Doctors Will Still Dispense Drugs Despite Fee Deregulation

GPs say their bundling — consultation, examination, medication — makes patient visits very affordable.

KUALA LUMPUR, Jan 20 — Despite deregulation of doctors’ consultation fees, physicians say they’re unlikely to stop dispensing medicines to patients who prefer the convenience of getting them from clinics.

Dr Raj Kumar Maharajah, president of the Medical Practitioners Coalition Association of Malaysia, said private general practitioners (GPs) would likely still keep dispensing medicines in their clinics because of treatment compliance and patient safety.

It was initially believed that following Cabinet’s landmark decision to deregulate private medical practitioners’ consultation fees, GPs would support separating the prescribing and dispensing of medicine to doctors and pharmacists respectively, because they would no longer have to rely on drug sales to sustain their business.

“Patients prefer a one-stop-centre as practiced for nearly a century now in Malaysia,” Dr Raj Kumar told CodeBlue. “It is convenient, cost-effective, and indirectly ensures compliance to medication as well.”

Even if doctors stop dispensing medicines at their clinics, Dr Raj Kumar said it will not affect pharmaceutical companies as patients will still have to get their medicines from pharmacies.

“Even though there will be lower drug sales to GPs and dentists, the sales will increase in pharmacies because patients still need to get their medications from somewhere.

“As long as there is a demand from patients, doctors will keep medicines in their clinics and do it as a social responsibility,” he added.

Under Schedule 7 of the Private Healthcare Facilities and Services Act (PHFSA) 1998, 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.

The decision to deregulate the fees will only be enforced after a regulatory impact assessment and stakeholder engagement sessions are carried out, following which the proposed changes to PHFSA would be drafted by the Ministry of Health (MOH), and then vetted by the Attorney-General’s Chambers (AGC). This could take one to six months.

The Federation of Private Medical Practitioners’ Association Malaysia (FPMPAM), meanwhile, spoke of the conventional and stable nature of the medical practice landscape, noting that it does not respond to disruptive forces as seen in most businesses.

“Whether with or without a fee schedule, sick patients will still continue to see their trusted doctor, and they will continue to see them at the same old cost, especially for those cash-paying and direct-company patients,” said FPMPAM president Dr Steven Chow.

“Over a period of time, the cost will gradually adjust in accordance to increased cost of living and running a practice,” he added.

“The cost of operating a practice with a one-stop pharmaceutical service will continue to be met by the margin from the dispensing of medications.”

Dr Steven Chow, president of the Federation of Private Medical Practitioners’ Association Malaysia (FPMPAM)

“Medication supply to GPs and dentists, especially the generics, will continue in its present trend,” Dr Chow said.

He said there may be some doctors who may not wish to dispense, but that this is a minority view.

Dr Chow also predicted that the medical profession would group together to insist on reasonable consultation fees and fair terms for GPs. He said his federation will support such a move, noting that a doctor’s professional fees goes to the salary of the doctor.

June Choon, a lecturer at Monash University’ School of Pharmacy, gave a similar view, although she said it was too soon to say how much of an effect the doctors’ consultation fee deregulation would have on pharmaceutical companies.

“We are not sure of the percentage of patients who will insist on their prescriptions so that they can purchase their medicines elsewhere. Some patients may still get their medicines from the GPs for the sake of convenience.

“If patients do go to the community pharmacies to get their medicines, almost certainly they will get the generic if generics are available for that drug. In this case, you will see an increase opportunities for the local pharmaceutical companies and perhaps decrease for the branded or multinational corporations,” she said.

Dr Raj Kumar also said that overall clinic fees will not increase as most third-party administrators (TPA) — who manage employee health care plans for companies — have capped their medicine prices on their respective portals, while doctors have the fee schedule provided by the Malaysian Medical Association (MMA) to refer to.

“We have been having a series of meetings with TPAs the past two years and all of them have acknowledged that we need to work closer for the benefit of the patients and they also acknowledged that doctors need to be rewarded with a respectable professional fee,” he added.

He also noted that doctors’ fees were only regulated in Malaysia since 2006, and prior to that, doctors were free to charge patients at their own set rates. During this time, there were not that many complaints of GPs overcharging patients, he claimed.

“(It’s) because we practise social responsibility, keeping to our Hippocratic oath, and the fact that medicine is a noble profession.

“GPs practice bundling, where we bundle our total fees, consultation, examination, procedures, counselling and medication into one, at a very affordable price. If you actually dissect and itemise each item, you will realise that the bill is actually much more,” he added.

“GP fees will remain the same.”

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