8th INTERNATIONAL CASEMIX

CONFERENCE

CASEMIX FOR CLINICAL

EXCELLENCE

29th - 30th July 2019

Bangi Resort Hotel,

Bangi Selangor Malaysia

Organised by

2

3

CONTENTS

Welcoming address 4

Background 5

Program schedule 6-7

Plenary I: Implementing Casemix in Teaching Hospital

10

Plenary II: Measuring Quality of Hospital Care Using Casemix

12

Plenary III: Impact Evaluation of Casemix in Malaysia

13

Plenary IV: Linkage between Casemix and Clinical Excellence

14

Symposium I: Sharing Experience and

Challenges of Using Casemix to Achieve

Clinical Excellence in other Countries

16-18

Symposium II: Casemix Data for Clinical

Excellence 19-21

List of free paper (oral) presentations 23

Abstracts 24-32

Committee members and Acknowledgment 33-34

4

WELCOMING ADDRESS

Assalamua’laykum Warahmatollah Wabarakatoh & Salam Sejahtera,

Welcome to the 8th International Casemix Conference. The theme for our

conference this year is Casemix for Clinical Excellence. It is a great honour

for us to host this great event here again at the National University of Ma-

laysia (UKM) in Kuala Lumpur, which will be held in Bangi.

Recently, Casemix system attracts interests of many decision and policy

makers in health care systems around the world. Casemix system has been

used in many countries to address the issues of efficiency and quality of

care. Presently many developing countries have tried to address the finan-

cial need for universal health coverage by introducing national health fi-

nancing programme based on social health insurance concept. Casemix sys-

tem was adopted as the provider payment method in most of these coun-

tries. Lack of technical capacity to establish and sustain locally developed

Casemix system is a major issue facing less developed countries that imple-

ment Casemix system. Next year, WHO will probably launch the updated

version of ICD, which is ICD-11. This will be followed by a new procedure

classification called ICHI. While these two new classifications will help to

provide more refined classification, the adoption of these new versions of

classification will pose great challenges to developing countries.

The focus on Clinical Excellence in this year’s conference reflects potential

use of Casemix data to monitor quality of care and cost of provision of

health services. Recently the new government of Malaysia has introduced

an innovative schemes called MySallam and PEKA B40. Both schemes are

providing coverage for the poor in the country. It is interesting to deliber-

ate in this Conference if Casemix system can be applied to these two

schemes in the future.

It is hoped that we can all share our knowledge and experiences on Case-

mix system and health financing in general in this conference. As the host

and main organiser of the 8th International Casemix, I wish all of you two

fruitful days of interesting and beneficial program. To our foreign friends,

may you have a pleasant stay in Malaysia.

Thank you. PROFESSOR DATO’ DR. SYED MOHAMED ALJUNID SYED JUNID Professor and Chair Dept of Health Policy and Management Faculty of Public Health Kuwait University Founder of International Centre for Casemix and Clinical Coding Hospital Canselor Tuanku Muhriz, UKM

5

BACKGROUND

International Centre for Casemix and Clinical Coding (ITCC) of Hospital Canselor Tuanku Muhriz

(HCTM), Universiti Kebangsaan Malaysia has proposed to conduct the 8th International Casemix Con-

ference in collaboration with Malaysian Health Economics Association (MAHEA), Casemix Solution

Sdn Bhd and School of Health Sciences, USM. The aim of the conference is to provide a platform for

participants to share their experience and best practices on casemix system implementation. The

target participants are policy makers, public health practitioners, clinicians, medical practitioners,

hospital administrators, medical records staff, nursing staffs, and all interested parties.

The development of casemix classification systems started since the 1960s to identify several cases

in utilisation review. Casemix classification systems were designed to group diseases into clinically

meaningful diagnostic clusters called Diagnosis Related Groups (DRGs). Each DRGs describes a clus-

ter of patients with related diagnoses with similar resource use which incur similar treatment cost.

Currently, casemix has been used as a tool to fund hospital services in many countries.

As the demand for health care services rose, healthcare cost escalates. To address these, countries

need an efficient health care financing system. An efficient health care services will result in good

quality service and cost containment. Casemix System is one of the possible solutions in achieving

those objectives.

Prior to the introduction of casemix, traditional allocations of resources were based on hospitals

output were described in terms of the number of beds or bed occupancy rate (BOR), length of stay

(LOS) and previous resource utilisation. Defining such output was highly unsatisfactory as the re-

sources used for per bed or one day of hospitalisation varies. The used of DRGs has facilitated fair-

er allocation of resources. Therefore, allocating hospital resources using the Casemix system ac-

cording to work-load will ensure all expenses used efficiently and produce a better quality of care.

Casemix has led to more cost conscious among hospital administrators and clinicians.

In introducing and implementing national health care financing mechanism for Malaysia, to en-

hance equity, accessibility, quality, and efficiency in the health system, casemix is one of the ele-

ments in the provider payment mechanism.

Since 2002, UKM has taken an initiative to lead the use of Casemix system in this country. In facts,

UKM has shared and extended our experience with many countries. It is hoped that casemix system

usage will extend to other hospitals to strengthen the health services in Malaysia.

Conference Objective:

To provide a platform for participants to discuss and share their best practices to enhance the im-

plementation of casemix system in developing countries.

6

SUNDAY, 28th July 2019

Preconference Workshop AP Dr Amrizal M N

MONDAY, 29th July 2019

0800 - 0830 Registration

0830 - 0845 Arrival of Guest

0850 - 0900 Arrival of YBhg Prof Datuk Dr. A Rahman A Jamal, Pro Vice Chancellor, Kuala Lumpur Campus

0900 – 0910 Negaraku and Citation of Doa

0910 – 0920

Welcoming Speech

By Prof Dato’ Dr Syed Aljunid Syed Junid,

Chairman of 8th International Casemix Conference

0920 – 0930

Opening Ceremony

By YBhg Prof Datuk Dr. A Rahman A Jamal,

Pro Vice Chancellor, Kuala Lumpur Campus

Chairman:

Dr Aidalina Mahmud

0930 – 1030

Keynote Address: Innovations in Casemix System for

Clinical Excellence

Speaker: Prof Dato’ Dr Syed Aljunid Syed Junid

Chairman:

Dr Amin Shah Ah-mad

1030 – 1100 Morning Break/Press Conference

1100 – 1200 Plenary I: Implementing Casemix in Teaching Hospital

Speaker: AP Dr Rosminah Mohamed

Chairman:

AP Dr Aznida Firzah Abdul Aziz

1200 – 1300

Symposium I

Topic: Sharing Experience and Challenges of Using Case-mix to Achieve Clinical Excellence in other Countries.

Speakers: 1. Singapore – Dr Jeremy Lim

2. Thailand – Prof Dr Supasit Pannarunothai

3. Indonesia – Prof Dr Rizanda Machmud

Chairman:

Prof Dato’ Dr Syed Aljunid Syed Junid

1300 – 1400 Lunch Break

1400 – 1500

Symposium I - continue

Topic: Sharing Experience and Challenges of Using Case-mix to Achieve Clinical Excellence in other Countries.

Speakers: 4. Philippine – Dr Madeline Valera

5. Korea – Prof Dr Sukil Kim

Chairman:

Prof Dato’ Dr Syed Aljunid

1500 – 1600

Plenary II: Measuring Quality of Hospital Care Using

Casemix.

Speaker: Dr Jeremy Lim

Chairman:

AP Dr Rosminah Mo-hamed

1600 Tea Break

28 & 29 JULY 2019 (PRE-CONFERENCE & DAY1)

PROGRAMME

7

TUESDAY, 30th July 2019

0800 – 0830 Registration

0830 – 0845 Salutation for King Coronation Ceremony

0845 – 0945 Plenary III: Impact Evaluation of Casemix in Malaysia.

Speaker: Dato’ Dr Hj. Bahari Dato’ Hj Awang Ngah

Chairman:

AP Dr Tuti Ningseh Mohd Dom

0945 – 1000 Morning Break

1000 – 1200

Symposium II

Topic: Casemix Data for Clinical Excellence

Speakers:

1. Managing Costing Data in Casemix – AP Dr Amrizal Mu-hammad Nur

2. Ensuring Accurate Coding in Casemix – Dr Siti Athirah Zafirah Abdul Rashid

3. The Role of Clinical Pathway in Casemix – AP Dr Aniza Ismail

4. DRGs and ICD-11 – Prof Dato’ Dr Syed Mohamed Aljunid Syed Junid

Chairman:

Dr Roszita Ibrahim

1200 – 1300 Free Papers Session 1 Chairman: AP Dr Amrizal Muhammad Nur

1300 – 1400 Lunch Break

1400 – 1500 Free Papers Session 2 Chairman: AP Dr Amrizal Muhammad Nur

1500 – 1600

Plenary IV: Linkage Between Casemix and Clinical

Excellence

Speaker: Prof Dr Supasit Pannarunothai

Chairman:

AP Dr Azimatun Noor Aizuddin

1600 – 1630 Closing Ceremony

1630 Tea Break

30 JULY 2019 (DAY2)

PROGRAMME

8

9

PLENARY SESSIONS

10

PLENARY I: IMPLEMENTING CASEMIX IN TEACHING HOSPITAL

ASSOCIATE PROFESSOR DR ROSMINAH MOHAMED

BSc.(Biotech)Australia, MMedSc.(Pub Health)UKM, PhD (Health Econ),WWF, Germany

Associate Professor Dr. Rosminah Mohamed is a Senior Lecturer at School of Health Sciences, Health Campus, Universiti Sains Malaysia (USM), Kubang Kerian Kelantan and Head, Casemix Evaluation Unit, USM. She obtained her Bachelor Degree in Biotechnology from Griffith University, Brisbane, Australia in 1997, Master in Medical Sciences from Universiti Kebangsaan Malaysia (UKM) in 2001 and PhD in Health Economics (European Casemix System) from Universitätsklinikum Münster, Westfaliche-Wilheim Universität, Germany in 2009.

She started her professional career as a Microbiologist at Scan Lab Sdn. Bhd, a Norwegian pharmaceutical a company and later attached to Medical Online Sdn. Bhd., a Telehealth company, appointed as an Assistant Manager, both in Kuala, before joining USM as a University Lecturer at School of Health Scienc-es, Health Campus, USM in 2003.

She teaches Health Economics, Health & Policy, Health Financing and Human Resource in Health Organization subjects for Bachelor and Postgraduate stu-dents in USM.

She also supervised a numbers of under and postgraduate students that in-volved several research projects on health economics and financing both in Malaysia and Indonesia. Among those were Implementation of Casemix Sys-tem in Hospital USM, Determination of Factor That Influence Hospital Utiliza-tion: A Survey at Hospital Dr. Zainoel Abidin Banda Acheh, Impact Of Clinical Coding Errors On Hospital Income Under DRG Assignment, The relationship between quality of life and willingness to pay among vestibular disorder pa-tient whose using home video balance exercise in Hospital Sains Malaysia, Determination of Health Economic factors in reducing health problem among Malaysian Pilgrims in Makkah, Development of Oral Health Casemix System and Options for Health Care Financing in Malaysia.

At the international level, she was chosen to take part in the Romanian Health Reformation Project, led by WHO in 2007 and in 2016, specially fund-ed by CDAE, she joined an Advance CEA application course in Oxford Univer-sity to strengthen her expertise in this area. Her contribution to the universi-ty is obvious, where she has been appointed in a team for hospital restruc-turing project and one of the members for Young Thinker.

She has published and co-authored several articles in journals and presented in conferences both local and abroad in areas of health economics. She was appointed as a reviewer for several journals such as Inquiry, Asia Pacific Journal, PLOS One and also an author for health economics and statistical text book for public and private universities students in Malaysia.

11

SYNOPSIS

Hospital Universiti Sains Malaysia (Hospital USM) is a tertiary care hospital with 890 beds has been providing healthcare facilities for more than 20 years to the local people in Kelantan, as well as the community along the east coast of Peninsular Malaysia. One of its goal is to ensure that resources and allocation for each department within the hospital are sufficiently dis-tributed to ensure health care delivery is efficient and maintained at a high quality for the patients. The implementation of the casemix system in 2014, as a hospital management tool is a long-awaited moment for Hospital USM since early 2000. The implementation of the system became a reality when a collaboration was established in an MoU between USM and UNU-IIGH-UKM in 2011. The “Casemix System Project” started at Hospital USM and was co-funded by Vice Chancellor Initiative Grant (APEX Grant) and Hospital USM allocation fund. The objective of its implementation was clearly outlined: to improve quality and increase the efficiency of health care provision at Hos-pital USM.

A Casemix System Evaluation Unit (CSEU) was established in June 2015 to ensure that the casemix system functions well, The main function of CSEU is to arrange and manage all activities related to the casemix system in Hospi-tal USM, including series of capacity building, consultation, research and innovation. Basically, the function of this unit is to professionally provide support services to Hospital USM with an inspiration to achieve the objec-tives of implementing the casemix system. CSEU is committed to present an annual report of the Hospital USM progress to the hospital top management. The report provides technical information regarding the treated inpatients at the Hospital USM facilities. The success of preparing the report, starting from data collection until to data analysis totally depended on the coopera-tion from the data providers: Human Resource Department, Finance Depart-ment, Pharmacy Department, Medical Record Department and Development Unit, Health Campus.

In the first 5 years of casemix implementation, trend changes can be seen in several dimensions of healthcare management at Hospital USM, such as im-provement in clinical coding, development of CodEx as a data collection tool for Hospital USM Casemix System, an increased awareness among the hospital staff and the development of selected Clinical Pathways.

We benefited a lot from the collaboration between USM and UNU-IIGH-UKM, where ITCC-UKM has provided the MY-DRG Casemix Grouper software that has been installed and customized for Hospital USM, as well as close consul-tation from their Consultants. The MoA had continuously extended between USM and ITCC-UKM, venturing into the development of Oral Health Casemix System (OHCS) project in 2014 and was officially launched in 2018. This pro-ject innovation was fully funded by APEX University Grant, USM.

