The private health care industry, together with the Insurance and Takaful organisations (ITO), have worked well together since the mid-1980s, ever since the introduction of health and medical insurance plans.
However, of late, the strain has been evident, especially in the last few years after Covid-19, with the rise in medical inflation. There are many factors to review and analyse but that will require a very detailed discussion.
I believe that we must find ways to make the entire ecosystem work better for all and bridge some of the misconceptions and realities of private health care.
Key to that would be first to stop demonising each other, as the connotations derived from every negative statement out there does more harm than good to actually address the problem.
We, the staff in private hospitals, are facing the brunt of anger due to these misconceptions.
We have seen of late of viral videos of people sharing their anecdotal experiences, why gloves and diapers are so expensive, even a celebrity chef cracking jokes in a dinner event that just goes to show that there’s a lot of misconceptions about private health care, downplaying the sincere effort and dedication and the knowledge to treat patients and bring them to recovery.
There’s gross oversimplification and trivialization of the kind of work that is put in place behind the scenes in a private hospital. So, if I may, I would like to take this opportunity to clear the air on behalf of the more than 200 private hospitals, 6,000 doctors, and a workforce of almost 100,000 nurses, pharmacists, allied health care workers, staff of the finance and marketing departments, the cooks and the cleaners who pour their heart and soul to the work that is private health care.
Private Hospital Specialist And Staff
We have always considered our work as complementing, not competing with the public sector. Remember, we are all at one point staff of the Ministry of Health (MOH), Ministry of Higher Education (MOHE), or Ministry of Defence (MOD), and to these organisations, we owe our basic training.
We are all about giving back to the society if asked of us. In return, we ask for reasonable compensation for the work done.
For doctors, there’s a fee to our work which is regulated in the 13th schedule of the Private Healthcare Facilities and Services Act 1998 (PHFSA) which has not seen a revision since 2013.
The fees are based on the knowledge and skill that is being brought to the patient. In return, we get them back on their feet as soon as possible so that they can continue to function physically and economically whilst getting their health and life back.
From the fees that we earn, we pay taxes, hospital management fees, accountants fees, our indemnity insurance, clinic rental and staff salaries and various other expenses.
The wages for health care workers have to be increased over the years and it’s not the hospitals’ fault.
Our staff are well trained and respected and do a great job, so when countries like Singapore and the Middle East recruit them, it’s inevitable that some will leave due to the much higher salary offered and also the opportunity to gain from the experience.
This was even more pronounced after Covid-19. We are not against it and in fact we encourage some who are dedicated to go and learn in a new environment as upon their return one day, they add on further value to the organisation.
But in the interim, for those who choose to stay, the wages have to be made competitive. Nurses and other allied health care workers are professionals and true assets of our organisations, and they should be treated with dignity.
Private Hospitals
The building of private hospitals in many of our cities has enabled the general public including the B40 and M40 to access health care and prevented outflow of money to countries like Singapore, India, and the United Kingdom, as what used to happen in the 1980s.
It has allowed access to the best medical expertise and equipment that otherwise would have been only available to the super rich known as the T20.
Today, most cities in Malaysia have at least a small secondary or tertiary level private hospitals where almost anyone can get most treatment done. Trust me when I say this level of access is not even available in the UK or Australia.
The presence of these hospitals not only offloads work of the public hospitals but makes it easier for patient with common medical problems to get their ailment sorted and return to productivity.
It’s wrong to think that private hospitals are actually focused on medical tourism and profit from that. Yes, it’s a revenue stream but the spillover of the investment made is actually benefiting our locals.
The accreditation exercises done in the pursuit of enabling our hospitals to be of international standards such as JCI, ACHS and MSQH automatically leads to investment in the necessary areas. Investments in new technology and latest medications according to the latest protocols are all being done by the private hospital’s own initiatives.
We doctors can only utilise our knowledge and skills if the private hospitals invest in these initiatives in the first place. The ultimate beneficiary are our patients as well who do not need to fly overseas to get their treatment done.
In comparison to our regional ASEAN countries, our health care costs still remain relatively low and often is deemed as a factor for foreigners to choose Malaysia as destination for their needs.
Unfortunately, the weakened ringgit, rising cost of operations, raising electricity tariff, increased medicolegal litigation running into the millions and other overheads necessitate adjustment of the hospital charges.
Obstetrics litigation payouts now run into the millions now, so that is why maternity care and delivery costs have been steadily rising to compensate for these payouts by both the hospital and the doctors.
Our line listing of items is for the purpose of transparency and not that we can compare the price of a diaper that you can get from a retail mart as there a different costs factors to consider. Many of the markups contain hidden costs that are not immediately clear to the end user.
What you’re paying is for the additional items that make up the total delivery of health care costs. In the case of private hospitals, more comfort, access to quicker radiology services, labs, blood banks, senior specialists and nursing team, and various other facets.
How transparent shall we be is a discussion that should take place but not at the expense of stifling innovation and expansion of medical services. Where the public hospitals cannot provide both in terms of equipment or speed or capacity, the private sector should be allowed to do so.
It is really up to the patient who is the consumer of private health care to decide on the type of hospitals he would like his care to be taken on. Not all private hospitals have grand pianos and the big aquariums that are placed at the lobbies of the hospitals, in fact many operate without many frills with equally competent specialists and staff.
The patient ultimately needs to decide because the overhead to run these hospitals may differ significantly, thus leading to variation of costs between different hospitals.
Please don’t be misled by the hospital group annual reports that focuses on the big revenue numbers that are often times quoted in the billions. Most private hospitals have after tax profits returns in the millions, not billions which is typically about 5 to 15 per cent of gross revenue. In fact, one private hospital recently disclosed a loss in its quarterly financial report as well.
The revenue that is generated is usually divided as dividends to be paid to the shareholders and the rest reinvested for future expansion plans and procurement of equipment that needs to be constantly upgraded.
I believe that the both the doctors and hospitals can work together with the public and the Insurance Industry. I believe the overarching theme has always been collaborative towards a mutual win-win situation.
At the same time, where there is unscrupulous behaviour out there that can’t be denied, we must be vigilant and focus our time and energy on the extreme outliers who are taking the public for a ride.
By having a more active input by the insurance industry to the in-hospital fee committee for example, we catch unscrupulous parties and errant practices early and nip it before it becomes rampant.
I will discuss some of the issues from the insurance industry perspective in the second part of my article.
Dr Gunalan Palari Arumugam is currently practising as a Consultant Anaesthesiologist and Critical Care Physician at a tertiary level private centre in Klang Valley. He was previously a Chairman of the Medical Advisory Board of two private hospitals, a medical director with a global insurance company, and represented doctors and hospitals in medicolegal cases, besides holding various portfolios in a few medical societies over the years.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
