KUALA LUMPUR, July 2 — The Ministry of Health (MOH) has reiterated to managed care organisations (MCOs) and third-party administrators (TPAs) that interfering with doctors’ medical practice may violate the law.
Health Minister Dzulkefly Ahmad cited Health director-general Dr Mahathar Abd Wahab’s previous statement that any action that undermined the independence of medical practitioners in carrying out their responsibility to treat patients may be interpreted as being inconsistent with existing legal provisions under the Private Healthcare Facilities and Services Act 1998 (Act 586).
“The Ministry of Health hopes that the relevant parties will take proactive measures from now on to curb practices that are inconsistent with medical ethics or the provisions of the law,” Dzulkefly said in a written Dewan Rakyat reply last Monday to Tanjong Karang MP Dr Zulkafperi Hanapi.
“The MOH maintains its position that the primary role of MCOs and TPAs is to facilitate financial and insurance claims administration, not to regulate the practice of medicine.
“Any disputes or contractual agreements between private clinics and MCOs or TPAs should be conducted fairly, without imposing undue pressure that could jeopardise the sustainability of clinic operations or the quality of patient care.”
Dzulkefly stressed that the MOH maintained a firm position in ensuring that the professional autonomy of medical practitioners was preserved, while the welfare and safety of patients remained the highest priority.
“The MOH takes seriously any allegations of interference by third parties, such as managed care organisations (MCOs) or third-party administrators (TPAs), that overstep their role in ways that compromise the quality of health care delivery in the private sector.”
The health minister added that the MOH played an active role in the Healthcare Partners Protocol & Solutions Committee (HPPSC) – a platform comprising Bank Negara Malaysia (BNM), the Malaysian Medical Association (MMA), the Association of Private Hospitals of Malaysia (APHM), the ITO Association, and TPAs – to discuss and identify comprehensive solutions to the key issues raised by stakeholders concerning professional fees and the financing of treatment at private health care facilities.
Dr Zulkafperi had raised allegations about MCOs’ involvement in setting charges and treatment plans in private clinics that jeopardised doctors’ autonomy and patients’ welfare.
Act 586 primarily regulates private health care facilities and services. The government has yet to enact legislation to regulate MCOs or TPAs despite their big role in the private health care ecosystem.
