KUALA LUMPUR, April 20 — Some private hospitals, clinics, and pharmacies in Malaysia have recorded steep revenue drops by at least 50 per cent during the Covid-19 crisis.
The Malaysian private health care sector is also bracing for the retirement of senior medical practitioners at this time, while many general practitioner (GP) clinics and community pharmacies are considering layoffs.
Medical professionals interviewed by CodeBlue predicted that the economic impact of the coronavirus pandemic on the private health care industry in Malaysia may last for at least three months, and up to a year, beyond the end of the Movement Control Order (MCO) on April 28. Private spending comprises almost half of total health expenditure in the country.
Patient loads at private hospitals have dropped by 70 to 80 per cent, and over 50 per cent at GP clinics, since the MCO began on March 18. Medical professionals expect patients to continue avoiding health facilities even after the partial lockdown is lifted, while medical tourists may also stay away because of lockdowns around the world.
“Through the calamities, An-Nur Specialist Hospital (ANSH) experienced 60 per cent drop in revenue during partial closure,” said Dr Musa Nordin, a paediatrician in ANSH, which is located in Bangi, Selangor.
Dr Milton Lum, an obstetrician and gynaecologist at Alpha Specialist Centre in Kota Damansara, Selangor, said revenue and profit at his facility have dropped by about 75 per cent due to the MCO.
Patient Numbers Drop Since MCO
The number of patients seeking inpatient treatment at private hospitals dropped by about 70 to 80 per cent, while outpatient treatment in such facilities is limited, according to Association of Private Hospitals Malaysia (APHM) president Dr Kuljit Singh.
“Our income is [for] 20 to 30 per cent of patients. It’s very low now. Hence, the profit and revenue has been reduced,” Dr Kuljit, who is also the medical director and consultant ENT (ear, nose, throat) surgeon at the Prince Court Medical Centre, Kuala Lumpur, told CodeBlue.
Apart from local patients, the virus as well as the MCO have hindered international patients from visiting private hospitals, as Malaysia imposed a restriction on tourists as part of the MCO.
“As more markets enforce lockdowns or impose more stringent movement and travel restrictions, patients have naturally had to – and in some cases choose to — defer elective medical procedures and services. This includes foreign patients who cannot travel to our hospitals at the current time,” a spokesperson of IHH Healthcare Berhad, which owns the Pantai and Gleneagles hospital chains, told CodeBlue.
This was also confirmed by Dr Kuljit, who said that medical tourists from other countries are most likely under some sort of lockdown, and “the fear of repeat lockdowns will further discourage international patients.”
As of April 16, more than 40 nations around the world are under either full of partial lockdown to avoid further spreading of Covid-19.
“International patients will not be coming for some months because of a number of reasons, for example flight schedules, quarantines here and in their homelands, increased costs from hospital PPE (personal protective equipment) etc,” explained Dr Lum.
According to the Medical Practitioners Coalition Association of Malaysia (MPCAM), most GPs have seen a 70 per cent drop in patients.
“Which means they are seeing only about 30 per cent — mostly corporate clients. Out-of-pocket patients have drastically dropped,” said Dr Raj Kumar Maharajah, the president of Medical Practitioners Coalition Association of Malaysia (MPCAM). Out-of-pocket refers to patients who pay for treatment themselves, rather than using personal medical insurance or coverage from their employers.
“Some clinics are already seeing between zero to five patients throughout the day. They have closed temporarily.”Dr Raj Kumar Maharajah, president of Medical Practitioners Coalition Association of Malaysia (MPCAM)
“Corporate clients whose bills are paid by employers have dropped slightly compared to patients who need to pay themselves. This could be due to the fact that people have not been going to work and have no salary,” Dr Raj Kumar added.
Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) president Dr Steven Chow said face-to-face clinic attendance at private clinics has declined by more than 50 per cent.
“There has been an increase in the number of patients consulting either by phone or via email. I am told that this is the same with most GP clinics nationwide,” Dr Chow told CodeBlue.
He said many patients wrongly believed that they could get infected with Covid-19 at private clinics.
