Despite Fee Deregulation, Doctors Still Oppose Medicine Dispensing Separation

By CodeBlue | 12 December 2019

Separating the prescribing and dispensing of drugs to doctors and pharmacists can only happen in a national health financing system, MMA argues.

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KUALA LUMPUR, Dec 12 — The Malaysian Medical Association (MMA) still doesn’t support separating the prescribing and dispensing of medicines to doctors and pharmacists respectively, despite the deregulation of physicians’ professional charges.

The country’s largest association of doctors said various health stakeholders had agreed back in 2015 that dispensing separation could only come about in a national health financing system, or a single-payer system.

A single-payer system means health spending is primarily made by the government, rather than the current multi-payer system that sees health care payments made by the Health Ministry, the Education Ministry, other federal agencies, private insurance, corporations, and people’s own out-of-pocket payments, among others.

“It’s not only the consultation fees. We’re talking about government structure, how they’re going to do that. What about the restriction? What is the audit trail? Will there be a duplication? Will there be fraud in the prescription? Who’s going to audit that? So there are lots of factors involved.

“So MMA will only support only when we have a single-payer system, which was agreed upon by all parties,” MMA honorary general secretary Dr R. Arasu told radio station BFM today.

The physician also said there must first be an electronic medical record (EMR) system that integrates patients’ medical histories between public and private health facilities, pharmacies, and general practitioner (GP) clinics.

“We must make sure the building blocks are in place,” said Dr Arasu. “Until then, dispensing separation is not feasible.”

The Health Ministry recently tried to criminalise non-compliance of mandatory prescriptions upon request, but was forced to postpone subsequent readings of the Poisons (Amendment) Bill 2019 in Parliament to next year after physicians’ and dentists’ groups expressed outrage against proposals of incarceration and fines for rejecting patients’ prescription requests.

The Pakatan Harapan (PH) administration made a surprise announcement recently that GPs, dentists and specialists in private clinics and hospitals would be free to set their own consultation fees, 13 years after the professional rates of private medical practitioners were first regulated by legislation.

Clinic GPs had long been demanding that their consultation charges of RM10 to RM35, a rate set since 1992, be increased to their hospital-based counterpart rates of RM30 to RM125.

Dr Arasu assured Malaysians today that the total encounter fee in private clinics would either remain the same or only see a “marginal increase”, despite the deregulation of family doctors’ professional charges.

“So what we foresee is that the medicine price will be reduced and the doctors will start charging appropriate consultation fees for the services they actually providing for the patients.

“And the other important thing we need to understand, 80 per cent of the patients that patronise the GP clinics — these are all our regular patients, some of them we know two generations, some of them three generations, whole family comes to see us, so we are very very cost-sensitive.”

Dr Arasu also pointed out that the deregulation of family physicians’ consultation fees would encourage GPs to provide other health services, like preventive counseling.

“Under the current consultation fee, there is no motivation or incentive to provide these.”

Dr Arasu praised Health Minister Dzulkefly Ahmad and PH for their “bold” decision to deregulate private medical practitioners’ consultation fees, which he said would increase competitiveness and lead to value-based health care.

“So, basically, what is going to happen is that the consumers will decide where they get the best value-based health care they’re looking for.”

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