Development of a National Health Insurance: Roles and Functions in supporting Universal health coverage (UHC) in MIC
Organised by ANHSS
Co organised with the International Training Centre for Casemix and Clinical Coding (ITCC) HCTM, UKM.
14-15th (Tues-Wednesday) Oct 2025
Venue: Faculty of Medicine (FoM), National University of Malaysia (University Kebangsaan Malaysia), Cheras, Kuala Lumpur Malaysia
We are pleased to announce a 2–day Policy Course on A Policy Course on Health System Transformation in Financing: Development of a National Health Financing in supporting Universal health coverage in MIC, which is offered by the Asia-Pacific Network for Health Systems Strengthening (ANHSS), and this time is co organised by the International Training Centre for Casemix and Clinical Coding (ITCC), HCTM, UKM.
The future challenges of an ageing population, the forthcoming new pandemics and NCDs and advancing technologies all play a role of increasing health care cost. Malaysia, Thailand and Indonesia are parts of the MIC in Asia and have faced many challenges in sustaining financial budget, while serving its population. All countries uphold the universal health coverage (UHC) that ensures no one is left behind, despite their ability to pay for health. It is important to emphasize that the role of Private Health Insurance can not be neglected. The result of ANHSS meeting in Hong Kong in early May showed that there is a strategic role of Private Health Insurance in achieving universal health insurance.
Ensuring this trajectory, Indonesia has developed a social insurance system, through the INA-CBG (Indonesian Case Base Groups), that models its benefit packages for the population through the casemix system, and eligibility via some sort of medical card. This ensuring enough coverage despite the insured attending either the public or private sectors hospitals and payment to primary care through the capitation system.
Adopting the casemix system and DRGs especially for inpatients care, will lead to a more efficient payment system to healthcare providers. However, the need for audit and frauds detection are important to prevent financial leakages. Development of inclusive benefit packages for the population, are important to prevent omissions of groups of patients such as rare diseases, mental health groups and patients suffering from long in patients’ stay. Essential Benefit packages in National Health Insurance National Health Insurance (NHI), would include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services, and more.
The purported upcoming National Health Insurance (NHI), working with the DRG will provide a sustainable value-based financing and reimbursement system for the mass population while the higher income may opt for voluntary insurance or fee for service. The involvement of clinicians and specialist by fraternities are important stakeholders as the inclusion of diseases and diseases may be swayed by their involvements. Unlike the Private health insurance, whereby the insurance plans may vary in terms of services covered, the deductibles and co-payments required while individual premiums are charged. The NHI in Malaysia may utilises premiums adjusted by population risks, rather than individual risk ratings.
Case studies on countries experienced in implementing NHI and benefit packages, for integration will be presented for learning purposes. A final session will cover critical factors for policy development, implementation, approaches in monitoring and evaluation of policy interventions.
The course will provide participants with:
- Understand the policy options of a public and private financing mix in National Health Insurance system in supporting UHC.
- Understanding the strengths, challenges and issues confronting both tax-based healthcare (issues on sustainability) and social insurance health systems in the transformation of a health system.
- Understanding the difference between user fee for services, health insurance (private vs social), and the use of benefit packages.
- Inform stakeholders on the method of value-based reimbursement and use of auditing in NHI.
- Formulate implementation, monitoring and evaluation strategies for strengthening public, the use and implementation of SHI and private health insurance in
Speaker from: Malaysia, Hongkong, China, Thailand, Indonesia, Sri Lanka and other
Schedule
|
Topic |
Speaker |
|
|
8.30am |
Opening session and Welcome to workshop in UKM and KL Malaysia, followed by Faculty of Medicine Deans’ welcoming notes. |
Prof Dr Sharifa Ezat Wan Puteh Dean School of Liberal Sciences Professor in Hospital and Health Management Faculty of Medicine |
|
9.00am |
Welcome message by Chairman of ANHSS |
Prof. Dr. Laksono Trisnantoro, Email: trisnantoro@ugm.ac.id |
|
9.20am |
Tea break |
Session 1: The Health Insurance framework
|
Topic |
Speaker |
|
|
9.30am |
