I WRITE to support the plea of Dr Peter Chan and Dr Raj Kumar Maharajah on behalf of the Medical Practitioners Coalition Association of Malaysia (The Star, May 15) on the need to regulate commercialised medicine to safeguard the long-term interest of the nation in sustainable medical care.
Few people realise the importance of the ordinary General Practitioner in the medical care of the public.
In all healthcare financing systems, the primary care doctors are the leaders who deliver the fruits of modern scientific medical care to the community. In a completely socialised system such as the United Kingdom, over 90% of 300 million annual out-patient visits are conducted by 30,936 full-time equivalent GPs. In a private system like the United States, of the nearly 956 million visits that Americans made to office-based physicians in 2008, 51.3% were to primary care physicians.
Regions with fewer GPs in the US (where one consultation to the GP clinic costs about USD300) are associated with the highest rate of unemployment, uninsured population and generally higher morbidity. Even in the UK where services are available free of charge, there is also a close correlation between areas with the lowest life expectancy and those with the fewest GPs.
A highly trained and experienced GP is the single most important cost-saving factor in any form of healthcare system. As gatekeeper for access to the high-cost, high-technology hospital system, the GP determines the need for referral, and provides treatment for patients who do not require high cost hospital intervention.
An aging population and the unbearably high cost of technology has already initiated the return of community care centres all over the rich countries.
For centuries, medical care had always been a largely private affair. People paid for what they could afford, often nothing, and the doctor did what he could, albeit very little. Medical care was a gift, not a right.
The dazzling success of scientific medicine in the last 150 years transformed a private need for care to become a part of human rights in 1946, as declared in Article 25 of the United Nations Universal Declaration of Human Rights: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services.”
Governments, then, have a responsibility for the health of their peoples. This created a multi-billion fertile meadow of commons in which everyone wants a piece of the cake. The interest of business is diabolically opposite to the interest of the public – the business of business is to make money; if you can’t make enough, then cut costs and quality and ration care.
For its naivety in economic matters, the medical profession became the first victim of this tragedy of the commons: complicity or out. Within this medico-industrial complex, the GP’s business is the least profitable and carries the highest management cost.
This management cost was then transferred to the third party administrators and managed care organisations who in turn transferred portions of it to the doctors. The GP is literally held by the neck and threatened with his livelihood to comply.
What the MACPM complained about is merely the result of this complex interaction. Are the doctors asking for too much? Apparently not. The World Medical Association in Geneva published a guideline on Incentives for Health Professionals which was adopted by the World Health Organisation in 2008. All that the medical profession is asking for is an incentive system that is fair, equitable, and transparent.
The Malaysian Medical Council (MMC) has jurisdiction only on the qualification and ethical aspects of the profession. But MACPM’s complaint has gone far beyond a simple matter of “fee splitting”.
MMC should also address the issue of whether a consultation fee of RM10-RM15, far below that stipulated by the Private Healthcare Facilities and Services Act or current economic conditions, can erode medical professionalism and ethics in a fundamental way. If that is the case, then there is a legal and ethical jurisdiction for its further actions.
Despite the profession’s tremendous contribution to health care in the country, the Government has not assisted GP practices for many years now.
Now, more than ever, we need to support the backbone of medical services in exchange for quality of care. Uncontrolled market oligopoly will eventually lead to the demise of GP professionalism and together with it, our medical GPS will also succumb.
DATUK DR SH LEE