primary Care that focussed on the structure (establishment and workforce) of primary care.

1.3 OBJECTIVES
General Objectives
The NMCS 2010 aimed:
1.

To collect reliable and valid data on the Malaysian (public and private) primary care setting

2.

To assess patient characteristics and morbidity patterns in health service activities

3.

To provide accurate and timely data on Malaysian primary care setting to various stakeholders including government bodies, primary care
practitioners, consumers, researchers and the pharmaceutical industry; and

4.

To establish a database of doctor/patient encounters in Malaysian primary care setting

Specific Objectives
The NMCS 2010 specifically collected information on clinical activities in the Malaysian primary care setting, including:
•฀

The characteristics of patients

•฀

Reasons for encounter and additional information such as:
-

Pharmacological treatment prescribed, including the dose and frequency

-

Follow ups in primary care and referrals to secondary or tertiary care

Reference
1.

American Association of Family Physicians (AAFP). Primary Care. http://www.aafp.org/online/en/home/policy/policies/p/primarycare.html#Parsys0001
Accessed June 2012. Last update 2012.

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NATIONAL MEDICAL CARE STATISTICS 2010

CHAPTER 2

| METHODOLOGY

2.1 SURVEY TOOL
A standard questionnaire specifically designed for the survey (Appendix 2) was used. The survey form was self-administered by the participating
doctors. Variables studied were as follows:
CATEGORIES OF VARIABLES

VARIABLES CAPTURED IN SURVEY

Patient Demography

Age, gender, ethnicity, nationality

Major reason(s) for visit/Diagnosis

Acute, chronic illnesses, preventive care

Source of payment

Out-of-pocket, private insurance, Ministry of Health subsidy, private managed care organisations

Drugs prescribed

Name, strength, dosage, route, frequency, duration

Visit disposition

No follow-up planned, return at specified time, referral

2.2 SAMPLING FRAME & RECRUITMENT STRATEGY
Based on responses from private doctors for the prescription survey in previous National Medicine Use Survey (NMUS)1, the total number of
patients seen per day by a general practitioner was estimated to be 30, with an average of 3 drugs per patient. The prescription survey under
the NMUS was a 7-day survey. In contrast, the NMCS strategy was to shorten data collection to 1 day per clinic and to recruit a higher number of
clinics. This approach was taken in order to reduce workload in clinics and to increase the response rate.
For administrative convenience, the clinics were grouped according to sectors, with each group being approached and briefed separately.

Private Primary Care Clinics
All private medical clinics registered with the Private Medical Practice Division of the Ministry of Health Malaysia (often referred to as the Cawangan
Kawalan Amalan Perubatan Swasta [CKAPS]) were eligible to be included in the sampling frame of the survey. This sampling frame included both
two. Briefings were organised at state-level for the convenience of clinics located in each state. Clinics that were represented during the National
Healthcare Statistics Initiative study briefing were also recruited. Participating clinics were given survey dates and forms. Below is the list of briefing
dates for private primary care clinics in all states.

3

2 Methodology

private primary care clinics as well as private specialist clinics because the registration with Ministry of Health did not differentiate between the

