Health Minister Can U-Turn Unless Parliament Approves Doctors’ Fee Deregulation

By Vinodh Pillai | 15 January 2020

Amend the law so the decision to deregulate private medical practitioners’ consultation fees won’t be overturned in future, urges Dr Milton Lum.

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KUALA LUMPUR, Jan 15 — Without a legal amendment passed in Parliament, private medical practitioners may not be guaranteed the freedom to set their consultation fees despite the government’s deregulation announcement.

Veteran physician Dr Milton Lum noted that there has been no mention of removing Sections 106 and 107 of the Private Healthcare Facilities and Services Act (PHFSA) 1998, which gives the health minister of the day the powers to amend fee schedules in PHFSA or to enact new regulations.

“This is a matter of law,” the former Malaysian Medical Association (MMA) president told CodeBlue, following Cabinet’s landmark decision to deregulate private general practitioners (GPs), dentists, and specialists’ professional fees, 13 years after they were legislated in 2006 with rates set in law by the federal government.

Dr Lum urged Health Minister Dzulkefly Ahmad to go to Parliament and remove Sections 106 and 107 of the PHFSA as the law was legislated by its two houses, adding that Dzulkefly’s statements so far on the deregulation decision have been “imprecise” by not mentioning whether the government would abolish the two sections.

“He makes no mention of whether Section 106 (of the PHFSA) is to be removed,” Dr Lum said.

“If it is not removed, then Section 106, which provides that the minister may put up a fee schedule, will hang like a Sword of Damocles over the health care providers.”

Dr Milton Lum, former president of the Malaysian Medical Association (MMA)

“The law is there what. Today I remove it, this schedule. There’s no schedule today, (but when) someone down the road, one year, two year, six months whatever, decides, ‘I think we need the schedule lah’, he can put it back,” Dr Lum added.

Under Schedule 7 of the PHFSA, private clinic GPs and dentists’ consultation fees are capped at RM10 to RM35, and RM25 to RM250 respectively. Under Schedule 13, private hospital specialists’ consultation fees are legislated at a rate of RM80 to RM235.

Some 7,000 clinic GPs in the country have long demanded that their rates be harmonised with their hospital-based counterparts, whose consultation fees were increased in 2013 to RM30 to RM125.

Section 106(2) of the PHFSA states that the health minister may, from time to time, after consulting the health department director-general, amend the fee schedule by order published in the gazette.

Section 107(1), on the other hand, states that the health minister may make such regulations as appear to him or her necessary or expedient for carrying out the provisions of the PHFSA.

It will take one to six months before GPs, dentists, and specialists in private clinics and hospitals are free to set their own consultation fees, after a regulatory impact assessment is carried out, followed by stakeholder engagement sessions, and the vetting of the proposed changes by the Attorney-General’s Chambers (AGC).

Dr Lum predicted a six- to 12-month period of trial and error before things start to cool down, after the deregulation decision kicks in.

Dr Lum, meanwhile, slammed the Ministry of Health (MOH) and Dzulkefly for calling for town hall sessions to discuss the matter, and asked what its purpose was.

The former president of the Federation of Private Medical Practitioners’ Associations of Malaysia (FPMPAM) questioned if the decision to have a town hall, as announced by Dzulkefly in his first public statement on the matter, was to inform stakeholders of the decision, or to seek feedback on whether the ministry should deregulate the fees or not.

“I think imprecise is probably a polite adjective lah. If you really want to be frank, it is confusing.

“I mean, you think I’m going to remove, I’m going to deregulate, yet you say I’m going (to have a) townhall, I’m going to remove the schedules, but you make no mention of the section in the Act. So, what are we up to?

“Until the minister comes up with more precise statements, I think the jury is still out,” he added.

Separately, Dr Lum questioned Dzulkefly and MOH on requiring private hospitals to inform patients of their consultation fees, noting that there are many different types of fees when patients seek treatment at private hospitals.

Dr Lum, a gynaecologist by training, spoke of a provision in PHFSA and its regulations that require the health care provider to inform a patient about the estimated costs of treatment, before commencing investigation and treatment.

Regulation 27(1)(a) of PHFSA on private hospitals and other private health care facilities regulations states: “The licensee or person in charge of a private health care facility or service shall take reasonable steps to ensure that a patient is provided with information about the nature of his medical condition and any proposed treatment, investigation or procedure and the likely costs of the treatment, investigation or procedure.”

“The medical profession has asked the ministry for years to enforce this on the private hospitals. It has not been done,” said Dr Lum. “So, the ministry’s silence on that raises some confusion.”

“You go to the website of the Singapore hospitals, whether private or restructured, they will have on their websites the estimated fees, or maybe the 10 common procedures, 10 costs of admission, so people have an idea (of how much these will be).”

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