General practitioners (GPs) form the backbone of Malaysia’s health care system. Yet, despite rising expectations and increasingly complex clinical responsibilities, GP consultation fees under many third-party administrator (TPA) and insurance contracts have remained stagnant for years.
This has created a widening gap between the cost of delivering quality care and the reimbursement GPs receive.
The issue is not about GP competence. Malaysian GPs are highly trained, regulated under the Private Healthcare Facilities and Services Act (PHFSA) 1998, and fully capable of managing acute, chronic, and preventive care.
The real problem lies in outdated fee structures that fail to recognise the true value and evolving role of primary care.
Below is a clear breakdown of why this situation is unsustainable and why TPAs/insurers must urgently revise GP consultation rates.
Rising Operational Costs Are Not Reflected In Current Fees
Clinic operating costs, including rental, utilities, consumables, technology systems, and staff wages, have increased sharply over the last decade.
Yet, TPA/insurance consultation fees have barely changed, some remaining at levels set more than 20 years ago.
This mismatch forces clinics to absorb increasing overheads without appropriate reimbursement, threatening long-term sustainability.
Impact On Quality Of Care And Patient Outcomes
Adequate fees allow GPs to devote sufficient time and attention to each patient. This ensures:
- More accurate diagnosis.
- Better chronic disease management.
- Appropriate follow-up and counselling.
When fees are artificially suppressed, GPs are pressured to increase patient volume just to remain financially viable. Rushed consultations increase:
- Misdiagnosis risk.
- Unnecessary specialist referrals.
- Avoidable complications.
- Higher overall health care expenditure.
Stronger primary care saves insurers money, but only if it is properly supported.
Retaining Skilled, Experienced Practitioners
Competitive consultation fees are essential to retain senior, experienced GPs within panel networks. When reimbursement becomes unreasonably low:
- Senior GPs withdraw from panels.
- Clinics opt out of TPA arrangements.
- Patients lose access to quality care near their homes or workplaces.
Without overdue fee adjustments, TPAs risk shrinking their own networks and compromising service levels for policyholders.
Primary Care Has Evolved, And Fees Must Reflect Modern Medical Practice
Today’s GPs manage conditions that were once handled only by specialists, including:
- Diabetes, hypertension, and dyslipidemia.
- Mental health issues.
- Preventive care.
- Lifestyle and chronic disease coaching.
- Early screening for cardiovascular, renal, and endocrine diseases.
The scope of GP work has widened, but fees remain stuck in the past. A modern fee structure must reflect the modern doctor.
Better GP Compensation Improves Patient Satisfaction and Continuity of Care
When GPs are fairly compensated, they can invest in:
- Up-to-date medical equipment.
- Better-trained nurses and staff.
- Improved clinic infrastructure.
- Digital health systems.
- Longer, more meaningful consultations.
This enhances patient satisfaction and strengthens trust, ultimately benefiting insurers and TPAs who rely on strong provider networks.
Fair GP Fees = Long-Term Savings For Insurers
Robust primary care is the most cost-efficient part of the health care ecosystem. By investing slightly more in GP consultations, insurers will:
- Reduce unnecessary specialist referrals.
- Prevent avoidable hospital admissions.
- Lower claims related to complications.
- Improve chronic disease control among policyholders.
A small increase in GP fees delivers major savings downstream.
Conclusion: Supporting GPs Strengthens The Entire Health Care System
GPs are not being marginalised because of a lack of competence. They are being marginalised because current reimbursement structures do not reflect:
- Rising operational costs.
- The evolving role of modern primary care.
- Quality and time needed for safe clinical practice.
- The long-term value GPs provide to insurers.
It is time for TPAs and insurers to recognise that strong primary care is the foundation of a cost-efficient, safe, and sustainable health care system. Fair consultation fees are not a privilege — they are a necessity.
The authors are both general practitioners from the Perak Medical Practitioners Society.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
