MMA Praises Madani Medical Scheme, But Admits Doctor Fees Inadequate

MMA admits that the Madani Medical Scheme’s (SPM) fee structure for panel GP services is “way below market” and that it’s still negotiating with the government to review some aspects, but maintains SPM is a “very good” public-private partnership project.

KUALA LUMPUR, Sept 4 – The Malaysian Medical Association (MMA) has acknowledged that general practitioners’ (GP) consultation fees for the Madani Medical Scheme (SPM) are insufficient, but maintained it serves as a good start.

MMA president Dr Muruga Raj Rajathurai was of the opinion that though the quantum of consultation and treatment fees reimbursed for SPM panel clinics was inadequate, the programme ought to be viewed more as a corporate social responsibility (CSR) initiative at this stage. 

He also revealed that ProtectHealth Corporation Sdn Bhd, a fully owned Ministry of Health company which administers SPM, initially offered GPs a consultation fee of below RM30 for the scheme, before raising it to that sum.

Dr Muruga highlighted that it took persistence to achieve the RM30 consultation fee and held that MMA’s ongoing negotiations are focused on achieving the maximum fee stipulated in the 7th schedule of the Private Healthcare Facilities and Services Act (PHFSA) 1998.

“So RM30 is, of course – it’s less. Less, not enough, but it’s good to start off with. We are still in negotiation with MOH to increase the fees,” Dr Muruga told CodeBlue in an interview at MMA House last Monday.

The ceiling consultation fee for clinic GPs is RM35, since the 2013 amendment to Schedule 7 of the Private Healthcare Facilities & Services Act (PHFSA) 1998 – which raised the RM10-RM35 range to RM30-RM125 – was never gazetted, unlike Schedule 13 for hospital-based GPs that was amended with the same quantum. 

The Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) previously told CodeBlue that at a meeting last May 16 between ProtectHealth and FPMPAM, the Medical Practitioners Coalition Association of Malaysia (MPCAM), the Organisation of Malaysian Muslim Doctors (Perdim), and MMA, the doctors’ groups had requested an RM50 consultation fee under SPM.

The maximum RM30 consultation fee for SPM panel clinics is, ironically, even lower than the RM40 payment for GPs registered with the Peka B40 health screening programme that is also run by ProtectHealth, even though SPM provides more complex care, i.e.: treatment for acute cases.

MMA general secretary Dr R. Arasu, who was also at the interview, said the cost of health care and business varies from place to place. 

“So obviously, when you look at it, of course, the price is way below market. That’s something that we need to acknowledge, [but] in principle, we think it’s a very good project. You’ve got to start somewhere. We have been talking about public partnership for many, many years. At least they’ve started something,” Dr Arasu told CodeBlue.

Dr Arasu said the MMA wants SPM to evolve into a resilient programme that is also capable of covering reasonable fees for private health care providers to allow GPs to continue providing services to the public. 

“We are still negotiating with the government to review certain things. At this point of time, we don’t want to disclose what we’re discussing with the government. But from what we were promised things are moving in the right direction at this point of time. So, we’ll wait for their announcement, if any changes are made,” he said.

Dr Muruga held that it was difficult for MMA to speak for doctors when it came to ProtectHealth’s fee structure for SPM, as this involved agreements between individual doctors and the company fully owned by the Ministry of Health. Thus, some GPs might be happy with the quantum of reimbursable fees, while others are dissatisfied. 

“See, every agreement is an individual agreement between the doctor and the TPA (third-party administrator). So, we cannot make decisions for them. But of course, on our side, we are negotiating to get our fees either deregulated or follow the Schedule 13 fee schedule,” the MMA president said.

MMA’s website declares that among the objectives of the country’s largest doctors’ association are to “serve as the integrated voice of the profession” and to promote the “interests of the medical profession”.

Besides low consultation fees, the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) and the Medical Practitioners Coalition Association of Malaysia (MPCAM) have also criticised the reimbursable limits for tests, basic therapeutic procedures, and medications under SPM that they say are significantly lower than market prices.

Fee Structure: Combined Consultation & Medication (RM60 Per Visit), Investigations (RM50 Per Visit), Therapeutic Procedures (RM50 Per Visit)

From June 15 to December 31, 2023, the SPM benefit limit supports treatment for acute conditions at private GP clinics for eligible beneficiaries and Sumbangan Tunai Rahmah recipients. Under the scheme, households are entitled to RM250 per household, senior citizens aged 60 and above are entitled to RM125, and singles are given RM75. 

Beneficiaries have access to treatments in three categories. The first is combined consultation and medication with a limit of RM60 per visit. This category covers conditions like cough, cold, diarrhoea, vomiting, sprains, strains, headache, and mild trauma. Services excluded from coverage are routine vaccination, health screening, follow-ups for chronic disease, and family planning, among others.

The second category is investigation (point-of-care testing (POCT) or diagnostic procedures) that is capped at RM50 per visit and covers 12 types of tests: full blood count, urine tests (including drug abuse tests), dengue tests, Covid-19 tests, HIV tests, glucometer, electrocardiogram, X-rays, pelvis ultrasound for obstetrics and gynaecology emergencies, speculum examinations, and proctoscopy examinations. 

The final category is therapeutic procedures (excluding basic life support that is reimbursed as per service item without a maximum limit per visit), which is also limited to RM50 per visit. Patients can use the scheme for the following procedures: nebulisation, compression and bandaging for a haemorrhage, immobilisation bandaging, simple wound dressing, wound cleaning and closure, opening of sutures, foreign body examination and straining of the eye, eye irrigation, removal of foreign body, removal of nail under local anaesthesia, evacuation of nail trephination for subungual hematoma, urinary catheterisation and insertion of intravenous cannula and/or Intravenous infusion, initiation. 

SPM – which will be expanded nationwide this month, just three months after its launch last June 15 – was allocated RM100 million by the federal government, lower than Selangor’s RM125 million for a similar scheme, Skim Peduli Sihat (SPS), during its 2016 launch, limited to state residents.

This is the third part of CodeBlue’s series on SPM.

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