KUALA LUMPUR, Nov 18 — The Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) has fought back against a Ministry of Health (MOH) mandate for private health care facilities to display drug prices.
FPMPAM today advised its general practitioner (GP) clinic members to institute a regulatory compliance charge (RCC) in their billing as a “relief measure”, pointing out that doctors’ consultation fees under Schedule 7 of the Private Healthcare Facilities & Services Act (PHFSA) 1998 have not been revised for more than two decades.
“This charge will help recover, to some extent, expenses as a result of the many mandatory pressures on the GP and specialist practice where they are required to comply to regulations, without the cost factor and professional and administrative time to the practitioners and clinic staff being taken into account,” FPMPAM president Dr Shanmuganathan TV Ganeson said in a statement.
“These are some expenses loaded on to the aggrieved practitioners:
- Compulsory medical indemnity.
- PDPA annual fees.
- Notification of Diseases administrative cost.
- Cost of data provision that has so far been given free by the GPs.
- Clinical waste fees.
- Expired drugs disposal fees.
“FPMPAM advises members to begin with a minimum charge of RM20 for this Regulatory Compliance Charge, with review to be done from time to time. For MCO (managed care organisation) patients, they are advised to collect directly from the patients. For panel patients, members should bill them accordingly.
“With further new regulations imposed, the RCC charge will be adjusted accordingly.”
FPMPAM has seven state societies with a total of more than 5,000 members nationwide. There are reportedly over 12,000 GP clinics in total across the country.
Health Minister Dzulkefly Ahmad told the Dewan Rakyat last Wednesday that private health care facilities will be required to display medicine prices beginning next year under the Price Control and Anti-Profiteering Act 2011.
In private hospitals, patients are already informed about the prices of their medications – along with their use of equipment, imaging, lab investigations, medical or surgical supplies, procedures, doctor charges, and room and board, among others – in itemised hospital bills after discharge.
But GP clinics do not usually provide patients itemised bills with a breakdown of doctors’ consultation fees, medicine prices, or use of equipment, among others.
FPMPAM’s statement today pointed out that the escalating cost of health care in private hospitals is due to private hospital charges, not fees paid to specialist doctors.
“The same applies to GP practice. The GP consultation and medications are one of the lowest in the region. This basic medical service is available, affordable, and accessible to all who do not wish to use the public facilities,” said Dr Shanmuganathan.
“The policy of the Ministry of Health should be to nurture and support our GP system for the welfare of the patients and not to stifle it with endless unproductive and unnecessary regulations.
“The Report of the Malaysia Productivity Corporation has also clearly indicated that the practice of medicine in Malaysia is already over-regulated. Such unwarranted regulations not only increase cost and decrease accessibility but will endanger the quality of care to the patients.
“This particular price display regulation will be no different.”
FPMPAM noted that the consultation cost of seeing a GP has remained static for the past 20 years, as the MOH failed to update the GP fee schedule and instead “took the erroneous step” to deregulate GP fees. This, according to FPMPAM, left a regulatory vacuum that is being exploited by middlemen.
“Today, commercialised contracts of the middlemen with their various medical cards, exclusion clauses, differential entitled benefits, guaranteed letters and pre-assessment documents have taken over the system,” said FPMPAM.
“This new trend prioritises compliance to administrative guidelines, which directly and indirectly increase cost, at the expense of personalised patient-centric medical care.
“Our private GP system is a time-proven, efficient and cost-effective system and should be used to ease outpatient congestion in all public facilities leaving the government hospitals to focus on secondary and tertiary care.”
FPMPAM claimed that various “quick-fix” measures in the public health care system have failed to reduce long wait times for patients, including increasing operation hours for government OPD (outpatient department) clinics to 10pm; using the emergency department as OPD clinics after office hours; posting more doctors to OPD clinics; sending medicines to patients by post and now e-pharmacy; among others.
“In the past, the private GPs, despite accounting for only 40 per cent of the outpatient health care providers, were able see up to 60 per cent of the out-patient load. Instead of improving this performance, all these quick-fix measures have resulted in the opposite outcome,” said Dr Shanmuganathan.
“GP patient loads have dropped and many GP clinics are closing due to the cost of over-regulation, the micromanagement and the boom of middle-men business in health care.
“The patients are now crowding up the public facilities creating a situation that is worse than before. The waiting times are even longer.”
Citing a 1986 study by the MOH, Dr Shanmuganathan noted that the cost per patient-doctor encounter in a private GP clinic (RM28 per patient) was half the cost in a government clinic (RM56 per patient).
“We are certain a repeat study today will show similar results.”
The Malaysian Medical Association (MMA), another doctors’ group, has similarly warned the government of “serious, unintended consequences” from mandating medicine price displays in private GP clinics.
MMA said this would significantly raise operational costs, pointing out that GP clinics have long relied on “modest” margins from medication sales to manage operational costs and keep services affordable. However, MMA stopped short of advising its members to impose a new regulatory charge.