“This is not true as all private clinics do practice pre-registration triage, proper social distancing, hand-washing hygiene and maintain proper public health preventive measures since the onset of this pandemic. To date, we have yet to hear any report of any cluster arising from private clinics,” said Dr Chow.
A recent survey among 806 private GPs and family physicians, which represents about 12 per cent of some 7,000 GPs nationwide, found that half of respondents reported getting only a quarter of their usual patient load during the Covid-19 epidemic. Some 21.7 per cent reported not getting any patients at all on most days. Over a third are planning to cut staff.
Community Pharmacy Revenue Halved
Apart from these hospitals and clinics, another major frontline business that is also struggling is private pharmacies. Despite a surge in sales of face masks, sanitisers and gloves in March, the month of April witnessed a slow in business, said Amrahi Buang, president of Malaysian Pharmaceutical Society (MPS), a pharmacists’ group.
“Only profit from items like gloves, hand sanitisers, thermometers and cleaning agents etc. When these are out of stock, most pharmacies have not much going on (even with delivery set up),” Amrahi told CodeBlue.
He also mentioned that a surge in sales of immune booster vitamins were witnessed since the MCO was introduced.
Yet, competition with supermarkets is causing these pharmacies a fortune.
“With supermarkets now selling most items at super low price and many online products and delivery portals, the community pharmacists are actually not profiting a lot at all,” Amrahi said.
“Many community pharmacists reported no crowd at all after a certain time, hence would notice many community pharmacists re-adjusting opening/ closing times.”Amrahi Buang, president of Malaysian Pharmaceutical Society (MPS)
“With the third phase of MCO implemented, the revenue has dropped at least 50 per cent again. It’s very unpredictable and community pharmacists can be between two hard places in deciding to stock up or not, while still ensuring they could pay rent and staff on time,” said Amrahi.
He added that despite this, pharmacies are still expected to open as they provide professional advice to the people.
“Bearing in mind, despite all the uncertainties, community pharmacists still have to open and remain in business, mainly to serve and contribute to the community, provide much needed professional advice and counselling to the people, which supermarkets / convenience store/ online portals cannot provide.”
Gloomy Expectations For The Next Year
With the MCO already in its third phase ending on April 28, there are no certainties on whether it will be extended again. Whatever the outcome of the MCO is, experts fear that the private health care sector may face long-term struggles financially, largely due to patients’ fear of contracting the virus if they are in a public setting even after the MCO ends.
“We are worried about private patients and their affordability. Some may have lost their jobs, no income or benefits reviewed. So, this may see some decrease in the numbers or slower return. Many may resort to go to public hospitals if there are no benefits. However, we cannot predict anything as yet. Too early to say,” expounded Dr Kuljit.
FPMPAM’s Dr Chow expected the depressed trend to continue for another three months before patients would feel comfortable in a waiting room with others who may be coughing or having a fever.
“Anywhere between six months to one year as people are still afraid of transmission of Covid-19,” predicted Dr Raj Kumar.
Dr Musa echoed the sentiment, saying that the health care industry would need between six and eight months to regain momentum.
Private pharmacies are expected to suffer for about a year before they can get back on their feet, said Amrahi.
Retrenchments At Pharmacies, Loss Of Senior Doctors
With loss of profit and revenue, many sectors are facing the inevitable choice of sustaining business and workers at the same time. This also applies to the private health care industry.
Although most private hospitals and clinics that CodeBlue spoke to are not looking at retrenching their staff, the industry is braced for the loss of some expert practitioners who may choose this time to retire.
“Those who are very senior in practice may find this as a good reason to retire. Those who have temporarily closed their practice during this time may not want to reopen again when all this is over,” Dr Chow explained.
Doctors who are relatively lesser experienced may continue to serve the community once the pandemic is over.
“The younger doctors will likely carry on as this pandemic will eventually be tamed by the development of herd immunity,” said Dr Chow.
But the same could not be said for private pharmacies.
“Retrenchment may be likely to offset the operation costs and reduction in profits and sales. Staff stuck in MCO but salary paid,” Amrahi said.