NATIONAL MEDICAL CARE STATISTICS 2010

NO

DATE

LOCATION

TARGETED PARTICIPATION

1

5 October 2009

Sungai Buloh, Selangor

Clinics from Selangor

2

6 October 2009

Sungai Buloh, Selangor

Clinics from WP Kuala Lumpur

3

7 October 2009

Serdang, Selangor

Clinics from Selangor

4

9 October 2009

Kuala Terengganu

Clinics from Terengganu

5

11 October 2009

Kuantan, Pahang

Clinics from Pahang

6

11 October 2009

Johor Bharu, Johor

Clinics from Johor

7

20 October 2009

Georgetown, Pulau Pinang

Clinics from Pulau Pinang

8

24 October 2009

Alor Setar, Kedah

Clinics from Kedah & Perlis

9

25 October 2009

Ipoh, Perak

Clinics from Perak

10

30 October 2009

Kota Bharu. Kelantan

Clinics from Kelantan

11

31 October 2009

Kota Kinabalu, Sabah

Clinics from Sabah

12

31 October 2009

Kuching, Sarawak

Clinics from Sarawak

13

1 November 2009

Kuching, Sarawak

Clinics from Sarawak

14

8 November 2009

Georgetown, Pulau Pinang

Clinics from Pulau Pinang

15

14 November 2009

Melaka

Clinics from Melaka

16

21 November 2009

Seremban, Negeri Sembilan

Clinics from Negeri Sembilan

17

22 November 2009

Ipoh, Perak

Clinics from Perak

Public Primary Care Clinics
The full list of 808 Klinik Kesihatans (KKs) was obtained from the Family Health Development Division and out of this, 150 KKs were selected
through stratified sampling to ensure representation of each state. These 150 clinics were notified and provided the relevant documents. Below is
the list of briefing dates for public primary care clinics in all states.
NO

DATE

LOCATION

TARGETED PARTICIPATION

1

25 January 2010

Ipoh, Perak

KKs in Perak

2

3 February 2010

Alor Setar, Kedah

KKs in Kedah and Perlis

3

4 February 2010

Kota Bharu, Kelantan

KKs in Kelantan

4

5 February 2010

Kuantan, Pahang

KKs in Pahang

5

8 February 2010

Johor Bharu, Johor

KKs in Johor

6

10 February 2010

Georgetown, Pulau Pinang

KKs in Pulau Pinang

7

10 February 2010

Kuching, Sarawak

KKs in Sarawak

8

12 February 2010

Kota Kinabalu, Sabah

KKs in Terengganu

9

12 February 2010

Seremban, Negeri Sembilan

KKs in Negeri Sembilan

10

1 March 2010

Kuala Terengganu KKs

KKs in Terengganu

11

4 March 2010

WP Kuala Lumpur KKs

KKs in WP Kuala Lumpur

4

NATIONAL MEDICAL CARE STATISTICS 2010

2.3 STUDY PERIOD
The study period was from 1/12/09 – 30/4/10 inclusive of 1st Dec and 30th April. Every day within this period was included plus weekends and
public holidays. A total of 151 dates were available.

Survey Date
Each recruited clinic was given a specific date on a first-come-first-serve basis from a list of 1,000 randomly arranged dates within the study
period. The dates were assigned during the study briefings. For clinics that were unrepresented during the briefings, the forms were sent by post
and the next available dates were assigned from the same list of 1,000 dates.
Clinics that were unable to conduct the survey on the given date were advised to do so on the following available date when the clinic was
operational. However, the clinics were advised to inform the research team prior to the change of date.

2.4 DATA COLLECTION
General
Reminders were given by telephone to all clinics approximately 1 week prior to the survey date. All clinics were given the option to respond to the survey
either by paper submission or online through a specially designed web-based application. For the latter, a unique username and password to access
this system was given to each clinic. For clinics choosing to respond on paper, they were given 2 weeks to return the forms after the survey date.
For all clinics (public and private) involved in this study, a public notice was provided that was to be displayed in an area where it can be viewed
by all patients. This notice served to inform patients of the clinic’s participation in the ongoing survey and that any patient had the right to opt-out
if they did not wish to be part of the survey.

Private Primary Care Clinics
Private clinics were asked to record all patient encounters seen in the clinic on the survey day.

Public Primary Care Clinic
As the KKs varied widely in patient load, a patient sampling strategy based on the Malaysian Identity Card (MyKad) numbers was devised to select
patient encounters for recording in order not to overburden the clinics. MyKad is the compulsory identity document for Malaysian citizens aged 12
and above. For large clinics with more than 100 expected attendances per day, visits by patients with MyKad numbers ending with the digits ‘1’
and ‘6’ were recruited. For clinics with an expected number of attendances ranging between 50 to 100, visits by patients with MyKad numbers
ending in ’0’, ’2’, ’4’, ’5’, ’7’and ’9’ were recruited. For clinics expecting 50 or less attendances per day, all patient visits on that day were included.

2.5 DATA ENTRY & DATA CLEANING
Data entry for all paper forms received was done inhouse with random checks performed to ensure data entry quality. Improperly conducted
surveys (wrong dates, not according to protocol) were excluded.
Data cleaning was conducted during the data entry process and continued during data analysis. Data range checks and consistency checks were
built into the data entry module and the age variable was auto-calculated based on the date of birth to reduce error in manual calculation.

