GP Fees Still Depend On Consultation Length Even If Raised, Doctors Say

Over 300 GP clinics shut down last year.

KUALA LUMPUR, June 14 — Even if clinic general practitioners’ (GPs) fees are increased, their charges will still depend on the length and complexity of their consultation, the Malaysian Medical Association (MMA) said.

The doctors’ group said if the consultation fees of private GPs operating shop lot clinics were to be harmonised with their hospital-based counterparts from the former’s 27-year-old rate of between RM10 and RM35 to the latter’s rate of RM30 to RM125, RM30 to RM50 may be charged for simple consultations (up to 10 minutes), RM51 to RM80 for intermediate consultations (up to 20 minutes), and RM81 to RM125 for complex consultations (more than 20 minutes).

“We wish to also reassure the public that even with the harmonisation of fee schedules, the B40 (bottom 40 per cent) segment will still be charged affordable fees,” MMA president Dr Mohamed Namazie Ibrahim said in a statement.

“Easy accessibility, overcrowding at hospitals, shorter waiting time and lower fees are reasons why most people would prefer to go to a clinic for health checks or treatment of minor health issues, but the current fee schedule is making it almost impossible for GPs to continue operating their clinics. Last year alone, over 300 clinics in the country had closed down.”

Health Minister Dzulkefly Ahmad refused to commit at a town hall meeting with GPs last Tuesday to a timeline to revise clinic GPs’ consultation fees that have stagnated since 1992.

Instead, the Amanah leader simply told doctors to wait for the economy to improve, claiming that the matter was just a “question of timing”.

Dr Namazie accused third party administrators (TPAs), who manage health care plans for employees or the insured, of “stinging” on GPs’ fees while paying high fees at private hospitals.

“And the government is playing along with delaying the harmonisation even though the Ministry of Health has agreed that harmonisation is indeed necessary,” he said.

“GPs in the country have been subsidising the health care of large and profitable corporations which have engaged the Third Party Administrators (TPA). These TPAs suppress the GP fees to make a profit for themselves.

“Several foreign TPAs have come in to feed upon this lucrative business,” added the MMA president, citing state sovereign fund Khazanah Nasional Berhad that sold a TPA to a foreign investor.

Federation of Private Medical Practitioners Associations Malaysia (FPMPAM) honorary secretary Dr G. Shanmuganathan said at Dzulkefly’s town hall meeting that most managed care organisations (MCOs) paid GPs RM30 for consultation, except for AIA Health Services Sdn Bhd and MiCare Sdn Bhd that held doctors to “the letter of the law”.

“That is why it’s so important that Schedule 7 is gazetted because once that is done, everything falls into place,” he said, referring to the provision under the Private Healthcare Facilities and Services Act (PHFSA) 1998 that regulates clinic GPs’ fee structure.

Health deputy director-general Dr Rohaizat Yon told the town hall that the ministry hoped to come up with the first draft for a common contractual agreement between MCOs or TPAs with GPs by this or next month.

Dr Ahmad Razid Salleh, director of the Medical Practice Division at the Health Ministry, said the ministry was looking at pushing an amendment to Section 107 of the PHFSA so that the minister can draft a regulation to require the registration of MCOs.

He also told the town hall that fee splitting required three elements: kickbacks, the entities involved (medical practitioners, health care facilities, organisations, or individuals), and inducement to refer or to receive patients.

“If one element is absent for that matter, we cannot term it fee splitting.”

Dr Namazie previous told CodeBlue that some MCOs charge GPs a fixed fee per transaction, while others take between 5 and 10 per cent of the GP’s total bill to the patient, which may be construed as fee splitting.

Health official Dr Razid pointed out that doctors had a choice in whether or not to sign a contract with MCOs.

“If it is offered by the MCOs for RM5, or RM10, or less or more, things like that, if doctors sign up, that is an agreement between both parties that has to be honoured.”

Deputy Health Minister Dr Lee Boon Chye told the town hall that GPs should not be charging less than their minimum consultation fee.

“We should not sign a contract which allows us to charge less than the minimum because when we do that, we’re selling our profession.”

Some GPs have complained about MCOs who only pay them RM10 or RM15 for consultation, with one Dr Mahendran telling the Tuesday town hall that MCOs have “destroyed the GP”.

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