The recent notification letters from a specific Third-Party Administrator (TPA) alerting general practitioners (GPs) about the commencement of an “administrative” fee from July 1 this year are causing major concern, not just among the impacted GPs, but will also have repercussions for everyone in the country.
The fees range from RM150 to RM1,000 per month, depending on the volume of patients and revenue provided by the TPA.
For over three decades, TPAs have been offering outsourced administrative health care services to both corporates and insurance companies.
They promise their clients relief from administrative tasks for a fee and also claim to “manage” the costs associated with health care services by “partnering” with GPs and hospitals. Their primary purpose is to serve these client groups.
However, some TPAs have started charging medical professionals as well, justifying it by claiming they provide services to doctors too. This action conflicts with the regulations under the Private Healthcare & Services Act 1998, which prohibits medical professionals from contracting with parties that supply patients to them.
Despite these regulations, TPAs circumvent the rules by labelling these charges as “admin” fees.
The medical community has raised concerns about this issue with various regulatory bodies, but little progress has been made.
Meanwhile, TPAs have expanded their operations, introducing additional financial schemes that require GPs to pay for patients referred to them. Some have become even bolder, by charging a “registration fee” for any new GP clinic which wishes to be their panel provider.
Imagine having to pay RM5,000 just to be listed as a panel clinic, without any benefit apart from potentially being accessible to the lives covered under their programme.
Further, TPAs have begun imposing restrictions on reimbursements to GPs and questioning the validity of doctors’ treatment protocols. Even after nearly 30 years, some TPAs and insurers have not adjusted their consultation rates fairly, with some rates as low as RM15 per consultation.
Lately, TPAs have now restricted GPs from dispensing long-term medications, and have instead partnered with retail pharmacies to take over that role, further complicating the situation.
By justifying these actions as necessary due to rising business costs, including IT upgrades, TPAs are shifting the financial burden onto doctors instead of passing these costs to their actual clients, namely the companies and Insurers.
But, in doing so, they are propagating a very dangerous practice of patients continuing their long-term medications unabated, and unmonitored for potential side effects and effective control of their chronic illnesses.
The escalating costs, coupled with the inability of GPs to pass them on to the users of their services are pushing many practices to the brink of closure.
With over 50 TPAs competing based on cost and strict expenditure controls, they are now turning to doctors to generate additional revenue through methods that bypass regulations, rather than pass those costs back to their actual clients and beneficiaries of their services – the corporates and insurers.
The current situation has pushed the primary health care industry to a critical juncture, facing potential extinction. If not addressed promptly and this time, effectively by the authorities, general practitioners in the country may not survive this decade.
The reliance on TPAs by a vast majority of employers and patients has created a scenario where GPs must be their panel providers to survive, posing a threat to the sustainability of the health care system.
Without private GPs, Malaysians will have to seek their health care from the already-stressed and over-crowded public system, further worsening the situation.
Suffice to say, this is not merely a private GP’s problem; it is a national crisis, and it will affect every single person residing in this country.
Unless regulatory bodies intervene to address this crisis and ensure equitable treatment for all stakeholders, including the GPs, there is a looming health care catastrophe on the horizon, jeopardising Malaysians’ access to immediate and essential health care services in the future.
To those authorities, namely the Ministry of Health, Bank Negara Malaysia, and the Malaysian Medical Council, we plead and urge you to look into this matter with the utmost of urgency, before it is too late.
The author is a private medical professional. CodeBlue is providing the author anonymity because the author fears reprisal from TPAs.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
