THE Federation of Private Medical Practitioners’ Associations, Malaysia refers to the announcement by the Health Ministry (MOH) on mandatory price labelling for GP clinics (The Star/CodeBlue dated Nov 12, 2024).
We fully support the effort of the government to address the issue of the rising cost of living and also the escalating cost of healthcare in private hospitals.
It has already been shown that this escalation is the result of private hospital charges and not the fees paid to the specialist doctors.
The same applies to GP practice. The GP consultation and medications are one of lowest in the region. This basic medical service is available, affordable and accessible to all who do not wish to use the public facilities.
MOH’s policy should be to nurture and support our GP system for the welfare of the patients and not to stifle it with endless unproductive and unnecessary regulations.
The Report of the Malaysia Productivity Corporation has also clearly indicated that the practice of medicine in Malaysia is already over regulated. Such unwarranted regulations not only increase cost and decrease accessibility but will endanger the quality of care to the patients.
This particular price display regulation will be no different.
What we are now seeing today are the results of the many quick-fix measures used in the failed attempts to solve the problem of long waiting time for patients among which were:
- Increasing operation hours for government OPD clinics to 10 pm;
- Using A&E as OPD clinics after office hours;
- Posting more doctors to OPD clinics;
- Setting up of 1Malaysia clinics manned by paramedics;
- Sending medicines to patients by post and now e-pharmacy; and
- Encouraging self-diagnosis and self-medication.
The consultation cost of seeing a GP for treatment has remained static for the past 20 years. The MOH had failed to update the GP fee schedule and took the erroneous step to deregulate GP fees without a replacement leaving a regulatory vacuum which is now being exploited by middlemen.
In the past, the private GPs, despite accounting for only 40% of the outpatient healthcare providers, were able see up to 60% of the out-patient load. Instead of improving this performance, all these quick-fix measures have resulted in opposite outcome.
GP patient loads have dropped and many GP clinics are closing due to the cost of over-regulation, the micromanagement and the boom of middle-men business in healthcare.
The patients are now crowding up the public facilities creating a situation that is worse than before. The waiting times are even longer.
Maintaining the social contract between the doctor and his patient is paramount and is reflected by the close patient-doctor interaction and caring-compassionate care.
Today, commercialised contracts of the middlemen with their various medical cards, exclusion clauses, differential entitled benefits, guaranteed letters and pre-assessment documents have taken over the system.
This new trend prioritises compliance to administrative guidelines, which directly and indirectly increases cost, at the expense of personalised patient-centric medical care.
Our private GP system is a time-proven, efficient and cost-effective system and should be used to ease outpatient congestion in all public facilities leaving the government hospitals to focus on secondary and tertiary care.
Based on a previous study in 1986 by the MOH, the cost of per patient-doctor encounter in the private GP clinic (RM28 per patient) is way below that in the government clinic (RM56 per patient). We are certain a repeat study today will show similar result.
It is time for the MOH to get its act together. The public sector is in a mess and now its policies are messing up the private sector as well.
In the meantime, as a relief measure to alleviate the problems of the unrevised Schedule 7 Fees, FPMPAM advises members to institute a REGULATORY COMPLIANCE CHARGE (RCC) in their billing.
This charge will help recover, to some extent, expenses as a result of the many mandatory pressures on the GP and Specialist practice where they are required to comply to regulations, without the cost factor and professional and administrative time to the practitioners and clinic staff being considered.
These are some expenses loaded on to the aggrieved practitioners:
- Compulsory medical indemnity
- PDPA annual fees
- Notification of Diseases administrative cost
- Cost of data provision that has so far been given free by the GPs
- Clinical waste fees
- Expired drugs disposal fees
FPMPAM advises members to begin with a minimum charge of RM20 for this Regulatory Compliance Charge, with review to be done from time to time. For MCO patients, they are advised to collect directly from the patients.
For panel patients, members should bill them accordingly. With further new regulations imposed, the RCC charge will be adjusted accordingly. – Nov 18, 2024
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