PLENARY I: IMPLEMENTING CASEMIX IN TEACHING HOSPITAL

12

DR. JEREMY LIM MD, MPH He is a Partner in Oliver Wyman’s Singapore office. He advises senior offi-cials at public sector agencies and has extensive experience consulting and advising multinational private and NGO clients on national and regional strat-egies for go-to-market plans and implementation, government engagement and public-private partnerships. Jeremy is also active in academia, holding appointments at several universi-ties. He teaches at the National University of Singapore (Saw Swee Hock School of Public Health, and Duke-NUS medical school), and in 2013 authored Myth or Magic: The Singapore Healthcare System, a book that draws lessons from the Singapore health system for health reform efforts in other countries. Prior to joining Oliver Wyman, Jeremy trained in surgery and public health. He has worked in senior executive roles in both public and private sectors, including time spent as a senior official in the Ministry of Health Singapore where he was also involved in a number of ‘Whole of Government’ initiatives. Jeremy chairs the steering committee of NIHA (NUS Initiative to Improve Health in Asia), an initiative to strengthen health policy research and educa-tion in Asia and sits on the Behavioral Sciences Institute, Singapore Manage-ment University, Centre for Health Informatics (NUS) and Next Age Institute (NUS) advisory boards. He also contributes as immediate past President of the Fulbright Association (Singapore) and convener for the Johns Hopkins Bloom-berg School of Public Health Singapore alumni. Jeremy enjoys serving in the NGO sector and in Singapore chairs the School Advisory Committee of the Me-ridian Junior College, the medical advisory committee of Dover Park Hospice and regionally, is a Member of the ‘Save the Children’ Asia Corporate Advisory Council. He is a volunteer physician with HealthServe, a Singapore NGO cater-ing to the health needs of migrant workers. SYNOPSIS

Sharing Experience and Challenges of Using Casemix to Achieve Clinical Ex-cellence in other Countries– Jeremy will share a brief overview of the intro-duction of Casemix in Singapore and how it has evolved from use primarily as a funding allocation tool to its current major use in value-based healthcare. More broadly, he will discuss the efforts in Singapore to shift away from 'eminence' to 'evidence' based decision making in clinical and sys-tem decision making.

Measuring Quality of Hospital Care Using Casemix - In this lecture, Jeremy will cover the following:

1. The history of quality measurement and management globally

2. Challenges faced and the introduction of Casemix in quality measurement

3. The experience of health systems such as Kaiser Permanente, New York University Health System and Singapore

PLENARY II: MEASURING QUALITY OF HOSPITAL CARE USING CASEMIX

13

PLENARY III: IMPACT EVALUATION OF CASEMIX IN MALAYSIA

YBHG. DATO’ DR. HJ. BAHARI DATO’ TOK HJ. AWANG NGAH

MBBS (Mal), MSc.HSM (South Bank), CMIA (NIOSH)

Director of Medical Development Division, MOH

Dato’ Dr Hj Bahari has long working experience as a director at multiple hospitals. He is none other than one of the pioneers who led the Cluster Hospital pilot project in Hospital Sultan Haji Ahmad Shah, Temerloh, link-ing it with Hospital Jengka and Hospital Jerantut. Besides being the go-to person in the working committee for Cluster Hospital, he is also part of the Technical Working Group for 1Care. In addition to that, he also con-tributed to the flexible working hour system (flexi-hour) for housemanship and its assessment.

SYNOPSIS

An eight-year in-patient casemix crusade in Ministry of Health Malaysia hospitals prevails impacts to healthcare system tremendously. It has made the health information gathering more uniformed, systematic work processes and yielded remarkable impacts to the provision of healthcare service. Gaining staff acceptant and involvement is one of major change management efforts, gaining slow acceptance at the beginning of imple-mentation; then steady rise and at present, almost all clinicians are palat-able about casemix input, process and the use of its output. Sustainabil-ity of the system is other challenge to design. Application up-grading suit to other than inpatient service shall be considered and revealed in the milestone of implementation of casemix system, so as to portray casemix

14

PLENARY IV: LINKAGE BETWEEN CASEMIX AND CLINICAL EXCELLENCE

SUPASIT PANNARUNOTHAI Centre for Health Equity Monitoring Foundation

Supasit Pannarunothai obtained medical degree (MD) from Faculty of Medi-cine Ramathibodi Hospital, Mahidol University in 1978; Diploma of Tropical Medicine and Hygiene (DTM&H) from Faculty of Tropical Medicine, Mahidol University in 1982; Master of Science (Public Health) from University of Sin-gapore in 1984 and Doctor of Philosophy from London School of Hygiene and Tropical Medicine in 1993. Having published equity papers from his doctoral study, he has championed on diagnosis related group and casemix research for equitable health care reform payment methods since 1993. He acquired Professor of Community Medicine in 2002 while he was teaching at Faculty of Medicine, Naresuan University. After retiring he is at present Chair of the Centre for Health Equity Monitor-ing Foundation undertaking fundamental research on equity measurement for Thailand and managing field implementations of equity improvements with lowest level of local government. He has been a consultant on DRG/casemix to China (Kunming Medical University), Indonesia (Ministry of Health), Malaysia (Oral Health Division, MOH), the Philippines (PhilHealth) and Vietnam (MOH). He is serving the second term of the member of the National Medicine System Development Committee. SYNOPSIS

Thailand’s universal health coverage has adopted casemix system (diagnosis related group: DRG) as a payment method for inpatient care since 2002. DRG compulsorily requires clinical data (principal diagnosis, secondary diag-noses, operating room procedures, discharge type) as well as demographic data (age, gender) and resource use data (admission and discharge dates) for processing claim payments. These data provide opportunities for manag-ing clinical excellence in many ways from individual patient outcomes to health systems goals. Medical record audit was first launched to mitigate DRG creep phenomenon, whereby hospitals tend to up-code clinical data for higher casemix index to get higher pay. The three government insurance schemes of Thailand UHC set their own audit systems with some levels of collaborations (using common clinical coding guidelines). Healthcare accred-itation system was later established by law as a voluntary mechanism to en-sure quality of care at hospital level and recently extended to primary care and network levels. The National Health Security Office set up since 2002 as a foundation of purchaser-provider-split within the UHC, employs strategic purchasing that facilitates clinical excellence implementations by defining explicit health benefit packages, central reimbursement payment or even bulk purchasing of medicines. The health technology assessment mecha-nisms accelerate the selection of medicines into the national essential drug list as well as other health technologies. The maintenance of DRG and de-velopment of new casemix systems need more accurate data for designing and monitoring towards higher clinical excellence health systems.

15

SYMPOSIUM SESSIONS

16

DR. JEREMY LIM MD, MPH He is a Partner in Oliver Wyman’s Singapore office. He advises senior officials at public sector agencies and has extensive experience consulting and advising multi-national private and NGO clients on national and regional strategies for go-to-market plans and implementation, government engagement and public-private partnerships. Jeremy teaches at the National University of Singapore (Saw Swee Hock School of Public Health, and Duke-NUS medical school). In 2013 he authored Myth or Magic: The Singapore Healthcare System, a book that draws lessons from the Singapore health system for health reform efforts in other countries. Jeremy has worked in senior executive roles in both public and private sectors, including as a senior official in the Ministry of Health Singapore where he was also involved in a number of ‘Whole of Government’ initiatives. Jeremy chairs the steering committee of NIHA (NUS Initiative to Improve Health in Asia), an initiative to strengthen health policy research and education in Asia and sits on the Behavioral Sciences Institute, Singapore Management University, Centre

SUPASIT PANNARUNOTHAI Centre for Health Equity Monitoring Foundation Supasit Pannarunothai is a medical doctor, and holds the Diploma of Tropical Medi-cine and Hygiene (DTM&H), the degree Master of Science (Public Health) and Doctor of Philosophy from London School of Hygiene and Tropical Medicine in 1993. He has championed on diagnosis related group and casemix research for equitable health care reform payment methods since 1993. He acquired Professor of Commu-nity Medicine in 2002 while he was teaching at Faculty of Medicine, Naresuan Uni-versity. He is at present, the Chair of the Centre for Health Equity Monitoring Foundation undertaking fundamental research on equity measurement for Thailand and manag-ing field implementations of equity improvements with lowest level of local govern-ment. He has been a consultant on DRG/casemix to China (Kunming Medical University), Indonesia (Ministry of Health), Malaysia (Oral Health Division, MOH), the Philippines (PhilHealth) and Vietnam (MOH). He is serving the second term of the member of the National Medicine System Development Committee.

