SIBU, Oct 10 – The Regulate MCO task force of the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) want the Ministry of Health (MOH) together with the Ministry of Domestic Trade and Costs of Living (MODT) to take action to protect patient and worker rights with regard to appropriate and safe medical care.
The task force urges the government to enact regulations under the Private Healthcare Facilities and Services Act (PHFSA) 1998 and Regulations 2006 and the Consumer Protection Act 1999 in order to regulate Managed Care Organisations (MCOs). MCOs are the middlemen whose business is the outsourcing of the management of medical benefits of employees.
The group is concerned that these MCOs, some which are owned by insurance companies, have carte blanche powers to introduce terms that puts financial interests ahead of patient and worker health care rights and safety, including their right to continue treatment with the doctor who have been looking after them for many years.
As such, the group, which represents more than 2,000 private general practitioners and specialists nationwide recently submitted a petition to the Prime Minister to urgently enact laws and regulations to curb abuse by MCOs.
The group also seeks to promote patient rights and safety as consumers of health care services via regulatory measures by ensuring that MCOs:
- Do not interfere with a patient’s right to access and receive any medical treatment that they need.
- Do not contravene the medical code of ethics and the Guidelines for Good Medical Practice.
- Provide full transparency of contracts with their employers and doctors pertaining to benefits and exemptions of health coverage.
- Provide a mechanism for patients and doctors to file their grievances.
- Do not default in the payment of fees for patients, which could affect continuity of care.
“We need these regulations so that doctors are not roped in as fait accompli when MCOs’ standard operating procedures and exclusion clauses are nothing more than tools for rationing of care for employees seeking medical treatment,” said FPMPAM president Dr Shanmuganathan Ganeson.
“This is counter-productive to the government’s efforts to encourage a productive workforce for economic growth and recovery,” he added.
Dr Shanmuganathan also said that the regulations should empower the government and related medical advisory bodies to protect the public and the employees before they enter into a health care service contract with an MCO, as well as later when they need medical care.
“It should bar these middlemen from imposing unfair contract terms when consumers, patients, and employees are not in a position to bargain freely on what treatment they can receive.
“These regulations are needed to protect patient rights and safety, promote the social and emotional aspects of care, as well as the assurance that their doctors are making decisions based solely on medical needs. Worker groups and employees’ unions should also purse this matter as it affects the health and wellbeing of their members and the working force,” added Dr Shanmuganathan.
