Mandatory Prescription – Don’t Be Misled, It’s All About National Health Insurance And National Health Financing — FPMPAM

The pharmacist may have the theoretical knowledge of the side effects of any particular medicine; so do the doctors.

The FPMPAM is in full support for improving patient safety.

However we have great reservation on the data cited by Malaysian Pharmaceutical Society (MPS) president Amrahi Buang. Are these statistics from the private sector or the public sector?

We are of the information that this was mainly from statistics collected from prescriptions in government facilities, in which case this is clearly a mischievous attempt to mislead the public and the policy-makers. We think it is important that the actual data be made available for open independent analysis.

Medical care has now progressed from just curative medicine to preventive medicine and in the area of curative medicine, from just diagnosing and treating a condition to diagnosing, treating and also providing counselling.

It is in this area of counselling that a lot can be done to improve patient care, especially patient safety. Today, doctors are spending more and more time to counsel patients on their illnesses, and their treatment, enquiring about their background of medical history and discussing with the patient their treatment regimes. If drugs are needed, also their usage and side effects.

In this 21st century age of information and the internet, even if the doctor forgets to mention, the knowledgeable patient will ask. This is one way to improve patient safety: “Talking to your doctors”.

That is also why we are concerned about this recent call for mandatory prescription (“Demand “rather than request) and to divert dispensing to selected pharmacies.

Should this government be so silly as to do that, it invites trouble. Asking a mother or family to go searching for a pharmacy at 2am on a rainy morning with a febrile wailing child is ridiculous, bordering on irresponsibility, when their doctor just sitting in front of him can explain and commence the medications and the reasons why, and the effects and side effects.

The pharmacist may have the theoretical knowledge of the side effects of any particular medicine; so do the doctors. But which medication is important for a particular patient, suitable for his present state of health and illness, only his caring doctor knows, unless the government is of the view that all patients are the same and all illnesses are the same and one size fits all.

The current system of prescribing and dispensing allows for choice.

The patient may wish his caring doctor to dispense. Should he not wish to, but wish his neighborhood pharmacy to dispense, he should be allowed the choice. This is the patients’ right, not the right of the pharmacist or the doctor.

Exclusivity breeds monopolistic business practice and is bad for patients. Free informed choice is what patients want. We are certain that this is what the patient wants, although it may not be what the pharmacists want. If in doubt, why not hold a national referendum on this?

Freedom of choice will enhance patient care and patient safety.

It is important to note that the doctors themselves already have a written Guidelines on Dispensing in the Code of Professional Conduct of the Malaysian Medical Council. These guidelines are comprehensive, crafted in line with existing laws, enforceable and more than sufficient to cater for the important provision of patient safety. This misplaced call for mandatory prescription is clearly out of time.

For it to be mandatory, it must be prescribed in law.

It is also important to differentiate whether the request or the demand is verbal or in writing and signed. For the mental peace and comfort all the practitioners, all and any request must be in writing, signed and witnessed. Doctors and patients would not want to spend their precious time in court arguing on whether a request or demand was made.

Is this the way forward for medical care in Malaysia?

It is important that the lobbyists for this be cognisant of the narrow path that they are driving the care of patients into.

The sanctity of the patient-doctor relationship must be preserved at all times. It is a time-tested social contract. The day you turn this into a business contract is the day you do away with the humanity of medical care.

Thereafter, it shall only be BUSINESS only! It is retrogressive, fragmentation of care and the patient is put through all the inconveniences and end up paying more for less care.

Already, because of the Private Healthcare Facilities and Services Act (PHFSA) 1998 and its Regulations 2006, the cost of setting up a private practice have skyrocketed from about RM30,000 in 1980s to about RM300,000 today and the government expects the shop house GPs to continue with RM10 to RM 35 per consultation. Common sense tells you that this is not a tenable situation.

If this continues, this Pakatan Harapan (PH) government shall be known in history as the one responsible for the death of compassion in medical care in Malaysia. The disappointing experience of the first year’s performance in its Peka B40 and mySalam initiatives is a harbinger of things to come.

The many overwhelming rules and regulations are toxic to the existence and mutual trust of our time-proven, cost-effective compassionate patient-centric one-to-one doctor-patient encounter that generations of Malaysians have grown up with.

Importing the cold-rigid inflexible system of rationed and commercialised care from the US or the UK is a sure recipe to bankrupt our health care budget big-time and to drive it into the hands of commercial insurers and middle-men.

Let’s be frank. The real issue today is not the ceiling-pricing or mandatory prescription, but the hidden drive for a single-payer national health insurance (NHI) and national health financing (NHF). Doctor-bashing is a well-tested populist modus operandi for this.

How much the rakyat need to pay for this and the “devil is in the details” is not brought out for public discussion. This was an agenda left unfinished by the previous administration. Our present PH leaders, in 2012, when they were not in government, had noted that our current system has served well, providing many generations of Malaysians with an affordable, patient-centric and universally accessible healthcare.

The previous administrations did not seek sufficient public referendum on this. Sadly, the present government is carrying on with business as usual.

In this intense head-over-heels drive to implement NHI/NHF our plea is, “please don’t throw away the baby together with the bath water”.

What ails Malaysian health care is basically a lack of sufficient funding and the massive financial hemorrhage of the system of the past.

However, with about 4 per cent of GDP, we have done remarkably well for our citizens.

Healthcare improvement and innovation with greater public–private integration, of course, is greatly welcomed. We would like to emphasise that retaining a two-tier system of public-private health care is crucial to a successful health care system for Malaysia. It provides for a check and balance on each other and also gives the “rakyat” a choice. This promotes healthy competition and no one is left out without the care that he or she needs.

Having just a one tier system, single-payer (like NHS-UK) would be a step backwards, as the public has less choice, pay more taxes and when that one system fails (as evidenced in the UK now), many have gone on to buy their own private insurance anyway. It ends up with a two-tier system eventually.

It can be predicted that in 30 years we will end up with what the UK system is today — plagued by rationing of care, cherry-picking by insurers, payers and middle-men, long waiting list for tertiary and even primary care and increasing cost with less care for the tax-paying rakyat.

Dr Steven KW Chow, Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) president

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