At the peak of the Covid-19 pandemic, doctors ruled the country. All other ministries acquiesced to the Ministry of Health (MOH) that dictated Malaysia’s lockdown strategy.
The Speaker of the House followed then-Health director-general Dr Noor Hisham Abdullah’s advice to close Parliament amid a Covid-19 outbreak.
Even the Election Commission (EC) bent the knee to MOH, breaching our inviolate right to vote by barring a Malaysian from casting his ballot in the 2022 Johor state election due to Covid-19 quarantine restrictions.
The Court of Appeal ruled last Wednesday that the EC had acted unlawfully, saying in its verdict that the right to vote was a “constitutional right and not a statutory right.”
MOH’s powers were unfettered to the extent that some had to obtain permission from the district health office to vote.
To be fair to MOH, they weren’t acting as dictators per se; the fault lay with other institutions that preferred to simply cede their authority to doctors instead of making the necessary accommodations to protect their own turf (and democracy).
During the pandemic, everyone – be it politicians across party, civil society groups, or the general public – supported the MOH’s decisions that superseded the interests of every other sector, trusting that doctors and medical experts knew what was best for us to save lives.
Five years on, the medical profession in Malaysia has fallen to a depth not seen before, undermining the political power of MOH – even if the ministry does not yet realise it – as the Health Ministry’s primary authority derives from doctors.
This is exemplified by how the Health DG is always a medical doctor even though health care spans beyond doctors, as the DG is also, by law, president of the Malaysian Medical Council (MMC) that regulates the medical profession.
The government’s recent decision to mandate prescriptions and itemised billing in private medical clinics is a huge affront to the medical profession, as a doctor’s prescription is sacrosanct.
The fact that these policy decisions were made by the National Action Council on Cost of Living (Naccol) and announced by Domestic Trade and Cost of Living Deputy Minister Fuziah Salleh, instead of Health Minister Dzulkefly Ahmad, only rubbed salt into the wound.
I remember CodeBlue breaking the story in November 2019 about the tabling of an amendment to the Poisons Act 1952 – under Dzulkefly as health minister too – that proposed mandating prescriptions upon request. Non-compliance would be considered a criminal offence, subject to a maximum RM50,000 fine, up to five years’ jail, or both.
The outrage from the fraternity was fast and furious; a few MPs openly told the government to withdraw the bill. The Pakatan Harapan administration postponed the second reading and the subsequent two governments never brought it up again.
Today, even though Naccol proposed mandatory prescriptions across board – going beyond mandating prescriptions upon request – politicians haven’t said anything.
Things were simpler six years ago. Now, the world is more chaotic and mandatory prescriptions are just one issue among a multitude of problems related to the health care system that have gained mainstream attention in recent months, besides global issues like US tariffs.
Shortly after the drug price display order under the Price Control and Anti-Profiteering Act 2011 (Act 723) came into effect on May 1, I told an MOH official in a casual conversation that I didn’t think it was helpful to paint doctors as the enemy and that the State should exercise its powers judiciously.
I pointed out that even government doctors were against the price display policy. When it comes to doctors, there is no public-private divide; the medical fraternity always bands together when under attack.
In response, the MOH official, who isn’t an MD, asked me what was so “special” about doctors. He said their argument that price display shouldn’t come under a different ministry was akin to telling traffic police not to issue summonses to doctors because medical practitioners aren’t regulated by the Home Ministry.
“I have to say that in the ministries that I have served throughout my years in public service, I have never ever come across a particular group (a minority) that thinks so highly of themselves—that they are so special, so untouchable, that they have to be given special preference over everyone else, just because they think that they’re indispensable,” he told me.
“This group of people should not forget that they are privileged in the sense that they could become doctors, which not many people can aspire to. Because of this privilege of becoming a doctor, they have to uphold their duty to serve the public.
