Over 2,000 Doctors Petition PM To Regulate Managed Care Organisations

Over 2,000 private GPs and specialist doctors have signed a petition to PM Anwar to enact the long overdue MCO Act to regulate managed care organisations; the bill should hold MCOs liable for adverse patient outcomes caused by undue constraints imposed.

KUALA LUMPUR, Oct 3 – A petition by private medical practitioners for the government to regulate managed care organisations (MCOs), which remain unregulated, has received more than 2,000 signatures.

The online petition by general practitioners (GPs) and specialist doctors to Prime Minister Anwar Ibrahim, which was started last September 19, urged the government to enact the “long overdue” MCO Act and ensuing regulations.

“This is in line with practices in many developed countries that have managed care legislation to protect patients and doctors from unscrupulous business practices,” said the petition.

“Legislation should include provisions to make MCOs liable as a result of imposing undue constraints on doctors that result in adverse outcomes of patients.”

Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) former president Dr Steven Chow told CodeBlue that the petition was only circulated among doctors and doctor groups. 

In a statement by FPMPAM, Dr Chang Chee Seong — president of the Private Medical Practitioners’ Association of Selangor & Kuala Lumpur, who leads the “Regulate MCOs” task force under FPMPAM — said in 2008, the Ministry of Health (MOH) required the registration of insurance and MCOs, but did not follow up with the promised MCO Act.

“The original MCO Bill was drafted in the mid 1990s and has not seen the light of the day, outliving the term of five ministers of health”.

FPMPAM president Dr Shanmuganathan Ganeson said private GPs have been subjected to low fees under the Private Healthcare Facilities and Services Act (PHFSA) 1998 fee schedules for far too long. Clinic GP fees have remained static for more than three decades.

“The MCOs have taken advantage of this oversight by the MOH, by insisting that they must abide by the law and that the fees imposed are consistent with the Schedule 7 for GPs. This represents an unfair situation on private GPs, who undertake ever rising financial risks while abiding by the law,” he said.

“In contrast, the MCOs are devoid of regulations and are controlling and rationing medical benefits of employees using quasi regulations that are getting untenable with time.”

Dr Chow — chairman of the “DrsUnite” group formed by FPMPAM to coordinate GPs and specialists to support the move to regulate MCOs — noted that back in 2008, doctors in major private hospitals in the Klang Valley grouped together and rejected guarantee letters (GLs) from a particular MCO that had demanded a “hefty discount” of doctors’ professional fees.

“After three days, the MCO was unable to continue with its business and had to withdraw its demand. Since then, that particular MCO have been sold off and is continuing its business as usual under a different name. This cannot be allowed to continue.”

The doctors’ petition also called for the relevant ministries to immediately vet all MCO contracts to ensure consistency, fairness to all concerned, and compliance with mandatory standards, which doctors said MCOs are obliged to meet as required by law. 

Private GPs also want the relevant minister or Bank Negara to protect the right of patients or enrollees of MCOs or insurers to appropriate quality and choice of care.

Medical practitioners further demanded the establishment of statutory responsibilities of MCOs towards patients, enrollees, and registered medical practitioners, the contracted providers.

In an open letter to Anwar, 13 medical practitioners’ groups claimed that “quasi regulations” imposed by MCOs result in “unfair” contracts that are contrary to optimal treatment for patients and fair reimbursement for registered medical practitioners.

These include limits on doctors’ choice of prescribed medicines and duration of treatment per visit, as well as directing patients to collect medications from specific pharmacies, including for repeat medications without supervision by their primary doctor.

Dr John Teo, a medical practitioner based in Kota Kinabalu, Sabah, recently pointed out that the patient entitlement per visit capped by MCOs is often so low that it barely covers basic consultation fees and medicine charges.

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