PUTRAJAYA, Jan 20 — Private hospitals incurred losses from a programme with patients outsourced from the Ministry of Health (MOH), said the Association of Private Hospitals Malaysia (APHM).
APHM president Dr Kuljit Singh said data showed losses from private hospitals empanelled with the MOH’s Hospital Services Outsourcing Programme (HSOP) over the last one year. HSOP is administered by ProtectHealth Corporation, a company fully owned by the MOH.
“There were actually losses. The private hospitals are absorbing it; we’re doing it like CSR (corporate social responsibility), but we’re willing to do it to help the government,” Dr Kuljit told a town hall on diagnosis-related groups (DRG) at MOH’s headquarters here last January 9.
He said that although HSOP is deemed as a “DRG concept”, it actually isn’t as the “calculation wasn’t exactly correct.”
When asked for an estimate of private hospitals’ losses from HSOP, Dr Kuljit said APHM is still getting the exact figures from its member hospitals.
“It’s generally not profitable as cases are more complicated than the expected payment, but as part of our commitment to do and help the government and our people, we continue. Is this a sustainable programme? It has to be reviewed,” Dr Kuljit told CodeBlue. “We in private hospitals will do as much as we can to help.”
Health Minister Dzulkefly Ahmad previously described the HSOP, with a bundled payment system, as an example of how private health care charges might be regulated.
According to MOH deputy secretary-general (finance) Norazman Ayob at a separate town hall for ministry staff last Monday, RM144 million has been allocated for the HSOP Medical Programme.
HSOP – which targets at least 30,000 outsourced patients from the MOH to private hospitals – currently covers nephrology, cardiology, cardiothoracic, and radiology and imaging. The programme, with prenegotiated rates, involves 91 panel provider hospitals and 46 MOH hospitals.
“It’s to reduce waiting time and congestion in our hospitals so that our doctors can focus on more critical cases,” Norazman said, adding that the MOH plans to expand HSOP to other services beyond the current four.
Based on a brochure by ProtectHealth, the services provided under HSOP comprise:
- Cardiothoracic: adult cardiothoracic (coronary artery bypass graft and open valve replacement), as well as paediatric cardiothoracic.
- Cardiology: percutaneous coronary intervention, exercise stress test, Holter, dobutamine stress echocardiography, transesophageal echocardiography, and transthoracic echocardiography, paediatric cardiology
- Radiology: CT scan, heart scan, MRI, heart MRI, ultrasound.
- Nephrology: Arteriovenous fistulas (AVF)
At the DRG town hall, Dr Kuljit said private hospitals, in principle, agree with the implementation of the DRG reimbursement model, pointing out that health economist Prof Dr Syed Mohamed Aljunid Syed Junid from IMU University has been invited to brief them.
“The main issue is that we do not want this to be rushed and done in a short period of time just to fulfil the need and issues that have been portrayed about increasing health care costs,” Dr Kuljit said.
“It cannot be done in one year, two years; it will take more than that.”
The APHM president pointed out that the “complexity” of private health care costs is very different from the public health care system.
He also stressed that while the MOH is responsible for taxpayers’ money with the public health service, private hospitals are responsible to their investors and public shareholders.
“So we cannot experiment with a system without being sold on its merit,” Dr Kuljit said, adding that DRG should not be mandated for private hospitals under the Private Healthcare Facilities and Services Act 1998 (Act 586).
“It’s a tool for us to make the private health care delivery system more efficient, but not by mandating it in law.”