Malaysia Healthcare System, strength and concerns, why the proposal to change. |
Prof Dr Sharifa Ezat Wan Puteh Faculty of Medicine, UKM |
|
10.00am |
The framework, roles and functions of NHI in supporting UHC in a LMIC setting. |
Prof. Eng-kiong YEOH, GBS, OBE, JP Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Email: yeoh_ek@cuhk.edu.hk |
|
10.30am |
The challenges and issues confronting both tax-based healthcare (issues on sustainability) and social insurance health systems |
Prof. Dr. Laksono Trisnantoro, Email: trisnantoro@ugm.ac.id |
Session 2: The Equity of Financing
|
Topic |
Speaker |
|
|
11.00am |
The equity perspective of health financing- a macro view (Thailands perspective). |
Prof. Siripen Supakankunti Email: Siripen.S@chula.ac.th |
|
11.30am |
How health insurance influence equity among population (compared with fee-for-services/FFS). |
Prof. Eng-kiong YEOH, GBS, OBE, JP Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Email: yeoh_ek@cuhk.edu.hk |
|
12.00 |
Lunch Break |
|
|
2.00pm |
Social health insurance, issues in sustaining coverage in Indonesia. |
Dr Diah Ayu Puspandari Director, Center for Health Financing Policy and Health Insurance Management |
|
2.30pm |
Transition of Tax funded subsidised healthcare to insurance based: possible impact to populations’ equity? |
Dr Ravindra P. Rannan-Eliya |
|
3.00pm |
Tea break |
|
|
3.30pm |
Group work and discussions |
|
|
5.00pm |
Adjourn D1 |
|
Session 3: Pooling, Payment, and Benefit Packages
Day 2 (15th Oct)
|
Topic |
Speaker |
|
|
8.30am |
Differences in functions and roles of China’s payment mechanism: China’s experience. |
Professor Chen Yingyao |
|
9.00am |
How development of Benefit packages for long stay and rare diseases- issues and recommendations- Philhealth’s experience. |
Professor Maria Elena B. Herrera Adjunct Faculty of Asian Institute of Management, Makati City, Metro Manila,Philippines Email: mayaherrera@gmail.com |
|
9.300am |
Health benefit packages for primary care; capitation payment, their roles and development- Thailands experience. |
Prof. Siripen Supakankunti Email: Siripen.S@chula.ac.th |
|
10.00am |
Tea Break |
|
Session 4: Quality and Value based principle in health Insurance
|
Topic |
Speaker |
|
|
10.15am |
Quality System Policy for applying value-based principle in social and private health insurance |
Professor Adi Utarini |
|
10.45am |
Roles and functions of Audits and regulations in mitigating frauds in NHI |
Prof. Dr. Azimatun Noor Aizuddin |
|
11.15am |
Mitigating Fraud and Consumers Protection in Insurance (Europe, Indonesia experience) |
Rimawan Pradiptyo, S.E., M.Sc., Ph.D Email: rimawan@ugm.ac.id |
|
11.45am |
Lunch Break |
Session 5: The way forward and scoping review of PHI (Dr April)
|
Time |
Topic |
Speaker |
|
2.00pm |
Dr April-special session on PHI (earlier before panel) 30 min. |
Research Assistant Professor aprilwu@cuhk.edu.hk |
|
2.30pm |
Regulations in nurturing private health insurance and private providers. |
Prof. Dr. Laksono Trisnantoro, |
|
3.00pm |
The use of private health financing in supplementing national health insurance. |
Prof Dr Sharifa Ezat Wan Puteh Professor in Hospital and Health Management |
|
3.30pm |
Voluntary PHI and Universal Health Coverage (UHC): Thailand’s healthcare |
Asst. Prof. Chantal Herberholz, Email: Chantal.H@chula.ac.th |
|
4.00pm |
Tea Break |
|
|
4.10pm |
Panel discussion on healthcare financing, benefit packages, sustainability of care? |
All speakers |
|
4.30pm |
Shanghai, Manila present proposal for future workshops. |
|
|
5.00pm |
Closing and Awards of Certificates. |
|
|
8.00-10.00pm |
Participants’ Dinner |
|
The amount of payment : USD 200 (international participants) and USD 150 (for Malaysians)
Payment to ANHSS account details:
Account Holder Name: Asia Pacific Network For Health Systems Strengthening Limited
| Address | : 2/F, School of Public Health Building, 30-32 Ngan Shing Street, Prince of Wales Hospital, Shatin, New Territories, Hong Kong |
| Account Number | : 44719019993 (USD SAVINGS A/C) |
| Bank Name | : Standard Chartered Bank (Hong Kong) Limited |
| Bank Address | : Payment Centre, 15/F Standard Chartered Tower, 388 Kwun Tong Road, Hong Kong |
| Swift Code | : SCBLHKHHXXX |
The Registration Link is at https://bit.ly/ANHSS2025-Malaysia and receipt of payment to be made to ITCC at Siti Hajarni at
casemix@hctm.ukm.edu.my
Office Nu : +603 9145 8401
Fax Nu: +603 9145 6670
Running of workshop will be based on 20-25 minutes lectures, followed by a short QA after. The sessions are structured into 5 sessions that dominate the topics in the session. A hybrid session will be done during workshop.
Accommodations nearby workshop venue will include:
- IYC hostel Cheras my/international-youth-centre-iyc/
- Komune Living at Komune Living Komune Living
- Zecon Hotel (within HUKM vicinity) Zecon Hotel website – Kuala Lumpur hotel
