COMMENTARY, May 3 — We (the Federation of Private Medical Practitioners’ Associations Malaysia, FPMPAM) have polled our members and the highest performance rating that Health Minister Dzulkefly Ahmad seems to have gotten from our private sector colleagues across the nation was a “C” (average).
Can Be Better
1. It is the perception of the private medical fraternity that many of the big issues facing our health care system have yet to be acknowledged or addressed. At most times, it seems to be a continuation of the status quo repeating exactly what previous ministers in the previous government had been harping on all the years.
For example, with regard to the ongoing escalating problem of insufficient training posts for housemen and medical officers, it is clear that the primary problem which is overproduction is yet to be acknowledged and addressed. Instead, there have been announcements of the implementation of all kinds of fire-fighting measures, one after another, which have been shown to be woefully ineffective.
The answer clearly is for a common qualifying examination to be implemented with urgency as this will ensure that only those who pass will be eligible for registration and training. Sadly, the political will to implement what is clearly logical seems to be lacking.
2. The profession had waited for one Minister of Health after another to enact the regulations for Act 674. Pathology Laboratory Act 2007 which is essential for proper regulation of private laboratories and their business. It does look like this will also not happen. It is inconceivable how an Act passed in 2007 still remains dormant, twelve years after its passage through Parliament.
3. The escalation of the commercialisation of medical care is also not addressed. Practitioners are increasingly uneasy as this is escalating the cost of care at the expense of the quality of care given to the patients. The present disequilibrium of the over-regulation of the practice of medicine versus the under-regulation of the business of medicine does not augur well for the future health care landscape.
4. Over the past year, it was clear that on many occasions, the Minister has not been listening to the needs of the rakyat which were communicated through their doctors. It would have been good to seek clarification from all stakeholders on important matters and opinions that have been presented by the Ministry’s top management. This has resulted in some rather embarrassing media goofs.
In particular, the top-down approach in the implementation of the Peka B40 scheme and the lack of meaningful engagement with all relevant stakeholders was contrary to what was promised.
5. The call to utilise our cost-effective GP system to treat, manage and not just to do screening has not been taken seriously. It is our view that this would cost-effectively relieve the load at government hospitals and clinics, thereby decreasing waiting time and freeing the government facilities for secondary and tertiary care. The previous administration had just paid lip-service to this proposal and it does look like this will be the same with the present one.
6. There has been poor or no outcome of the meetings with the Minister and Ministry of Health on GP issues and a glaring lack of institutional memory of previous meetings and decisions.
For example, on April 24 2006, the Private Health Care Facilities and Services Act (PHFSA) and its Regulations were enacted and came into force. It was the promise of the Minister of the day that a number of specific provisions of the Regulations would be amended or removed within a year so as to avoid unnecessary micromanagement of medical practice in clinics. The amendments were finalised by the Amendments Committee that was formed by the Ministry that last met in 2008. Nothing has been heard about this since then.
Similarly, the Ministry of Health (MOH) seems to be dragging its feet on the long-overdue MCO Bill to regulate the managed care organisations (MCOs). Now, with the MOH itself having its own MCO, by the very definition of the PHFSA, how will it be possible for the regulator to regulate when it is also involved in the business of medicine?
Some Good Outcomes
1. There were some areas where our members felt that the Minister had achieved positive outcomes, namely securing more budget for health care, implementing smoke-free regulations nationwide and the formation of the National Health Advisory Council.
2. The Federation is glad that the issue of inequality and inequity of access to health care, especially affecting the indigenous and marginalised communities, has been taken heed of by the Ministry and there has been positive support by the Ministry for the medical outreach work to these communities by the Federation and other medical non-governmental organisations (NGOs).
Our Wish List For Next Three Years
1. For the rest of the term of this Government, we hope the ministry should focus on and implement programmes on “Population Health”. We believe this is the way forward as the focus will then be on the health of ordinary people, ie back to the basics which in the bigger picture will be translated as better, cost-effective and efficient health care. MOH should ensure that the priority of care should be based on urgency and need and not on ability to pay.
2. To improve our healthcare services to the rakyat, we call on the Pakatan Harapan (PH) government to increase the health care budget and spending to 6 per cent of GDP in keeping with what we realistically need.
3. We look forward to meaningful private-public partnerships. Better outcomes will be forthcoming when there is serious and meaningful effort to involve all stakeholders in policy formulation and implementation.
Dr Steven Chow, President of the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM)