Madani Medical Scheme’s GP Consultation Fee Raised By RM5, Programme Expanded Nationwide

ProtectHealth raises GP consultation fee under Madani Medical Scheme (SPM) from RM30 to RM35 and the limit for combined consultation & med per visit from RM60 to RM70. Also, 20 drugs added to the medication list. SPM was expanded nationwide from Sept 15.

KUALA LUMPUR, Sept 19 — ProtectHealth Corporation has increased the consultation fee for panel general practitioners (GP) under the Madani Medical Scheme (SPM) from RM30 to RM35, falling short of the RM50 demanded by doctors’ groups.

The Ministry of Health (MOH) owned company sent panel GPs an email last Friday, as sighted by CodeBlue, informing them that the scheme received “enhancements” effective immediately for patient visits starting September 15.

These “enhancements” included the consultation fee increase, as well as a raise in the reimbursable fee limit for combined consultation and medication per visit from RM60 to RM70. This means that with the new RM35 maximum consultation fee, the maximum reimbursement for medication is now RM35.

Additionally, ProtectHealth has added approximately 20 medications to the existing medication list of 152 drugs covered by SPM. 

The company told doctors that it has also increased the payment rate for certain medications covered by the scheme, but did not specify these drugs or the quantum of increase for reimbursements. 

“The benefit package of the Skim was designed with input from stakeholders, including clinical experts, to ensure the needs of both GPs and patients are met. 

“The list of medications, tests, and procedures, along with reimbursement rates and limits, has been carefully designed to allow GPs to address a wide range of acute primary conditions while benefiting as many B40 individuals as possible within the budget provided,” read the September 15 email from ProtectHealth to SPM panel GPs.

ProtectHealth’s email also announced that SPM has been expanded for full-scale nationwide implementation since last September 15, following “successful implementation” of the first two phases of the pilot programme that provides low-income Malaysians fully subsidised treatment for acute conditions at private GP clinics.

“As a result, all General Practitioners (GPs) throughout Malaysia can now actively participate in the Skim and provide acute primary care services to Sumbangan Tunai Ramah (STR) recipients,” said ProtectHealth.

Health Minister Dr Zaliha Mustafa, during her winding-up speech on the 12th Malaysia Plan mid-term review in the Dewan Rakyat earlier today, announced the nationwide expansion of SPM since last September 15.

“To date, more than 1,300 private clinics have registered as panel clinics in this programme,” she said. “The number of treatments provided reaches nearly 4,000 a day and is increasing even more.”

SPM was expanded nationwide just three months after the programme was launched last June 15. ProtectHealth stated in its email that the programme has received 125,000 patient visits and served more than 80,000 B40 households.

Treatments covered by SPM are divided into three categories: Combined consultation and medication; investigations (point-of-care testing or diagnostic procedures); and therapeutic procedures. 

While combined consultation and medication per visit saw a limit increase (from RM60 to RM70), ProtectHealth’s email made no mention of a change to reimbursable prices for the other two categories, which both have a cap of RM50 per visit. 

The benefit limits for SPM beneficiaries until December 31 are merely RM75 for singles, RM125 for seniors, and RM250 for households. 

SPM was allocated only RM100 million, deemed by the Galen Centre for Health and Social Policy as inadequate for its target of reaching 700,000 households nationwide. 

The similar Iltizam Selangor Sihat, formerly known as Skim Peduli Sihat (SPS), by the Selangor state government was allocated RM125 million for its launch in December 2016 that initially targeted 250,000 households in the state.

The new RM70 limit for combined consultation and medication per visit under SPM matches the treatment cap under the Iltizam scheme.

FPMPAM Has Reservations About RM5 Increase in Consultation Fee, SPM Panel GP ‘Disappointed’

Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) president Dr Shanmuganathan Ganeson said he had reservations about the new RM35 limit for consultation fees under SPM, though he was glad that ProtectHealth responded to doctors’ criticisms.

“We actually asked for RM50. Probably, they are keeping to the outdated Schedule 7 in maxing at RM35. It is time that Schedule 7 be rectified to mirror an upwardly corrected Schedule 13,” Dr Shanmuganathan told CodeBlue.

He was referring to the RM35 cap on clinic GPs’ consultation fees under Schedule 7 of the Private Healthcare Facilities and Services Act 1998, versus the RM125 cap on the consultation fees of hospital-based GPs under a 2013 amendment to Schedule 13. Schedule 7 was amended in 2013, but the amendment was never gazetted.

“Public-private partnership should be just that — a partnership. The Madani intentions are good; the maths needs proper costing. Remember, GPs do not have pensions like retired government servants,” Dr Shanmuganathan said.

Medical Practitioners Coalition Association of Malaysia (MPCAM) president Dr Soo Tai Kang was of a similar opinion as Dr Shanmuganathan, calling the raise a good remuneration. 

“With extra medications in the list, it will give doctors more choices to treat patients accordingly,” Dr Soo told CodeBlue. 

On the other hand, Dr Saravanan Ramasamy, an SPM panel GP who practises in Shah Alam, expressed disappointment with the RM5 raise. 

“Yes, I was quite disappointed too. But I guess we just have to keep pressuring them,” he told CodeBlue.

SPM panel GPs’ consultation fee was increased after CodeBlue reported criticisms from medical practitioners’ groups about the “insulting” RM30 consultation fee and reimbursable fees for some tests, procedures, and medications that were “way below” market rates.

FPPAM, MPCAM, the Organisation of Malaysian Muslim Doctors (Perdim), and the Malaysian Medical Association (MMA) had previously asked for an RM50 consultation fee under SPM in a meeting with ProtectHealth last May, before the launch of the programme in June.

ProtectHealth: ‘We Deeply Respect Discretion And Clinical Judgement Of GPs’ 

CodeBlue reported last September 8 outrage from doctors’ groups towards ProtectHealth’s recent suggestion for SPM panel GPs to “modify the treatment plan”, so as to not cross the benefit limit of RM60, and to subsequently refer the patient to a government facility for further care.

Medical practitioners said this requirement interfered with doctors’ autonomy and created the potential for malpractice suits. 

“We deeply respect the discretion and clinical judgement of GPs. In the event that the treatment needed by the patients is not able to be covered under the current SPM package, the GP can refer the patient to the Ministry of Health’s Klinik Kesihatan (health clinics) or Hospital Emergency Department,” ProtectHealth said in its September 15 email to SPM panel GPs.

ProtectHealth’s request that patients be referred to hospital emergency departments, in particular, for simple illnesses seems to run contrary to the MOH’s goal of reducing overcrowding in public hospitals and health clinics. 

Last month, Health Minister Dr Zaliha Mustafa hailed SPM as a successful hospital decongestion method, as the majority of patients coming to public emergency departments are from the B40 and those who come after office hours.

ProtectHealth’s September 15 email also reminded SPM panel GPs not to practise balance billing, noting that some B40 beneficiaries have expressed concerns about being asked to partially pay for services under the programme.

Balance billing occurs when a panel clinic bills an extra amount to a beneficiary on top of the specified payment rates and services of SPM.

“If a patient’s treatment costs exceed the coverage limit provided by the scheme, we kindly request that you refer them to the nearest Ministry of Health Klinik Kesihatan or Hospital Emergency Department. This approach ensures that they receive the necessary care without facing financial hardship.” 

Editor’s note on Sept 20: FPMPAM president Dr Shanmuganathan Ganeson’s comments were amended to better reflect his opinions.

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