“Some community pharmacists are unable to focus on their losses because they prioritised serving the community, this is quite unfair because their service and sacrifice are barely highlighted in the press. It depends whether the community pharmacists want to stay open and how do they maintain adequate sales with all the current changes, and still maintain staff on payroll etc. There will be sacrifices that the community pharmacists will have to choose.”
Private Health Sector Wants Government Assistance
The medical professionals interviewed feel that they do not receive the financial assistance they deserve from the government, largely due to the misconception that the private sector is financially able to sustain their businesses.
The government has twice announced stimulus packages at a total of RM1.6 billion for the Ministry of Health (MOH) to fight the outbreak, but this may not be of much help for private medical practice. MOH has mostly focused on the public health aspects of the Covid-19 outbreak, with few announcements on affected private facilities.
Apart from that, the amount in the coronavirus stimulus packages was allocated for Covid-19 equipment and services, which include services from private hospitals; but these hospitals need additional economic allocations for other areas as well.
To this end, private practitioners have called on the government to consider stimulus packages just for the private health care sector.
“Government should give some stimulus packages to private hospitals,” Dr Kuljit said. “Though it is a misnomer that private hospitals are known to earn a lot, but actually this is not true.
“Just because hospitals bills look expensive with big figures, but our expenses are big too to sustain high standards.”Dr Kuljit Singh, president of Association of Private Hospitals, Malaysia (APHM)
Dr Kuljit urged the government to consider tax rebates and some subsidies for the private health care sector, as well as an economic package for staff remuneration.
“Private hospitals will soon take non-Covid patients from government at cost price with no profits. Hence the government should have some relaxation in taxation. Private specialists and other doctors are frontliners in treating patients and we hope some personal tax reliefs can be considered.”
This was echoed by Dr Raj Kumar, who added that it is imperative that the government assist the private health care sector, particularly GP clinics.
“We being an SME (small and medium enterprise), we need the government to pump some money into this sector, or else we will see a total collapse of the primary health care sector.”
He further suggested that the government explore telemedicine as an option.
“Further we should encourage telemedicine as an option and to come up with guidelines for this, so patients who are at home can still consult their doctor.”
Apart from that, cooperation between both public and private health sectors is vital.
“Government, particularly the Ministry of Health, cannot address the Covid-19 problem alone. The sooner they accept this, the earlier health sector problems can be addressed,” said Dr Lum.
The private health care industry is currently working alongside their public counterparts to combat coronavirus. For example, IHH is working on multiple efforts to assist the public sector in battling the Covid-19 pandemic.
“We are already taking in Covid-19 patients in our home markets of Singapore, Turkey and India, supporting testing services in Malaysia, Singapore and Hong Kong, while supporting border screening in Singapore,” the IHH spokesperson said.
“In Malaysia, we have also loaned 20 ventilators to public hospitals. At the same time, we are ramping up our ability to serve patients remotely through telemedicine and online diagnostics platforms. Our recent investment into Doctor Anywhere is one such example of how we will lead the transformation of health care services to meet patient’s changing needs.”
ANSH is also prepared to test patients, with many facilities including their screening and declaration services, as well as Covid-19 drive-through testing.
As for private pharmacies, Amrahi said he would like the government to find ways “to ensure continuity of supply of products and medicines at the current cost, to ensure smooth logistics, to provide assurance to the staffs of this business; and to support and recognise community pharmacies as one of the businesses that is the backbone of Malaysian economy.”
He also called on the government for fair treatment when it comes to PPE distribution.
“Hoping the government can be fair and provide basic support such as PPE for all community pharmacists so they don’t have to fork out their own funds to obtain PPE, it is common knowledge that sick people will visit pharmacies and the community pharmacists need to be protected.”
Update at 11.40am:
CodeBlue erroneously reported that patient load at private hospitals dropped by 20 to 30 per cent. The number of patients seeking inpatient treatment at private hospitals, according to Dr Kuljit Singh, had dropped by 70 to 80 per cent. The article has been amended.