At the outset of the study, both private primary care and specialist clinics were included in the survey due to limitations of the sampling frame.
It should be pointed out that, in a concurrent survey under NHSI, namely the NHEWS Primary Care, all participating clinics were required to selfreport whether they were primary care providers or specialists. However, based on the details in this pooled data, the respondents were later
divided into primary care clinics and specialist clinics. Only data from private primary care clinics were analysed and presented in this report. The
issue of separating data did not arise for public clinics as all KKs provided only primary care services.
5

2 Methodology

2.6 IDENTIFICATION OF PRIVATE PRIMARY CARE CLINICS

NATIONAL MEDICAL CARE STATISTICS 2010

2.7 DATA CODING
The reasons for encounter were coded according to the International Classification of Primary Care Second Edition (ICPC-2) codes2 whereas the
prescription drugs were coded according to WHO Anatomical Therapeutic Chemical (ATC) Classification system.3 The Clinical Research Centre
obtained a 2-year free license for the usage of ICPC-2 codes in the Malaysian NHSI project starting 22 February 2011 from the World Organization of
Family Doctors (WONCA). WONCA is made up of national colleges, academies or organisations concerned with the academic aspects of general family
practice.4 The Anatomical Therapeutic Chemical (ATC) license was purchased from the WHO Collaborating Centre for Drug Statistics Methodology.3

2.8 DATA ANALYSIS
This report is primarily descriptive. Therefore, no test of significance has been presented. Analysis was done using STATA version 11.1 and
the confidence intervals for rate were calculated using Open Epi Calculator Version 7.5.115. The encounter was the primary unit of inference.
Encounters with no reasons for encounter and no drugs recorded were not analysed.
Proportions with 95% confidence intervals were used to describe the distribution of an event that can occur only once at a consultation (e.g.
patient’s age and mode of payment). The proportions may not always add to exactly 100% due to rounding off. Meanwhile, for an event that can
happen more than once in a consultation (e.g. reasons for encounter or medications), data was reported as rates per 100 encounters.
Data was reported as per collected. No weightage was applied to extrapolate the data to national level.

2.9 LIMITATIONS OF THE STUDY
1.

The survey is a cross sectional study. Therefore, no conclusion can be derived, neither in terms of long term management of chronic diseases
nor in terms of disease episodes in primary care setting.

2.

The survey is self-administered by participating doctors and therefore accuracy of data depends largely on the accuracy of recording and
interpretation. This might not necessarily reflect the actual practice.

3.

The survey is encounter-based. If the same patient visits one clinic and then goes to another clinic for an unrelated reason during the same
survey day, it will be considered as two encounters.

4.

Morbidity patterns observed in the survey collectively only reflected those cases managed in a primary care setting but not that of the
incidence or prevalence of diseases in the community.

5.

The morbidity patterns reflected only those managed during the recorded encounters. Incidence of co-morbidity in the same patient that was
not treated at the encounter would not have been recorded.

6.

Prescription data in the survey included only those provided at the recorded encounter. The presence of a drug in a prescription did not
necessarily mean that the patient was not already given the drug in a previous encounter. Similarly, the absence of a drug did not necessarily
indicate that the patient will not be given it in a future encounter.

Reference
1.

Pharmaceutical Services Division and Clinical Research Centre, Ministry of Health Malaysia. Malaysian Statistics on Medicine 2007. Kuala Lumpur 2010

2.

Wonca International Classification Committee (WICC). International Classification of Primary Care – 2nd Edition (ICPC-2 English). Available at http://archive.
globalfamilydoctor.com/wicc/pagers/english.pdf. Accessed January 2012.

3.

WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2011. Oslo, 2010.

4.

Global Health Workforce Alliance. WONCA – World Organization of Family Doctors. Available at http://www.who.int/workforcealliance/members_partners/member_list/
wonca/en/index.html. Accessed October 2012.

5.

Emory Rollins School of Public Health. 95% Confidence Interval for a Rate version 7.5.11. Available at http://www.sph.emory.edu/~cdckms/exact-rate.html
Accessed July 2012.

