The recent publicity and outcry over the rising costs of private health care insurance has now reached the necessary attention of Parliament, government, and Cabinet. It is good that all cards are now on the table.
For a long time, fingers have been wrongly pointing at the doctors. The growing plight and dilemma faced by doctors, both the private general practitioner and the private medical specialists since the introduction of the Private Healthcare Facilities and Services Act (PHFSA) 1998 should now be addressed.
Under Schedule 7 and Schedule 13 of PHFSA, private clinic general practitioner and specialist consultations are capped at RM35 and RM235 respectively, while procedure fees are listed out separately.
The patient who desires cover for hospitalisation health care purchases a policy from an established insurance body based on the expected total claims over the year, with actuarial studies ensuring “no loss” to the company.
For every “customer patient” admitted, the insurance company is the payer, and the private medical centre providing the services is the recipient of the fund, with or without a third-party administrator.
To provide for these services, private hospitals take in private medical specialists by contract, some by salaried employment, billing the relevant insurance body for every admission. Two decades ago, the large majority of patients (>80 per cent were cash paying), and currently the minority (<20 per cent are self paying), while private medical centres have mushroomed significantly.
All the major hospital networks are for profit, and the majority are owned by government subsidiaries. With proper management, these private hospital networks should not lose a sen, though payment defaults do occur, especially for long-staying patients.
In recent years, private medical specialists have been given the raw end of the stick, for example, with the decision that the goods and services tax (GST) was not zero rated, hence chargeable for specialist doctors’ consultations. Private medical specialists cannot form a Sendirian Berhad, and our consultation fees and procedure charges remain capped for years.
No other professional body suffers this “price-controlling law”, limiting the profession from giving its best, and equating the youngest new specialist to the senior consultant in this capping of fees.
No other professional body suffers from this “looming cloud of litigation risk”, forcing every specialist and general practitioner by law to purchase medical indemnity insurance, which may amount to six figures a year for certain higher risk specialties.
Can we sue our lawyer if his weak defence ends up with us in jail, our accountant whose error makes a signficant loss in our tax returns, our architect when the pipe bursts or building cracks, or the commercial pilot if the plane crashes?
The proposal to bring Diagnosis-Related Groups (DRG) charges is yet another chain or manacle for the private medical consultant in an attempt for the authorities to hijack a private insurance scheme for health care. DRG is currently active in the United States as a “tried tired tirade” in health care.
Health care authorities must involve private medical specialists in any form of discussion and decision, rather than just talk to the big boys in both insurance industries and private hospital management, backed by corporations.
Without general practitioners and private medical specialists, the private health care industry will come to a grinding halt in 24 hours. Yet, we are currently merely pawns.
We, the Association of Specialists in Private Medical Practice, strongly object to the introduction of DRG for inpatient hospitalisation charges at this early stage without proper evaluation, our views, or studying the woes of this system in the US.
We have a viable, healthy two-tier form of health care, providing good if not great health care for the poor, middle income, and higher income groups. Our charges are still compatible, if not lower, than that of other developed or developing nations.
Changing it overnight requires a good and serious in-depth study. Obamacare cannot become Kennedycare overnight in 2025; nor can our two-tier care become AI-Care or OneCare overnight.
The medical profession is at its nadir. The young enthusiastic medical student has to find a rich guardian to fork out half a million ringgit to study locally, and two million ringgit abroad in a good institution, for fees alone, compared with barely RM15,000 for this writer in the seventies.
On graduation, he or she has to wait nearly one to two years to be offered a contract for 2+2 years, with career uncertainty after that. With a starting pay of RM5,000, he or she will take 10 years just to pay back the RM500,000 loan, by which time bullying and lack of training prospects forces him out of the system, into the private health care, where he becomes a pawn in the industry.
Bringing in DRG will only mean that private medical specialists will be capped further by management seeking a keen supplier, meaning that “we can take it or leave it.”
If the government is really serious about health care for all, it must be willing to provide and manage a good corruption-free, multi-billion ringgit national health care insurance system, funded fairly by all and for all, including pensioners.
This letter was written by Dr Sng Kim Hock, past president and adviser of the Association of Specialists in Private Medical Practice Malaysia (ASPMP), on behalf of ASPMP. The ASPMP president is Dr Balwant Singh Gendeh.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
