Doctors: Peka B40 Using Us To Feed Insurance Companies Data

Insurance companies can then identify who to exclude from coverage.

KUALA LUMPUR, Sept 6 — A physicians’ group suspects that private general practitioners (GPs) are being recruited for the Health Ministry’s Peka B40 health screening programme to collect information for insurance companies.

Insurance companies can then use the data to deny coverage to people with pre-existing conditions, or health problems before purchasing a policy, the Federation of Private Medical Practitioners’ Association, Malaysia (FPMPAM) alleged.

The Finance Ministry’s mySalam health protection scheme for the bottom 40 per cent of income earners (B40), which is administered by Great Eastern Takaful Berhad, doesn’t provide its key RM8,000 lump sum cash benefit to Malaysians diagnosed with critical illnesses before January 1 this year.

Pakatan Harapan has also hinted at adopting some form of social health insurance to boost Malaysia’s increasingly unsustainable tax-financed health system.

“I don’t 100 per cent agree that Peka [B40] is actually a good thing,” FPMPAM president Dr Steven Chow told the Second FPMPAM Malaysian Health Care Conference here last Saturday.

“They’re using GPs to be data collectors. You don’t want them to treat, you just want them to collect the data so that this data can be sent back to the insurance company. You know who they exclude from mySalam, isn’t it? Am I correct? It’s as simple as that.”

The Peka B40 programme is meant to be driven by private GP clinics, rather than overcrowded public health clinics, to provide free health screenings to the B40 aged 40 and above, paid for by the Health Ministry.

But if test results are abnormal, private GPs are expected to make referrals to government facilities, instead of treating their own patients. Those who want treatment at private clinics must pay for it themselves.

FPMPAM honorary secretary Dr G. Shanmuganathan pointed out that mySalam has only made over RM1 million in payouts so far since its launch last January, even though the government is paying Great Eastern about RM400 million in premiums annually. The Singapore-based insurance company is contributing RM2 billion to the mySalam fund for five years.

“When they get this data, then they will have a lot of information on who has got pre-existing diseases. ‘Before you came into this scheme, you already had this, this, this. Rejected’. Because it’s insurance. That’s our suspicion.

“They can’t get the data themselves, so they’re using the GP population,” Dr Shanmuganathan alleged.

He also said very few solo GPs or small group practices joined the Peka B40 scheme, claiming that the majority of the health care providers were private clinics in rural areas in Sarawak and public health clinics.

The Health Ministry’s payments of RM40 for the first visit and RM20 for the follow-up visit, he said, were too low for the amount of work GPs were expected to do, such as getting B40 patients to come in, performing various tests like breast and prostate examinations, and blood tests, and keeping records.

“Then they gave us a ‘take it or leave it’ fee. We thought if we accepted that fee, which is against the Schedule 7 even, then we’re only failing the members by agreeing to something which we’re fighting against,” Dr Shanmuganathan said, referring to the regulation that caps private clinic GP consultation fees at RM10 to RM35.

He said Peka B40 was initially considered a good programme because it served the poor.

“But subsequently, when we saw the big scheme of things — we’re being used.”

Health Minister Dzulkefly Ahmad revealed last month that the RM100 million Peka B40 pilot project has so far screened only 40,119 people since its April launch, just 5 per cent of this year’s target of 800,000. This led the ministry to widen the programme to 40-somethings, from the initial minimum age of 50.

The highest number of Peka B40 screenings was conducted in Sarawak with 9,852 people, followed by Kedah (6,324), Penang (4,582) and Perak (4,209).

You may also like