The Doctor Says

Published: Sunday June 22, 2014 MYT 12:00:00 AM
Updated: Sunday June 22, 2014 MYT 7:23:01 AM

Money talks?

The fundamental question is how much value should be placed on patients’ interests. –AFP

The fundamental question is how much value should be placed on patients’ interests. –AFP

A PRIVATE hospital bill has two components – the doctor’s professional fees and the hospital’s fees.

The doctor’s professional fees include consultation fees, fees for ward visits and procedure fees.

The hospital charges include accommodation, laboratory, imaging, medication, and nursing, as well as labour ward, operating theatre, physiotherapy and other charges, if applicable.

A distinction has to be made between a doctor’s professional fees and the hospital’s charges.

This is important as the doctor is, not uncommonly, criticised for the whole hospital bill because he is in the front line of the healthcare system.

Doctors’ professional fees are regulated by the Private Healthcare Facilities and Services Act (PHFSA). However, the hospital charges continue unregulated, for reasons best known to the powers-that-be.

The mere regulation of doctors’ professional fees does not ensure that private hospital bills are contained, when private hospital charges continue unregulated.

How can the total hospital bill be contained when only the doctors’ professional fees, which comprise between 15% and 30% of the total bill, are regulated?

This is reflected in the facts. Until about eight years ago, a private hospital bill of RM100,000 was uncommon; today it is not uncommon, and this is due to hospital charges.

Doctors’ professional fees may vary in different hospitals and clinics, and even within the same hospital and clinic. This is because the individual circumstances of each patient are different.

A Palestinian doctor wearing a protective mask against swine flu or influenza A(H1N1) checks an X-ray scan at Al-Shifa hospital in Gaza City on December 8, 2009. Hospital masks and anti-bacterial hand gel vanished from shelves in the Gaza Strip as fear gripped the besieged Hamas-ruled territory after the first deaths of swine flu. AFP PHOTO/MOHAMMED ABED
The mere regulation of doctors’ professional fees does not ensure that private hospital bills are contained when private hospital charges continue unregulated. – AFP

Any reduction of a doctor’s professional fees is a matter between the individual doctor and the patient. Many doctors have waived part or all of their professional fees for patients who are not financially well-off or who have incurred a bigger-than-anticipated hospital bill.

Doctors do not publicise this fact because it may be construed as advertising, which is not permitted by the Malaysian Medical Council (MMC).

The patient should, upon request, be provided with an itemised bill by the private hospital to enable the patient to know what has been charged for. Although there are provisions in the PHFSA and its Regulations for the hospital to comply with such a request, its compliance leaves much to be desired simply because of poor enforcement.

Many who have complained to the authorities have also groused about this bureaucratic quagmire.

Although the initial owners of private hospitals and clinics were doctors, the last two decades saw the entry of commercial entities into healthcare, converting many doctors into paid workers or contractors, and healthcare into common goods, to be bought and sold.

The direct relationship between a patient and a doctor and/or hospital was converted into one where there are middlemen.

Previously, the healthcare ringgit went towards reimbursement of the patient’s hospital or clinic charges and doctors’ professional fees. With the arrival of managed care organisations (MCOs), all of which were commercial entities, the healthcare ringgit had to include their staff, marketing expenditure and dividends for their shareholders.

The number of MCOs has not increased much since 1995. Many MCOs have come and gone, primarily because they did not get their arithmetic right, leaving many private hospitals and doctors with valueless guarantee letters and substantial financial losses from unpaid bills.

The marketing strategies of MCOs are repeated over and over again. The major initial selling point was, and still is, cost containment.

This still finds currency with many employers who want to contain the costs of their employees’ medical benefits.

Another strategy is to provide management of employees’ medical benefits.

Many employers have human resource departments that only have vague ideas on handling employee healthcare.

Many find it attractive to outsource this function to MCOs, who appoint staff, some of whom were former nurses, to vet doctors’ decisions to decide whether they will pay, and if so, how much.

Another strategy which MCOs claim is quality healthcare.

Although MCOs have been around for two decades, there is, as yet, no published data of how they have contributed to an improvement in the quality and safety of care.

MCOs have also approached private hospitals and doctors for discounts with the promise of increase in patient loads with preferential referrals from the MCOs.

This inducement of an economic carrot has been very tempting to some private hospital chief executive officers.

However, this meant agreeing to terms and conditions that contravene the PHFSA and MMC’s Code of Professional Conduct.

The question that must be answered is how and to what extent do discounts benefit patients.

Would their range of healthcare benefits be increased? Would the premiums be adjusted downwards in subsequent year(s)? Is it acceptable for an MCO, which is a non-healthcare provider, to take a slice of the healthcare ringgit for its staff, marketing expenditure and dividends for their shareholders?

In short, patients’ interests continue to be traded like common goods sold in the supermarket.

The fundamental unanswered question is how much value should be placed on patients’ interests.

There are two components of a private hospital bill – doctors’ professional fees and hospital charges. The former is regulated by law; the latter is unregulated.

Unless and until hospital charges and MCOs are regulated, cost containment is a pipe dream, and patients and doctors will continue to get the short end of the healthcare ringgit respectively.

Is there any will to act in the patients’ interests?

Dr Milton Lum is director of Medical Defence Malaysia. This article provides general information only and is not intended to replace, dictate or define evaluation by a qualified doctor. The views expressed do not represent that of any organisation that the writer is associated with. For further information, e-mail The information provided is for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.

Tags / Keywords: Opinion, column, hospital costs

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