The recent string of adverse reports on the many maladies in the public health care delivery is a call to the government to look at the basics before embarking on any more ad-hoc fire-fighting measures.
Consult the Patient
The Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) is of the opinion that patients, who are the eventual payors and recipients of the health care system, are the most important stakeholders. Their views, needs, and expectations must be considered in all the various measures taken to improve health care delivery.
Use Our GP System
What we are now seeing today, are the results of the many quick-fix measures used in the failed attempts to solve the problem of long waiting times for patients, among which were:
- Increasing opening hours for government clinics to 10.00pm.
- Using emergency and trauma departments as clinics after office hours.
- Posting more doctors to government clinics.
- Setting up 1Malaysia clinics manned by paramedics.
- Sending medicines to patients by post.
- Encouraging self-diagnosis and self-medication.
In the past, private general practitioners (GPs), despite accounting for only 40 per cent of outpatient health care providers, were able see up to 60 per cent of the patient load.
Instead of improving upon this performance, these quick-fix measures have resulted in the opposite outcome. The patient load for GPs has fallen, and many GP clinics are closing due to the cost of over-regulation, micromanagement, and the boom of the middlemen business in health care.
Maintaining the social contract between the doctor and patient is paramount, and is reflected by close interaction and caring and compassionate care. Today, the middlemen, with their medical cards, exclusion clauses, differential entitled benefits, guaranteed letters, and pre-assessment documents have taken over.
This new trend prioritises compliance with administrative guidelines, which directly and indirectly increases costs, at the expense of personalised patient-centric medical care.
The private GP system is a time-proven, efficient, and cost-effective system, and should be used to ease outpatient congestion at all public facilities, leaving the government hospitals to focus on secondary and tertiary care.
To lessen costs, sending patients to GPs near their homes makes sense, and is economically the correct solution, like what is already being done is a neighbouring country.
Based on a previous study in 1986 by the Ministry of Health (MOH), the cost of each patient-doctor encounter in a private GP clinic (RM28 per patient) is way below that in a government clinic (RM56 per patient). We are certain a more recent study will show similar results.
In the PEKA 40 programme, using the GP network to be mere data collectors, and then requiring patients to be sent to government clinics for treatment is a waste of the potential of the GP system. It will worsen overcrowding in the government clinics.
For a meaningful private-public partnership in primary health care delivery, the GP system should be nurtured and efficiently utilised to ease outpatient waiting time.
The hundreds of millions used for the 1Malaysia clinics and the PEKA 40 programme should instead be channelled to subsidise medical care for the needy at GP clinics nationwide.
A global conference in October 2018 reaffirmed primary health care and stressed its pivotal role in achieving universal health coverage. Private GPs have always contributed to the success story of Malaysia’s universal health coverage.
Private Hospital Cost
There is clearly a great disparity between the costs paid by patients for care at public hospitals versus costs incurred at private hospitals. However, it must be said that the actual cost of care at public hospitals is not quantitated, and the bulk is paid for by taxpayers.
Furthermore, the costs of wastage and redundancy are not included. Based on available data from MOH studies, the usage of public hospital facilities is not optimum, with some hospitals showing a bed-occupancy rate (BOR) of less than 25 per cent, with some more than 100 per cent.
Private hospitals should display not only their room rates, but also the estimated costs of all common medical and surgical procedures and investigations. This is already being done in many neighbouring countries, and it helps patients make informed choices.
This is a good first step, and should be implemented immediately. With free market forces and open competition, prices for private care are likely to fall in time.
Unfortunately, regulating private hospital charges is unlikely to happen anytime soon, as the regulator, which is the government, is in the business of health care via its extensive network of GLC-owned hospitals.
Dr Steven KW Chow is the president of the Federation of Private Medical Practitioners‘ Associations Malaysia.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
