Interrupted Health Policies And Laws When Pakatan Fell

Deregulation of medical practitioners’ consultation fees, jail for not issuing prescriptions upon request, drug price controls, promotion of contract government doctors, vaping regulations, mySalam, and health financing reform.

KUALA LUMPUR, Feb 27 — Pakatan Harapan (PH) planned sweeping health-related legislation and policies, some welcomed and others opposed by health care professionals, before the maiden government collapsed this week.

Some of the key proposals that then-Health Minister Dzulkefly Ahmad had intended to implement this year were the deregulation of medical practitioners’ consultation fees and drug price controls.

These are the health-related policies and Bills that were interrupted when the PH administration fell, less than two years after the coalition’s historic win in the 2018 general election.

Deregulation of medical practitioners’ consultation fees

The Cabinet made a landmark decision last December to enable general practitioners (GPs), dentists, and specialists in private clinics and hospitals to set their own professional fees that were capped under the Private Healthcare Facilities and Services Act (PHFSA) 1998.

Some 7,000 GPs operating shoplot clinics throughout Malaysia were particularly ecstatic over the move, as their consultation fees had been capped for almost three decades under the Schedule 7 fee schedule at a rate of RM10 to RM35. Clinic dentists’ consultation fees are capped under Schedule 7 at RM25 to RM250.

The consultation fees of the minority of GPs working in private hospitals were previously raised in 2013 under Schedule 13 to RM30 to RM125. Under that schedule, private hospital specialists’ consultation fees are legislated at a rate of RM80 to RM235.

Then-Deputy Health Minister Dr Lee Boon Chye told the Senate last December that it would take months for the health minister to gazette amendments to the fee schedules, though veteran physician Dr Milton Lum has called for amendments to the PHFSA itself in Parliament to effect the deregulation decision in a more permanent manner.

Jail for not issuing prescriptions upon request

PH tabled in Parliament last November amendments to the Poisons Act 1952 that made it mandatory for medical practitioners to provide medicine prescriptions requested by patients, failing which they would face up to five years’ imprisonment, a maximum RM50,000 fine, or both.

After CodeBlue broke the news about the Poisons (Amendment) 2019 Bill, the outraged medical fraternity issued several statements opposing the criminalisation of doctors, dentists, and veterinarians for not issuing prescriptions upon request, forcing Dzulkefly to postpone the second reading of the Bill. Some government MPs had also criticised the Bill.

Health director-general Dr Noor Hisham told doctors, pharmacists, dentists, veterinarians, and other stakeholders last Tuesday that the Ministry of Health (MOH) would remove the threat of incarceration from the Poisons amendment Bill.

Medicine price controls

Regulating drug prices this year was among the PH administration’s most contentious proposed health policies, with health care providers warning the government about potentially disastrous consequences for Malaysia’s entire health care system.

Dzulkefly was targeting single-source innovative drugs sourced through public procurement in the government’s first phase of medicine price controls, by using external reference pricing to benchmark drug prices in Malaysia against seven to eight countries. The average three lowest reference prices will be chosen to determine the maximum medicine prices allowed in Malaysia at the wholesale and retail levels (clinics, hospitals, pharmacies).

Consumer groups welcomed PH’s move to introduce drug price ceilings at the wholesale and retail levels, pointing out that Malaysia had among the highest medical inflation rates in the region, with a projected gross 14 per cent medical inflation rate this year.

But doctors, pharmacists, hospitals, and both local and foreign drug makers have all opposed drug price controls. The Pharmaceutical Association of Malaysia (PhAMA), which mostly represents multinational pharmaceutical companies in Malaysia, proposed its willingness to declare wholesale drug prices to MOH in lieu of price ceilings.

Promoting contract government doctors, pharmacists, dentists

Dzulkefly announced last November that the Cabinet had agreed to promote contract medical, pharmacy and dental officers from the UD41 civil service grade to their permanent counterparts’ UD43.

MOH announced last December 9 that the government was still considering changing contract medical officers’ status from UD41 to UD43 upon completion of their housemanship.

“However, to ensure that compulsory service runs smoothly, the government is still offering UD41 contracts and officers’ grade change to UD43 will be done once it is approved by the government,” said MOH’s Human Resources Division on MOH’s website.

Vaping regulations

Dzulkefly was reportedly planning to table a Bill in Parliament this year to regulate e-cigarettes and vaping products, though anti-tobacco, medical, and consumer groups have called for a complete ban.

Although MOH officials may be inclined towards a ban on e-cigarettes, the local vaping industry, dominated by Bumiputera businesses, has lobbied PH lawmakers like Kapar MP Abdullah Sani Abdul Hamid to regulate vaping instead.

Health protection scheme mySalam

mySalam, a health protection scheme that gives low-income and middle class Malaysians RM8,000 and RM4,000 respectively upon diagnosis of a critical illness, was widely panned by health advocates and Barisan Nasional (BN).

PH’s five-year scheme, under the purview of the Finance Ministry, began last year when Singapore-based Great Eastern Holdings gave the Malaysian government RM2 billion for mySalam in exchange for not divesting 30 per cent of their shareholdings to local investors under Bank Negara rules. The Malaysian government in turn pays Great Eastern the insurance premiums of mySalam beneficiaries, about RM400 million annually for five years.

However, the Finance Ministry revealed that mySalam only paid out about RM14 million to some 10,000 low-income Malaysians in 2019, or just 3.4 per cent of the RM400 million in premiums received by the insurance company. Besides the RM8,000 one-time cash benefit for the bottom 40 per cent (B40), this sum also included beneficiaries who received a daily RM50 allowance for hospitalisation for any condition that is capped at 14 days’ maximum yearly.

mySalam was expanded this year to the middle class, who will get RM4,000 cash if diagnosed with a critical illness, and increased coverage from 36 to 45 critical illnesses.

Doctors and health advocates previously criticised mySalam for excluding coverage of pre-existing conditions, which means that the B40 who were diagnosed with a critical illness before January 1, 2019, would not receive the RM8,000 benefit.

Health financing reform

Dzulkefly proposed to then-Prime Minister Dr Mahathir Mohamad last October wide-ranging national health reforms.

The former health minister tweeted last Tuesday that his Sihat Bersama 2030 plan comprised public sector reforms (consolidating all health services into a single programme), private regulatory reforms (nurturing value-based private health care), and health financing reforms (creating a national health fund).

Dzulkefly did not specify if his proposed national health fund required contributions from workers, much like the Employees Provident Fund (EPF). Health analysts and stakeholders say that government spending on health care, which is derived from general taxation, is still insufficient and have proposed alternate health financing mechanisms, like a social health insurance scheme funded by additional taxes.

Impact from a new (or old) government

If PH manages to form a government led by PKR leader Anwar Ibrahim, the above policies and proposed legislation will likely continue if Dzulkefly is reappointed as health minister in the new Cabinet.

However, if Anwar leads a minority government, it will be more difficult to pass laws in Parliament, as the government will be forced to seek support from Opposition lawmakers for each Bill. This would be especially onerous for legislation with potentially wide-ranging impact, like health financing reform.

A snap election will lead to the complete interruption of these health-related policies and proposed laws by PH, though it is unclear if mySalam, for instance, will be binding on the new government in an agreement with Great Eastern.

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