SYMPOSIUM 1: SHARING EXPERIENCE AND CHALLENGES OF USING CASEMIX TO ACHIEVE CLINICAL EXCELLENCE IN

OTHER COUNTRIES

17

SYMPOSIUM 1: SHARING EXPERIENCE AND CHALLENGES OF USING CASEMIX TO ACHIEVE CLINICAL EXCELLENCE IN

OTHER COUNTRIES

PROF.DR.RIZANDA MACHMUD, MD, MPH, FISPH, FISCM

Department of Public Health and Community Medicine Faculty of Medicine, Andalas University She is a Professor in the Department of Public Health and Community Medicine, Faculty of MedIcine, Andalas University since 2010 and became a Dean in Faculty of Nursing Andalas University for 2016-2020. She received a medical degree from the Faculty of Medicine, Andalas University, Padang, 1997 and a Master and Doc-toral degree of Public Health in School of Public Health, University of Indonesia. Receiving Harvard Scholar, Summer School in Public Health at Harvard School of Public Health, Boston, USA for a course of Analysis of Health and Nutrition Data from Low-Income Countries, HENRI Programme.

She is also as an invited speaker both inside and outside the country; authoring over 10 international’s articles and writer of some books with topics such as social determinant of health, tuberculosis, and health public policy on morbidity of pneumonia.

She has led and/or supported research through funding from WHO, Global Fund, USAID and other agencies. She has substantial experience with community en-gagement and outreach to marginalized populations, particularly through many years of community-based work in tuberculosis with Community Empowerment People against Tuberculosis’s project. The work has involved community-driven interventions to reduce discrimination and stigma among remote and poor com-munities

18

SYMPOSIUM 1: SHARING EXPERIENCE AND CHALLENGES OF USING CASEMIX TO ACHIEVE CLINICAL EXCELLENCE IN

OTHERS COUNTRIES

DR. MADELEINE DE ROSAS-VALERA,

MD, MSc International Health ( Heidelberg)

She is presently the Sustainable Financing and Partnership Manager of TB Platform, a USAID project on Tuberculosis and a Faculty of Ateneo School of Business. Dr. Val-era was a former Executive Director of Infant and Pediatric Nutrition Association of the Philippine, Undersecretary of Health for Health Policy, Planning, Research, Na-tional Drug Policy and International Health ( 2012-2013), WHO-WPRO Technical Of-ficer for Patient Safety and Health System (2009-2012), Senior Vice-President of the Philippine health Insurance Corporation ( 1998 – 2010).

Dr. Valera is recognized for her effort in the introduction and expansion of Health Technology Assessment, ICD 10, and the Philippine Diagnosis Related Grouping in the Philippines. As Senior Vice President, she initiated the development of the Quality Assurance standards, Fraud detection and Outpatient Benefit for TB, MCH, HIV-AIDS and Peritoneal Dialysis. She also served as Chairperson for the ASEAN Sen-ior Officials’ Meeting for Health Development (2012-2013).

Dr. Valera has a master degree on Community Health Management (International Health) at the Heidelberg University and was awarded a Gustav Nossal Health Re-form Leadership Fellow, University of Melbourne and Pharmaceutical Policy Fellow at Harvard University.

Last February 20,2019, the Universal health Care Act (UHC) was passed and major reforms in the Philippines’ health system is expected. Philhealth will become the national purchaser of health goods and services. Philhealth announced that by 2023 there will be introduction and incorporation of DRG and Global Budget.

PROFESSOR SUKIL KIM graduated from the college of medicine at the Catholic Uni-versity of Korea. He was trained as a specialist in preventive medicine at the Yon-sei University. He got a Ph.D. degree in public health at the Yonsei University and an additional Master of Science degree in medical informatics at the University of Utah.

He has been involved in the WHO activities since 2006. He is a co-chair of WHO Family of International Classification (WHO-FIC) Asia-Pacific Network. He is a former co-chair of ITC (Informatics and Terminology Committee). He is involved in several committees and reference groups as a member; FDC (Family Development Committee), ITC, and MbRG (Morbidity Reference Group).

He has been chairing the research committee on the patient classification of the Korean Medical Association since last year. He is also a member of the com-mittee of Patient Classification as well as a member of the consultative group on the New Korean DRG. He played an active role in developing recent version (4.0) of the Korean DRG which was conducted by the Korean Medical Association since 2012. He pointed out several issues that should be rectified for the proper implementation of DRG in Ko-rea. Some of them were published in both Korean and international scientific jour-nals.

19

SYMPOSIUM 2:

CASEMIX DATA FOR CLINICAL EXCELLENCE ASSOCIATE PROFESSOR DR. AMRIZAL MUHAMMAD NUR is a Deputy Head of Interna-tional Centre for Casemix and Clinical Coding (ITCC) and Senior lecturer in Depart-ment of Community Medicine, Faculty of Medicine, National University of Malaysia (UKM). He holds a PhD (with Distinction) in Public Health (specialisation in Health Economics, Financing & Casemix System) from National University of Malaysia, and a master’s degree in Health Care Management from University of Science, Malaysia (USM) and Medical Doctor’s degree from Andalas University of Padang (West Su-matera Indonesia). He teaches Master of Science in Public Health (Health Economics and Hospital Management), DrPH Programme and PhD programme in Public Health and Hospital Management at UKM.

He has 26 research projects in health economic and health financing mostly funded by local and International donor agencies. He has supervised and co-supervised 20 PhD and 5 Masters candidates. He has published numerous scientific publications and presented scientific papers in various conferences, seminars and workshops at international and local level.

His main interest is in the strengthening of national health care systems through re-search and development in health economics and financing. He has vast experience in health economic evaluation methodologies and techniques. He is currently in-volved in supporting a number of developing countries to develop and implement casemix systems for provider payment methods under Social Health Insurance pro-grammes for universal health coverage. His work on casemix systems covers re-search and capacity building programmes in many countries around the world in-cluding Malaysia, Indonesia, Philippines, Uruguay and Vietnam. He has experience working as a health economics, health financing and casemix consultant for Interna-tional Agency such as WHO, GTZ, ADB and AUSAID in casemix project from year 2006-2019.