“If being a doctor means that they can use that particular privilege to exempt themselves from having to follow rules and regulations or to submit unreasonable demands to the government, then I think this is a betrayal of that particular privilege.”
Post-pandemic, doctors in Malaysia (and probably around the world) are no longer the unquestionable authority figures that they once were.
The exclusivity of the medical profession is eloquently described in a judicial review application by the Private Medical Practitioners Association of Selangor and Kuala Lumpur (PMPASKL) and Medipulse Healthcare Sdn Bhd – the second lawsuit against the drug price display mandate – that argued that Act 723 cannot interfere with a so-called “health care regulatory regime” comprising five health care laws.
Now the Domestic Trade and Cost of Living Ministry (KPDN), which regulates the prices of retail goods like chicken and eggs, has taken a big leap to expand jurisdiction (doctors say, “encroach”) over clinical practice.
On one hand, I believe that mandatory prescriptions and itemised billing make sense as accompanying policy measures to price transparency.
Routinely issuing prescriptions for every consultation may help improve Malaysians’ poor health literacy. I would even argue that this is a consumer rights issue – which is within KPDN’s purview.
During an informative TikTok Live session by a senior official from MOH’s pharmaceutical services programme (PSP) on medicine price display, a woman asked if the price lists displayed could simply state the drug category, like fever medicines or antibiotics, since she didn’t know drug names.
While dispensing separation may be the way forward, this cannot happen as long as general practitioners’ (GP) consultation fees remain stuck at a pathetic rate of RM10 to RM35 for more than three decades.
Doctors’ groups have proposed a new rate of RM50 to RM80. Personally, I support a mandatory floor to prevent third-party administrators (TPAs) from taking advantage of small GP clinics, but there should not be a ceiling.
The so-called flourishing of GP clinics isn’t a problem, contrary to what some politicians think. Even if GP consultation fees were deregulated, with just a legal floor rate, a large market of providers will ensure competitive fees.
But Cabinet has rejected a review of GP fees. Dzulkefly told Parliament that the MOH was instructed to “refine” the proposal by going back to stakeholder engagements.
The government cannot have its cake and eat it too.
If it wants price transparency, then it must enable GPs to run a sustainable business (yes, health care is a business) with consultation fees commensurate with their expertise.
If the government wants to reduce health care costs by prioritising primary and preventive care over hospital-based curative care, then it cannot kill off GP clinics.
Ironically, the perceptions of the MOH official who thinks that doctors shouldn’t get “special treatment” – now translated into KPDN’s exercise of authority over the medical profession – have eroded MOH’s own power and prestige.
The first encroachment by a non-medical institution into the health care space was when Bank Negara took charge of the medical inflation issue last year. MOH ceded leadership to the central bank that primarily focused on safeguarding the insurance industry, instead of the ministry setting the tone on how health insurance should work for patients, clinicians, and health care providers.
Then MOH failed to broaden its scope of influence over government for “health in all policies.” The sales and service tax (SST) expansion covered imported fruits, while fruits and vegetables were omitted from the list of eligible goods for RM100 Bantuan Sara. Instead, the RM100 credit for Malaysian adults covers unhealthy foods like biscuits, instant noodles, and canned food.
Even though the price transparency policy originated from MOH, the ministry is forced to provide KPDN the manpower to enforce drug price display, since KPDN is deputising pharmacy officers as its own assistant price controllers – meaning all operations are solely conducted by KPDN.
The democratisation of health information, especially after the Covid-19 pandemic, empowered people to challenge the authority of doctors and emboldened other ministries to invade the once esoteric world of medicine.
Like the beginning of the fall of the Roman Empire, there probably isn’t any turning back. Doctors need to roll with it and deal directly with KPDN or other institutions that propose policies related to them, instead of asking MOH for help.
The medical profession isn’t under siege; barbarians are no longer at the gate but have already breached the city.
Boo Su-Lyn is the co-founder and editor-in-chief of CodeBlue.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
