Rising health care cost is a natural phenomenon all over the world. Apart from the standard yearly inflationary costs, a rise in salaries and remunerations, the upgrading and introduction of new technology invariably will raise the costs of health care, whether in the public or the private sector.
In Malaysia, in recent years, private medical health care has seen tremendous growth, throughout the country where private medical centres are now in almost every town and city.
Major health care providers and hospital owners are strong corporations, which are mostly government linked corporations, with a few other major players. As the demand for private health care has grown, insurance bodies have joined in to provide affordable policies that currently assures full coverage, once policyholders are admitted.
With the Private Healthcare Facilities and Services Act 1998, fees for consultation and procedures for specialists and family practitioners or general practitioners are capped and controlled, but hospitals are excluded.
It is obvious that the rising cost of health care has to be passed down to the consumer or policyholder, as insurance bodies are profit-making enterprises. It is also obvious that hospital operators have to scale up their charges to match all the factors above.
With the furore reaching the attention of the Cabinet and Parliament, a solution is needed. The latest proposal is another form of “capping or restriction” imposed on the provider i.e. the hospitals by introducing DRG, or the Diagnosis-Related Groups system, that will force hospitals to provide care and services for a fixed amount related to each diagnosis group.
With the introduction of the DRG, it will immediately be a win-win-win situation for three parties i.e. the Ministry of Health (problems immediately solved), insurance bodies (a controllable capping of bills), and the patient or customer (services met) – leaving the hospital and specialist with a “piece of the cake” to split and share.
Thus, it is obvious that the private medical specialist will get the raw end of the deal and end up having to sweat for a less than appropriate fee.
As it is, whatever consultation and procedure fee that each doctor is earning is well below par compared with our fellow professionals for their time and energy.
A doctor engaging a complex problem will get a fee of RM235 for a consultation that often runs over an hour. A surgeon engaging in a complex operation for several hours – at risk to his own health and a risk of medical litigation – is paid well below his other professionals on an hour to hour basis.
With the DRG, when the cake has to be divided, the private specialist’s income per service and per hour may fall below that of a hairdresser, masseuse, beautician, or even a plumber or electrician.
Many private specialists may still earn a comfortable income, while many family practitioners will still have to work hard to survive.
It is incorrect in these days to say that all doctors are making a lot of money and all doctors are super rich. Yes, some popular doctors are still doing well, but not for long.
Many doctors, especially solo medical practitioners, have closed down when it is no longer viable economically. We have seen that trend in countries where DRG rules the doctors, where the doctor’s income is whittled down and down over time.
What we seek is fair remuneration, not more. Therefore, the Association of Specialists in Private Medical Practice (ASPMP) strongly objects to the implementation of the DRG system.
If the authorities still wish to push it through, then use it for hospital services and spare the specialists’ consultation and procedure fees, as we are already capped by the current Fees Act.
This letter was written by ASPMP past president and adviser Dr Sng Kim Hock on behalf of the association.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