ASSOCIATE PROFESSOR DR.ANIZA ISMAIL obtained her Medical degree from Universi-ti Sains Malaysia in 1994. She started her career as medical doctor with Malaysian Ministry of Health for 6 years in various fields. She left the Ministry in 2001 to further her study in Master of Public Health (Hospital and Health Management). In 2012 she has completed her study for Phd under program UKM-UNU IIGH. Her main interests are quality of care and health economics. AP Dr. Aniza is currently a Head of Quality Department Hospital Chancellor Tuanku Muhriz, National University of Malaysia and Public Health Medicine Consultant. She has supervised more than 100 postgraduate students since 2006 and involved about 80 research projects. She has published about 70 full articles and has presented papers in conferences, symposiums and workshops both local and international. She also has published book and book chapters. She is a member of the Malaysian Public Health Association, a treasurer of Health Economics Association of Malaysia and Asia Pacific Academic Consortium for Public Health (APACPH - Malaysia).

20

SYMPOSIUM 2:

CASEMIX DATA FOR CLINICAL EXCELLENCE

SITI ATHIRAH ZAFIRAH is currently working as PrograM Development Execu-tive at Casemix Solutions Sdn Bhd. Due to her excellent result in Malaysia Certificate of Education, she was selected to study in Japan in 2008 under the Malaysia Program of Look East Policy and was awarded a Government Scholarship to pursue a Bachelor Degree. Prior to her study in Japan, she has attended one and half year Preparatory course in Institute Bahasa Teikyo in Kuala Lumpur and obtained Certificate of Japanese Language Lev-el 2.

She was then graduated from University Utsunomiya of Japan with 1st Class of Honors in Bachelor of International Studies in 2012 majoring in Interna-tional Economics. After her Bachelor Degree, she started to work with Case-mix Solutions and in charged for Casemix Implementation Project in few countries such as Indonesia and Vietnam. She obtained her PhD in Communi-ty Health without a Master Degree from Universiti Kebangsaan Malaysia in the year 2018.

Her PhD study focused on economic impact of clinical coding errors under the supervision of Associate Professor Dr. Amrizal Muhammad Nur and was sponsored by Ministry of Higher Education. During her study, she has pub-lished and co-author several articles in journals and presented in conference both local and international in the areas of clinical coding. She has also won few awards related to her study research including Best Poster Presentation in Patient Classification System International Conference in Doha, Second Runner-up for Oral Presentation in 2nd Casemix Conference, Runner-up for Oral Presentation in 9th Postgraduate Forum in Universiti Kebangsaan Malay-sia and Best Poster Poster Presentation in 10th Postgraduate Forum in Uni-versity of Gajah Mada Indonesia.

Her main interest is Casemix System Management, Clinical Coding, Economic Evaluation Study and also Costing Analysis.

21

SYMPOSIUM 2:

CASEMIX DATA FOR CLINICAL EXCELLENCE

PROFESSOR DATO’ DR SYED MOHAMED ALJUNID is the first Professor of Health Economics in Malaysia. He is the first Malaysian to obtain PhD in Health Economics from London School of Hygiene and Tropical Medicine in 1995. He obtained his MD from National University of Malaysia and Master of Science in Public Health from National University of Singapore. He is the Founding Head of International Centre for Casemix and Clinical Coding, a centre of excellence on casemix and health economics research in Faculty of Medicine UKM, which was established in 2011. Prior to this he served as a Senior Research Fellow of United Nations University International Institute for Global Health from 2006 to 2014.

Currently he is appointed as the Founding Professor and Chair of Health Policy and Management, Faculty of Public Health, Kuwait University from 1st January 2016. He is also the Director of Postgraduate Programs of Faculty of Public Health Ku-wait University. He is now appointed as a consultant and adviser on casemix sys-tem at National Centre for Health Information of Ministry of Health Kuwait. He is a Fellow of Academy Science, Fellow of Public Health Medicine and Fellow of Academy of Medicine Malaysia.

His main interest is in the strengthening of health care system of developing coun-tries through research and development in health policy, health economics and financing. He has conducted more than 50 research projects; most of the projects are to support policy decisions on health financing. He is currently involves in sup-porting a number of developing countries to implement Social Health Insurance programs. His work on Social Health Insurance covers many countries around the world including Malaysia, Indonesia, Philippines, Mongolia, Vietnam, Bhutan, Chi-na, Saudi Arabia, Kuwait, United Arab Emirates, Sudan, Nepal, Uruguay, Iran, Chile, Kenya and Ghana. He served as the Co-chair Morbidity Technical Advisory Group of ICD-11 Revision of World Health Organisation-Family of International Classification from 2007-2016. He is the Founding President of Malaysian Health Economics Association (MAHEA) and Malaysian Society of Pharmacoeconomics and Outcome Research (MY-SPOR) and the current Deputy President of the Public Health Medicine Specialists’ Association of Malaysia.

He has published more than 180 journal articles, book chapters and scientific re-port. He has presented more than 250 papers in local and international confer-ences, seminars and workshops. He has authored and co-authored five books. His recent book is “Development of Pharmacy Service Weights for Implementation of Casemix System For Provider Payment. Concepts Methods and Applications”.

22

FREE PAPER

PRESENTATION

23

LIST OF FREE PAPER PRESENTATION

No. Title Presenter

1 Root Cause Of Moral Hazard In The Implementation Of So-cial Health Insurance In Rural Province Hospital Indonesia

Syafrawati Syafei

2 Costing Method In Estimating The Economic Burden Of Cog-nitive Frailty Among Elderly People In Malaysia

Ahmed Alkhodary

3 “PEKA B40 – The General Practitioner (GP)’S Gatekeeper Paradox In Health Prevention”

Mohammad Husni Jamal

4

The Influencing Of INA-CBG System On Completeness Of Medical Records In Achmad Mochtar Hospital In West Su-matera Province Of Indonesia

Kamal Kasra

5 Clinical Discharge Documentation And Coding Accuracy - The Financial Implications

Rusilawati Jaudin

6 Towards Excellence In MalaysianDRG Casemix System: A Case Study

Sarah Saizan

7 Institut Kanser Negara Casemix Top-Down Costing Ap-proach: Cost Analysis For Cancer Cases

Ezaty Dalila Adil

8 Leadership Styles Of Managers To Strive Towards Excel-lence Services In Military Hospitals In Malaysia

Junaidah Kamarruddin

9 The Managerial Skills Of Quality Managers Shafik Mohammed

24

ROOT CAUSE OF MORAL HAZARDS IN THE IMPLEMENTATION OF SOCIAL

HEALTH INSURANCE IN RURAL PROVINCE HOSPITAL INDONESIA

Syafrawati1, Rizanda Machmud2, Syed Mohamed Aljunid3,4, Rima Semiarty2

1 Faculty of Public Heath, Andalas University, Padang, Indonesia 2 Faculty of Medicine, Andalas University, Padang, Indonesia 3 International Centre for Casemix and Clinical Coding, Faculty of Medicine, National

University of Malaysia, UKM Medical Centre, Bandar Tun Razak, 56000 Kuala Lumpur,

Cheras, Malaysia. 4 Department of Health Policy and Management, Faculty of Public Health, Kuwait Universi-

ty.

