I refer to your article What Matters to Malaysians in Health Care, published in Code Blue on 4 March 2019
Consult the Patient
The Federation is of the opinion that the patients who are the eventual payer and recipient of our healthcare system are the most important stakeholders. Their views, needs and expectations must be considered in all the various measures taken to improve healthcare delivery.
Use our GP system
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 times for patients, among which were:
- Increasing hours for government out-patient-department (OPD) clinics to 10 pm
- Using accident & emergency departments (A&E) as OPD clinics after office hours
- Posting more doctors to OPD clinics.
- Setting up of 1Malaysia clinics manned by para-medics
- Sending medicines to patients by post
- Encouraging self-diagnosis and self-medication
In the past, the private general practitioners (GPs), despite accounting for only 40% of the outpatient healthcare providers were able to see up to 60% of the outpatient load. Instead of improving on this performance, all these quick-fix measures have resulted in the opposite outcome.
Patient GP loads have fallen and many GP clinics are closing due to the cost of over-regulation, micromanagement and the boom of the middle-men business in healthcare.
Maintaining the social contract between the doctor and patient is paramount and is reflected in close patient-doctor interaction and caring and compassionate care.
Today, commercialised contracts of the middle men with their various medical cards, exclusion clauses, differential entitled benefits, guaranteed letters and pre-assessment documents have taken over.
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.
To lessen cost, sending the patient to the GPs near their home makes common sense and is economically the correct solution like what is already being done is a neighbouring country very much like the Peduli Sihat scheme in Selangor.
Based on a previous study in 1986 by the Ministry of Health, the cost of per patient-doctor encounter in the private GP clinic (RM 28 per patient) is way below that in the government clinic (RM56 per patient). We are certain a repeat study today will show the similar result.
In the PEKA B40 (Skim Peduli Kesihatan B40) programme, using the GP network to be mere data collectors and then requiring patients to be sent to government clinics for treatment is a sheer waste of the potential of our GP system. It will further worsen the over-crowding in the government clinics.
For a meaningful private-public partnership in our primary healthcare delivery, the strength of our GP system should be nurtured and efficiently utilized to ease outpatient waiting time. The hundreds of millions used for the 1Malaysia clinics and the PEKA B40 program should instead be channelled to subsidise medical care for the needy at GP clinics nation-wide.
The Global Conference on Primary Health Care in Astana, Kazakhstan in October 2018, reaffirmed PHC (primary healthcare) and stressed its pivotal role in achieving UHC (universal health coverage). Since before independence, private GPs have contributed to the success story of Malaysia’s UHC.
Private hospital cost
There is clearly a great disparity between costs paid by the patient for care in public hospital versus the private hospital. However it must be remembered the actual cost of care in the public hospital is not quantitated and the bulk of this cost is paid by the taxpayer. The cost of wastage and redundancy have yet to be computed into this cost.
Based on available data from MOH studies, usage of pubic hospital facilities is not optimum with some hospitals showing Bed-Occupancy Rate (BOR) of less than 25 percent and some even more than 100%.
All private hospitals should display not only their room rates but also the estimated cost of all common medical and surgical procedures and investigations.
This is already done in many neighbouring countries. It helps patients make informed choice. This is a good first step and should be implemented immediately. With free-market forces and open competition, prices in private care are likely to fall in time.
Regulating private hospital charges is unlikely to happen as the regulator, the government itself, is in the business of healthcare via its extensive network of GLC-owned hospitals.
Dr. Steven KW Chow is president of the Federation of Private Medical Associations Malaysia
- This is the personal opinion of the writer or publication and does not necessarily represent the views of Code Blue.