6

NATIONAL MEDICAL CARE STATISTICS 2010

CHAPTER 3

| THE RESPONSE RATE

This chapter examines the survey samples and response rates. As described in Chapter 2, public clinics were selected through stratified sampling
to ensure representation of each state. Out of 150 public clinics sampled, 122 responded (response rate 81.3%). Meanwhile, 755 out of 1,495
private clinics responded (response rate 50.5%). However, some of these clinics were subsequently found to be specialist or other types such as
aesthetic clinics (Table 3.1) Data from such clinics were removed from analysis.
The full list of the public and private primary care clinics which responded to the survey is available in Appendix 1.

Table 3.1: Number of respondent public and private clinics
SECTOR

Public

TYPE OF SERVICE

POPULATION

SAMPLED

RESPONDED

STATUS

Primary Care

806

150

122

Analysed

Primary Care

5,108

652

Analysed

103

Excluded

Private

1,495
Specialist/Others

1,254

A total of 21,914 encounters were collected from 122 public and 652 private primary care clinics. However, 46 encounters were excluded as
these neither contained data on reasons for encounter nor the medications prescribed. Total analysable encounters were 21,868; 4,173 from
public (average 34.2 encounters per clinic) and 17,695 from private (average 27.2 encounters per clinic). The demographic characteristics of

3 The Response Rate

these encounters are shown in Chapter 4.

7

NATIONAL MEDICAL CARE STATISTICS 2010

CHAPTER 4

| THE ENCOUNTERS

This chapter describes the demographic pattern of patient encounters recorded in NMCS 2010.
Table 4.1 shows distribution of encounters in NMCS 2010 by age groups. The age range was reported in accordance with the Department of
Statistics population data1 and National Health and Morbidity Survey III.2 In general, young adults made up the bulk of encounters. The age group
25-29 (10.8%) had the highest proportion of encounters, followed by age groups 30-34 (9.7%) and 20-24 (8.2%). Among children and youth aged
19 years and below, the encounters were highest for children aged 1 – 4 years (7.5% of total encounters) and tended to decrease with increasing
age. On the other hand, the geriatric population (60 years old and above) only contributed 12.5% of the total encounters.
On average, for the purpose of this study, each clinic provided data for about 30 encounters. As there were 652 private clinics versus 122 public
clinics responding to the survey (Chapter 2), the majority of encounters (80.9%) appeared to be from private clinics. Nevertheless, this cannot be
interpreted to mean that private clinics were seeing more patients than the public clinics. Also, only slight differences were observed between the
sexes, with female patients accounting for 51.3% encounters as compared to male patients which were about 48.7%. (Table 4.2)
The majority of patients presenting to primary care clinics were Malaysians with only 6.8% of patients being foreigners. This finding is in proportion
to the estimated number of foreigners in the country (8.2%)1. When the ethnicity for Malaysians were analysed (Table 4.2), the distribution were
also found to be similar to that reported by the Department of Statistics.1 (Malay and Indigenous (Bumiputera) 67.4%; Chinese 24.6%; Indians
7.3%; and others 0.7%)
The most common mode of payment for private primary care services in NMCS 2010 was out-of-pocket payment (56.8%), followed by payment
through private third parties (22.0%). Private third parties refer to employers, panel companies (companies which appoint private clinics to look
after their workers who fall sick), managed care organizations (MCOs) and private insurance companies. Meanwhile, all encounters presented to
public clinics were considered under government subsidy. Some visits to private clinics were reported to be subsidised by government. (Table 4.3)

Reference
1.

Department of Statistics. Population And Housing Census, Malaysia 2010 (2010 Census). http://www.statistics.gov.my/portal/index.php?option=com_content&view
=article&id=1215&lang=en Accessed June 2012. Last update 05 June 2012.
Institute of Public Health. National Health and Morbidity Survey III 2006.

4 The Encounters

2.

9

NATIONAL MEDICAL CARE STATISTICS 2010

Table 4.1: Characteristic of encounters by age group in NMCS 2010
AGE GROUP 1

NUMBER

PERCENT OF
ENCOUNTERS

95 % CI
LOWER

UPPER