The Private Health Care Facilities and Services Act contains two Regulations – one for clinics; and another one for private hospitals and other facilities.
The fees doctors can charge are found in Schedule 7 in the former and Schedule 13 in the latter. Schedules 7 and 13 contain fees for general practitioners (GPs) practising in clinics and hospitals respectively.
Any change to the Regulations has to be gazetted.
Amendments to fee schedules
The doctors’ fees were reviewed and approved by the previous government in 2012 after protracted discussions by the Fee Amendment Committee of the Health Ministry.
The change in the GPs consultation fees was reflected in the Director General of Health’s press statement on 6 March 2014 (see also below) in which he stated “It was noted that the consultation fees was increased from a range of RM10-RM35 to RM30-RM125 for general practitioners. It was agreed after much deliberation on the quantum imposed in relation to the services provided and taking into account of the rental costs at different locations of the facilities that varies greatly. In addition, the duration of a consultation may vary from 5 mins to an hour or so depending on cases and complexity coupled with the variable level of expertise, competency and different types of clinical examination. Allowance was given to cap the upper or maximum range one can be charged.”
Amended Schedule 7 was not gazetted
The amended Schedule 13 was gazetted on 10 October 2013 but the amended Schedule 7 was not.
The effect was disparity between the fees of GPs practising in clinics and those in hospitals i.e. higher fees for the latter, who, in general, have fewer years of experience than those practising in clinics.
This is the first time that an inconsistency in a healthcare law was created.
The Malaysia Productivity Corporation reported that the Health Ministry bureaucrats stated in an interview with them on 26 April 2016 that “the difference occur because of Seventh fee schedule was not revised when Schedule Thirteenth was revised in 2013.” (refer page 106 of the report)
This raises the question as to whether the bureaucrats knew that there were many more GPs practising in clinics than in private hospitals and whether they knew that there were Schedules 7 and 13.
Further questions are inevitable if they claimed that they did not know or if they knew but did not gazette the amended Schedule 7 at the time that the amended Schedule 13 was gazetted.
The omission was pointed out to the Health Ministry but nothing was done so much so the amended Schedule 7 has still to be gazetted 5 1/2 years later. The non-gazettement of amended Schedule 7 raises the inevitable question as to whether unseen hands were involved.
The public and all doctors, particularly GPs, are owed an explanation of how and why this gross omission occurred.
To date, there has been a deafening silence.
The Health Minister announced that he had handed a memorandum on the “harmonisation” of Schedule 7 with Schedule 13 to the Cabinet on 24 April 2019 and that the Cabinet had recommended that the matter be discussed at the National Cost of Living Council meeting after which the matter would be brought up again for the Cabinet’s consideration.
The statements that the GPs are asking for a new increase in their fees is a gross distortion of the facts and a crude attempt to cover up a bureaucratic failure, for which no one has taken responsibility.
The use of the term “harmonisation” was, to say the least, inappropriate and, at worst, misleading.
Was the Cabinet informed of the facts? Was the Cabinet misled? Why was the Cabinet’s precious time spent revisiting part of a decision that had not been acted upon by the Health Ministry’s bureaucrats?
Implications of non-gazettement of amended Schedule 7
Out-of-pocket payments to GPs practising in clinics have been and will continue to be subject to market forces. As such, it is very improbable that gazettement would have led to an increase in patients’ out-of-pocket payments. Any such claim is pathetic and a crass attempt to cover up an administrative bungle.
GPs practising in clinics have lost out since 2013. Payments from insurance and managed care companies and employers have been based on the 2006 Schedule 7, which in turn was based on a Malaysian Medical Association fee that is currently 27 years old.
Reports of GPs practising in clinics being reimbursed RM10 by managed care companies for an initial consultation are disturbing. Even tradesmen get at least RM50 for attendance nowadays. The GPs’ situation has been aggravated by delays in payments and even non-payments. It is no surprise that many clinics have closed.
Have insurance and managed care companies as well as employers benefited from the paltry fees of GPs practising in clinics? Have shareholders of insurance, managed care and other companies also benefited?
There is no published data that patients whose fees are paid by their employers and/or insurance and managed care companies have benefited.
There is a cost to healthcare and when reimbursement is so low, how can safe and quality care be expected?
The strong undercurrents among doctors, particularly GPs, are reflected in the postings and statements in the mainstream and social media.
A Kedah GP wrote “The morale and livelihood of the GPs is very low nationwide. This is the real picture at grass root level. They change the BN government because they expect new government will listen and do the best for the rakyat (doctors also rakyat). At the end when we voice out, we were told either take it or leave it!”
A Klang Valley specialist wrote “The strategy is to starve the GPs using restrictive regulations and quasi regulations by MCOs etc to prepare the ground work for what was called 1Care…The old guoman 1Care is still very much unchanged. Different names by different guomans.”
The Health Minister’s call to the GPs “Let’s work together and move forward” is meaningless if amended Schedule 7 is not gazetted without further delay.
It is only proper and honourable to rectify an injustice that GPs practising in clinics have endured for 5 ½ years.
Dr Milton Lum is a Past President of the Federation of Private Medical Associations, Malaysia and the Malaysian Medical Association. This article is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation the writer is associated with.
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