Background: Moral hazards has been identified as an important component that contribute

to the financial deficit of Social Health Insurance (SHI) in Indonesia. Whilst rural hospitals

play the role as the main providers for health services under the SHI, little is known on the

contribution of moral hazards to SHI. Objective: To obtain a deeper understanding of moral

hazards in relation to SHI of rural provincial hospitals in Indonesia. Method: We conducted

a qualitative study using Focus Group Discussion (FGD) and in-depth interviews in hospitals

located in a rural province of Indonesia. In-depth interviews were held on two hospital di-

rectors and two officers from the Badan Pengelenggara Jaminan Sosial (BPJS), an agent

that manage SHI. Six clinicians and six coders attended the FGD. We asked open-ended

questions about their perceptions on moral hazards in hospitals. The interviews were rec-

orded and transcribed verbatim. The transcripts were thematically analysed. Results: Moral

hazards can be categorized into two types; unintentional and intentional. Most of the moral

hazards that were unintentional were due to lack of communication and socialization of SHI

by BPJS to the hospital staff. Other factors included appointment of non-medical doctors as

internal verificators, lack of clear coding guidelines, and poor coordination in between hos-

pital and BPJS to resolve coding disagreements. The main reason for intentional moral haz-

ards was for financial gain. This was commonly carried out for cases where the case mix

(INA-CBGs) tariffs were lower than the hospital cost. Lack of specific sanctions for moral

hazard practice had further promote this adverse practice in the hospitals. Conclusion:

Policies to prevent and manage moral hazards should be urgently developed and imple-

mented in the SHI programme in Indonesia. Implementation of more realistic case-mix (INA-

CBG) tariff could help reduce the incidence of moral hazards in the hospitals. Keywords:

Hospital, moral hazard, root cause

25

COSTING METHOD IN ESTIMATING THE ECONOMIC BURDEN OF COGNITIVE

FRAILTY AMONG ELDERLY PEOPLE IN MALAYSIA

Alkhodary A. A. 1,4, Aljunid S. M.1,2, Nur A. M.1, Putih S. E.1, Ismail A.3

1. International Centre for Case-mix and Clinical Coding, Faculty of Medicine, National Uni-

versity of Malaysia

2. Department of Health Policy and Management, Faculty of Public Health, Kuwait Universi-

ty, Kuwait

3. Department of Community Health, Faculty of Medicine, National University of Malaysia

4. Ministry Of Health, Gaza Governorates, Palestine

Recently, there is a concern on the occurrence of age-related syndromes ie, Cognitive Frail-

ty, as a potent risk factors for dementia, functional disability, poor quality of life and mor-

tality. Cognitive Frailty can be defined as a heterogeneous clinical manifestation character-

ized by the simultaneous presence of both physical Frailty and Cognitive impairment as de-

fined by a clinical dementia rating score of 0.5, without Alzheimer’s disease or dementia or

any other brain disease that can lead to dementia. Several methods can be used to estimate

the economic cost of this syndrome. Step-Down Costing is a common method for such calcu-

lation. Within this method, several steps need to be followed: The first step is to identify

the syndrome criteria properly. The second step is to identify the direct and indirect cost of

care related to this syndrome. The direct cost of care includes all payments related to the

health condition, whether paid within or outside the health care facilities. This can be as-

sessed by the economic burden questionnaire for inpatient and outpatient healthcare utiliza-

tion. The indirect costs includes all productivity losses of the patient or his/here relatives

due to premature mortality or morbidity, this can also be assessed by the above mentioned

form. The third step is to fill up the health care facility costing templates over the three vir-

tual cost centers (overhead, intermediate, and final cost centers). In case of absence of

health care facility cost centers information, Casemix data base (i.e. International Center

for Casemix and Clinical Coding at the National University of Malaysia) can be used to esti-

mate the cost of public health care services. The fourth step is to sum all direct and indirect

cost calculations to identify per patient cost of syndrome. The last step is to calculate the

economic burden among the Malaysian community based on the mentioned findings and the

prevalence of the syndrome and other necessary public figures. Key words: Cognitive Frail-

ty, Economic Burden, Costing, Elderly, Malaysia

26

PEKA B40 – THE GENERAL PRACTITIONER (GP)’S GATEKEEPER PARADOX IN

HEALTH PREVENTION”

Mohammad Husni Jamal 1,2, Syed Mohamed Aljunid 3,4, Aznida Firzah Abdul Aziz 5

1 Cyberjaya University College of Medical Sciences. 2 Academy of Family Physicians of Malaysia. 3 International Centre for Casemix and Clinical Coding, Universiti Kebangsaan Malaysia. 4 Department of Health Policy and Management, Faculty of Public Health, Kuwait University 5 Department of Family Medicine, Universiti Kebangsaan Malaysia.

A gatekeeper is a health care professional, usually a primary care physician or a physician ex-

tender, who is the patient's first contact with the health care system and triages the patient's

further access to the system. The concept of PEKA B40 was launched by the new government

as a health coverage to cater for the 40% low-poverty sector of the Malaysian population de-

scribed as the B40 group, specifically targeting those above 50 years of age. GPs are invited

to participate in executing screening programs to detect undiagnosed non-communicable dis-

eases and mental health cases estimated at 47% for the former and 32% for the latter. The

process involves two phases- the initial full medical and mental health assessment, relevant

physical examination with specified laboratory tests; followed by a review of the results. Up-

on detection of a non-communicable disease, referrals must be made by the GPs to the public

Klinik Kesihatan and hospitals for further management. The engagement of GPs by the Minis-

try of Health is a credible move towards public-private integration, with the purpose of posi-

tioning the GPs in the frontline of the healthcare delivery as gatekeepers. Strict criteria for

recruitment, limited scope of screening modalities and poor reimbursement rates are among

the weaknesses of the scheme. Recognising the fact that the current initiative is still in its

pilot phase, however, the GP’s role in PEKA B40 does not fulfil the concept of effective gate-

keeping, with many imitations imposed resulting in certain controversies. These then resulted

in the GP’s gatekeeping paradox. Key words: PEKA B40, general practitioners, gatekeeper

27

THE INFLUENCING OF INA-CBG SYSTEM ON COMPLETENESS OF MEDICAL

RECORDS IN ACHMAD MOCHTAR HOSPITAL IN WEST SUMATERA PROVINCE OF

INDONESIA

Kasra K1, Aljunid S.M1,2, Muhammad Nur A.1

1 International Centre for Casemix and Clinical Coding, Faculty of Medicine, Universiti

Kebangsaan Malaysia 2 Department of Health Policy and Management, Faculty of Public Health, Kuwait University,

Kuwait

Background: The Ministry of Health of Indonesia has launched the INA-CBG casemix system in

the effort to achieve universal coverage by 2019. The INA-CBG casemix system is important

because the reimbursement of health facilities is based on this system. In turn, the health

facilities need to ensure the completeness of Inpatient Medical Record (IMR) based on this

casemix system. Aims: The study aim is to assess the completeness of Inpatient Medical

Record (IMR) by implementation of INA-CBG at Achmad Mochtar Hospital. Methods: A combi-

nation of quantitative and qualitative methods through in-depth interviews and Focus Group

Discussions were employed in this cross-sectional study. A total of 390 IMR in year 2008 and

2012 were selected. Results: The results showed that the completeness of IMR score in-

creased from 3.1% (12/390) in year 2008 to 96.9% (378/390) in year 2012 (X2= 2.966E2 df=1

p<0.001). The marked improvement of the IMR components completion from 1.3% to 99% (p <

0.001) was noted among the secondary procedure; followed by secondary diagnoses which

improved from 12.3% to 66.4% (p < 0.001); and discharge dates from 19.5% to 62.6% (p <

0.001). The incompleteness of IMR was presumed to be due to the doctors only filling in the

main diagnoses that affect reimbursement and completing the IMR was an activity which in-

creased the doctors’ workload without any additional incentives. Nonetheless, because com-

pleteness of the IMR record can affect reimbursement, comprehensive training on INA-CBG

must be given to doctors and coders. Conclusion: In conclusion, the proportion of complete-

ness of IMR at Achmad Mochtar Hospital increased after the implementation of the INA-CBG

casemix system but hospital management must further improve the completeness of the IMR

without affecting on the quality of the records, reimbursements or the doctors’ services.

Keywords: Casemix system (CS), INA-CBG, Completeness, Inpatient Medical Record.

28

CLINICAL DISCHARGE DOCUMENTATION AND CODING ACCURACY: THE FINANCIAL

IMPLICATIONS

Sarah Saizan1 (SS), Rusilawati Jaudin2 (RJ), Najib Majdi Yaacob3 (NMY) Surianti Sukeri1 (SS)

1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia,

Kubang Kerian,Kelantan 2Medical Development Division, Ministry of Health Malaysia, Blok E1

Kompleks E Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya, 3Unit of Biostatistics and Re-

search Methodology,School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Ke-

lantan

Background: Case-mix system is a health management tool developed with the intention to

improve efficiency and quality of health care provision in hospitals. It also measures the costs

of health service provision that is fundamental in the planning of a hospital budget. The Malay-

sianDRG, casemix system has been implemented in Ministry of Health (MOH) Malaysia hospitals

since 2010, yet, the trends of providers gain acceptance on its importance are rather slow.

Objectives: To highlight this problem, we calculated the financial loss that occurs due to inac-

curate clinical discharge diagnosis documentation and ICD-10 coding in the MalaysianDRG,

casemix system. Methodology: Using a cross-sectional cost analysis design, 226 coded case

notes from the two MOH Malaysia healthcare institutions were selected and re-coded. If the

difference between codes were observed, the new code would be chosen as the final code.

The cases were then re-grouped using the MalaysianDRG application. The cost per case derived

from the new and original codes were compared. The outcomes were then verified by a case-

mix expert from the Ministry of Health. Results: 68.1% inaccurate cinical discharge of main

condition documentation and 74.8% ICD-10 coding error of the main condition. The difference

in costs due to inaccurate documentation was RM227,657 and RM68,217 for coding error. Using

paired t-test analysis, differences between mean (SD) cost per case of the original vs. new

codes due to inaccurate documentation [RM10,208.19 (12273) vs. RM11,244.53 (13785.27),

p<0.05], and coding error [RM10,208.19 (12273.04) vs. RM11,215.52 (13798.03), p<0.05] were

statistically significant. These results raise important questions regarding the costly financial

implications arising from inaccurate documentation and coding error in the MalaysianDRG, case

-mix system. Conclusion: To achieve the full benefit of the MalaysianDRG case-mix system, the

quality and accuracy of its data is vital and needs to be stressed upon continuously to the vari-

ous players. Keywords: case-mix, coding error, Malaysia, health financing, health economics

29

TOWARDS EXCELLENCE IN MALAYSIAN DRG CASEMIX SYSTEM: A CASE STUDY

Sarah Saizan1, Rusilawati Jaudin2, Mohd Zarawi Mat Nor3, Surianti Sukeri1

1Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia,

Kubang Kerian,Kelantan

2Medical Development Division, Ministry of Health Malaysia, Blok E1 Kompleks

E Pusat Pentadbiran Kerajaan Persekutuan, Putrajaya,

3 Department of Medical Education School of Medical Sciences, Universiti Sains Malaysia,

Kubang Kerian, Kelantan

There are four indicators in monitoring the annual clinical diagnosis documentation perfor-

mance of the Malaysian DRG casemix system in the Ministry of Health (MOH) hospitals, Malay-

sia. Despite the vast improvement in three indicators; accuracy in main condition, coding ac-

curacy main condition and coding accuracy other condition, a five-year trend analysis

showed the poor performance of the completeness in clinical documentation indicator. A

case study of MOH hospital (anonymized) was conducted to explore this underachievement in

order to improve the overall performance of the Malaysian DRG casemix system. Purposive

sampling was employed, and data collection was carried out using in-depth-interviews, ob-

servation, and documents review. Thematic analysis of the data discovered a multitude of

issues related to personal characteristics and inadequate commitments of medical profes-

sionals, lack of resources for facilities and training, system and network failures, heavy

workload - all of which stemmed from unfortunate disregard by the medical communities on

the importance of Malaysian DRG as a potential funding tool. Lesson learned from this case

study were used to derive practical solutions and tailored recommendations to pave the way

towards future excellence in Malaysian DRG, casemix system in Malaysia. Keywords: case-

mix, case study, Malaysia, health financing, health economics

30

INSTITUT KANSER NEGARA CASEMIX TOP-DOWN COSTING APPROACH: COST

ANALYSIS FOR CANCER CASES

Ezaty Dalila Adil, Rusilawati Jaudin, Asmayani Khalib,

National Cancer Institute, Putrajaya, Malaysia.

Introduction: Institut Kanser Negara (IKN), Malaysia, applies the Ministry of Health Malaysia

Casemix System which also known as MalaysianDRG, October 2016. Casemix system is classifi-

cation of patient treatment episodes designed to create classes which are relatively homoge-

nous in respect of the resources used and contain patients with similar clinical characteris-

tics. Casemix costing data of IKN, Malaysia, first took place in year 2017 and it used top-

down costing approach. Method: Top-down allocation method start with total expenditure of

directs and indirect costs consumed by the health facility. It is then divided by measure of

total output i.e. patient visit, day-stay or admission, to give an average cost per patient per

visit, per day-stay or per admission. Cost data collection was for expenditures from January

till December 2017. The costing process involved analysis of actual cost consumed

(expenditure) for 3 levels of cost centers, that are, the overhead, intermediate,and final

cost centres. Results: Data was collected from 3 cost centers which were Overhead Cost

Center (OCC), Intermediate Cost Center (ICC) and Final Cost Center (FCC). OCC includes ad-

ministration, maintenance, human resource, finance, utilities and IT departments. An ICC

includes departments such as pharmacy, radiology, pathology, anaesthesiology, physiothera-

py, operation theatre; while FCC includes Radiotherapy and Oncology Department, Surgical

Oncology Department, Nuclear Medicine Department, Palliative Department and Psychiatry

Department. Casemix in IKN currently is applied to in-patient service. Total IKN discharges

from 1st January till 31st December 2019 were 8,603. IKN has 20 Major Diagnostic Categories

(MDC) out of 24 and 167 Diagnosis-related Groups (DRG) out of 243 that has been listed in

Ministry of Health Malaysia Casemix facilities. Majority of IKN cancer cases belongs to Severity

Level 1 (52.27%), followed by Severity Level 2 (35.97%) and Severity Level 3 (11.76%).

