KUCHING, Sept 14 — Dr Kelvin Yii interprets ProtectHealth Corporation’s suggestion to Madani Medical Scheme (SPM) panel clinics to change treatment plans for cost containment as choosing generics over original medications.
The company fully owned by the Ministry of Health (MOH) – in an email to SPM panel general practitioners (GPs) last September 7 – told doctors to “modify the treatment plan” to stay within per-claim constraints, if a patient’s treatment costs exceed their benefit limit, and to subsequently refer the patient to a public health care facility.
ProtectHealth Corporation’s email did not explain how SPM panel GPs should “modify” their treatment plan.
“I do not agree if doctors are asked to change their treatment plan which will compromise the patient’s quality of care. That is something that I think is not right and shouldn’t be encouraged,” Dr Yii, who is special advisor to Health Minister Dr Zaliha Mustafa, said in an interview with CodeBlue at the sidelines of the Sarawak Health Summit 2023 in Kuching here last Saturday.
“However, there are instances where there are alternatives that a doctor can do – in the sense, there are generic medicines which are cheaper compared to other medications that can fall within the price caps.
“The reason there is a cap is so that certain doctors – again, I’m making a generalisation – certain doctors do not overcharge or over-quote medications that are a bit more expensive, but it gives them the ability to choose the generics.
“The safeguards to ensure that quality of care is not compromised under the Madani Scheme is – they do encourage patients, if the cost is more and the patients need additional follow-up treatment, to refer to the government sector. So, there is a follow-up to ensure that they do not miss out or get compromised quality of care.”
SPM –which provides low-income earners fully-subsidised treatment for acute conditions at private GP clinics – was launched last June precisely to reduce congestion in public hospitals and health clinics.
Dr Yii, who is also Bandar Kuching MP, said the reimbursable prices for medications and treatments provided under SPM were not figures “plucked out of thin air”, claiming that the prices were based on “average costs”.
“But with that said, we are in the midst of reviewing the cap and [the] review will be announced soon. Modifying the treatment plan does not mean that you give worse treatment, but if you can fit within the cap of a generic drug, that’s what they mean.
“But then, if there is an additional need, there has to be a follow-up within the KKs (klinik kesihatan) and also the general hospitals.”
Panel GPs under SPM have received a list from ProtectHealth stipulating the treatments they can carry out on patients and a list of medications that they can prescribe, with specified fees and prices for reimbursement.
It is unclear if doctors are allowed to depart from the medication list given by ProtectHealth.
Last month, Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) president Dr Shanmuganathan Ganeson condemned the reimbursable fees by ProtectHealth, calling the medication prices in particular “unbelievable”.
Average treatment prices provided by Dr Shanmuganathan showed that reimbursements offered by ProtectHealth for investigations and therapeutic procedures under SPM were up to 93 per cent below market prices.
Doctors’ groups also want the GP consultation fee under SPM increased from RM30 to RM50. The maximum reimbursable fee for combined consultation and medication per patient visit is only RM60.
FPMPAM feared that ProtectHealth’s price list would serve as a precursor to future public-private partnerships and a reference point for a national health care financing scheme, among the reforms outlined in the Health White Paper.
Allaying the above concerns, Dr Yii said the SPM pilot project was merely the starting ground for public-private partnerships and was a “progressive step”.
“We will continuously engage with the private sector, engage with all the different bodies to find a win-win solution. This is always the most tricky part – the payment scheme.
“I believe in the potential of this partnership. I believe that a middle ground can be found, and once we discuss and strengthen the public-private partnership, we can reduce that dichotomy between the public and the private, and I think we can get better equality.”