Cost per-discharge by clinical specialty is highest for Palliative Care (RM9,120) followed by

Nuclear Medicine (RM8,082), Radiotherapy & Oncology (RM6,494) and Surgical Oncology

(RM2,484). Mean cost per patient-day is highest for Nuclear Medicine RM17,490 with mean

length of stay 4.96 days; followed by Radiotherapy and Oncology (RM10,157) with mean aver-

age of stay 5.13 days. Top three highest DRG for procedure cost is Radiotherapy with compli-

cations (RM67103) followed by radiotherapy without complication (RM64361) and Spinal & spi-

nal canal procedures with major complications (RM31132). Discussion: Top-down costing is

simple and feasible approach to produce quality results to be used for better management of

hospitals. IKN costing is still high considering its still new and we hope by years the patient

per-day and per-discharge costing will be reduced.

31

LEADERSHIP STYLES OF MANAGERS TO STRIVE TOWARDS EXCELLENCE

SERVICES IN MILITARY HOSPITALS IN MALAYSIA

Junaidah Kamarruddin1, Aljunid S. M2,3, Zafirah SA2, Mohamed Nor Yahya1, Adlina S1.

1 Faculty of Defence Studies and Management, National Defence University of Malaysia 2 International Centre for Casemix and Clinical Coding, National University of Malaysia 3 Department of Health Policy and Management, Faculty of Public Health, Kuwait

University

Background: Leadership style of managers may influence hospitals in achieving excellence

in providing their services to patients. Researchers had found that transformational leader-

ship style was shown to have positive impact on the achievement of services’ excellence.

This leadership style encompasses inspirational motivations, individualized consideration,

intellectual stimulation and idealized influence. This study is to identify the leadership style

amongst managers in Military Hospitals and its ability to achieve excellence of services.

Methods: This is a cross-sectional study involving military and non-military managers serving

in five Military Hospitals across Malaysia. A set of self-administered questionnaires consisting

of 30 items for assessment of hospital performance and 20 items to assess the leadership

style of the hospital managers, were developed, pre-tested and distributed to all managers

in the hospitals. Each item was ranked based on 5-point Likert scales. Based on the total

scores, the leadership style of managers was classified into Transformational (TS) and Non-

Transformational style (Non -TS). Results: A total of 501 out of 750 respondents returned

the questionnaire giving the response rate of 66.8%. Most of the respondents were females

(68.7%), below 40 years of age (61.9), had been in service less than 20 years (77.0%) and are

non-military managers (74.9%). By using the cut-off points of 80, it was found that 32.5%

(163) of the respondents had Transformational Leadership style. The military managers were

more likely to practice Transformational Leadership than the non-military managers (46.3%

vs. 28.0%, X2 =14.158 p<0.001). The overall mean score of the service performance is 102.5

(SD=14.89; range: 39 – 150). Among the respondents, 12.6% (63) had excellence manage-

ment performance. Among the leaders with Transformational Style, 31.9% of them had ex-

cellence performance compared to only 2.7% among the Non-Transformational leaders (X2

=87.920 p<0.001). Conclusions: Most of the managers in the Military Hospitals do not prac-

tice Transformational Leadership. The managers with military background are more likely to

practice Transformational Leadership style in the hospitals. The transformational leadership

style is proven to be related to excellence in hospital management. Keywords: Leadership

style; Military Hospitals; transformational and non-transformational.

32

THE MANAGERIAL SKILLS OF QUALITY MANAGERS – REVISITED

Shafik Mohammed 1 and Syed Mohamed Aljunid 1,2

1International Centre for Casemix and Clinical Coding, Faculty of Medicine, UKM,

2Department of Health Policy and Management, Faculty of Public Health, Kuwait Universi-

ty, Kuwait

The management excellence is essential for organizations to survive and thrive in the new

era competitive environment. Many organizations are looking for the skillful managers as

added value and to improve profitability and efficiency. To perform that, quality managers

should possess a range of skills and human qualities with proper knowledge and experience.

Although managerial work has been examined from the different views expressed by re-

searchers, the question remains "what are the conclusions made from such studies? In other

words, “how the existing literature describe the managerial skills of the managers and to

what extent in relation to quality managers? “The aim of the study was to explore the man-

agerial skills of managers in general and quality managers in particular as derived from the

literature review and previous researches. The study is descriptive involving review of the

relevant literature and researches about the skills of managers in general and quality man-

agers in particular. Three databases, Google scholars, Ebsco and Proquest, were searched

for relevant articles for the period of 1990 to 2019. Altogether, more than 35 papers were

linked to managerial skills out of them 12 papers were linked to quality management skills

and underwent an inductive content analysis. The review concluded that skills of managers

are similar in broad terms and interwoven and interdependent rather than a clear cut. The

literature suggests that the core competences of managers are similar in various organiza-

tions and improved organizational performance .In addition, the managerial skills are af-

fected by background education, work experience and training. The managerial skills noted

in the literature in link to health services: communication and interpersonal skills, leader-

ship, professional competence, organizational abilities and planning, decision‐making, team

work and emotional intelligence. Key words: quality management, managerial skills, job

description, manager tasks

33

This conference co-organised by ITCC, HCTM, MAHEA, Casemix Solution Sdn Bhd

and School of Health Sciences, USM.

Patrons Prof. Ir Dr Mohd Hamdi Abd Shukor Vice-Chancellor, UKM

Advisors Prof. Dato’ Dr Hanafiah Harunarashid Hospital Canselor Tuanku Muhriz (HCTM) Director, UKM

Chairman Prof. Dato’ Dr. Syed Mohamed Aljunid

Deputy Chairman AP Dr Aznida Firzah Abdul Aziz

Secretary AP Dr Azimatun Noor Aizuddin

Treasurer AP Dr Aniza Ismail

COMMITTEE MEMBERS

Secretariat & Registration

AP Dr Azimatun Noor A. (L)

Dr Aidalina Mahmud

Ms Siti Hajarni Isahak

ITCC Staff

Scientific Paper

AP Dr Amrizal Muhammad Nur (L)

Prof Dr Mohd Rizal Abd Manaf

Prof Dr Maznah Dahlui

AP Dr Azimatun Noor Aizuddin

AP Dr Rosminah Mohamed

AP Dr Tuti Ningseh Mohd Dom

Dr Nor Haty Hassan

Dr Haliza Hasan

Dr Aidalina Mahmud

Dr Syuhada Hamzah

Ahmed Alkhodary

Publicity

Dr Roszita Ibrahim(L)

AP Dr Mohammad Husni Ahmad Jamal

Dr Amin Sah Ahmad

Logistic & Protocol

AP Dr Aznida Firzah Abdul

Aziz (L)

Dr Norhaty Hassan

Dr Syuhada Hamzah

Finance,

Treasurer & Sponsorship

AP Dr Aniza Ismail (L)

Dr Siti Athirah Zafirah Abdul

Rashid

Multimedia & Technical

Rosman Mat Rashid (L)

Dr Khairul Baharin Mohd Baharuddin

34

ACKNOWLEDGEMENT

The Organizing Committee wishes to express

our gratitude and appreciation to:

All speakers

All authors & co-authors

All presenters and participants

Universiti Kebangsaan Malaysia Medical Center

Ministry of Health, Malaysia

Individuals who have assisted either directly or indirectly in the

8th INTERNATIONAL Casemix CONFERENCE 2019

THANK YOU

‘Terima kasih’

Note:

The full version of this booklet can be accessed from the following

website:

www.mahea.org.my

35