Since Malaysia attained independence, our health statistics have shown a dramatic improvement, our infant mortality rates have dropped significantly, and our life expectancy has increased and is in line with, or even better than some, developed nations.
However, there is a price to pay for our success.
Today, as our nation ages, we are faced with an unhealthy population that is plagued with poorly-controlled non-communicable diseases (NCDs) like type 2 diabetes mellitus, high blood pressure (hypertension), obesity and high cholesterol levels.
These are all lifestyle diseases of which control is in the hands of the individual, guided by the doctor.
It is heartening to note that in keeping with the World Health Organization’s (WHO) call for universal health coverage, the Government has provided healthcare facilities from basic primary care to state-of-the-art tertiary hospitals.
We know that all these services are provided at highly-subsidised rates, and at times, free.
However, due to the huge demand for these services, there are long waiting times for appointments.
While the Health Ministry has taken many innovative steps to overcome this, overcrowding still exists in most urban government polyclinics because you simply can’t beat the value for your money!
This is where the private general practitioner (GP) fills in the gap.
Our data shows that three-quarters (75%) of people seek treatment for minor aliments at the private GP clinic, and this is mainly because it is fast and has a reasonable price.
Patients pay out of pocket or are reimbursed by their employer.
These GPs provide a wide variety of services that complement the services provided by public healthcare services.
In most developed nations, the GP network is increasingly looked upon as the most cost-efficient system to deliver quality healthcare.
In the OECD countries, the GP is part of an integrated care network, that is to say, rather than having a patient with multiple NCDs be seen by several specialists either in public or private hospitals, the GP manages the patient in a patient-centred approach that is more cost-efficient and shows better outcomes.
If we as a nation want to move towards a healthier future, we need to harness this untapped potential.
We have to recognise the vital role that private GPs have played and can be made to play.
Of late, there has been lots of unhappiness and rumblings amongst the private GPs, because they feel that they have been marginalised.
For one, their professional fee schedule is obsolete – it has not been revised in the last 27 years.
Is there any other professional in this day and age in Malaysia who is only allowed to charge RM10-RM35 per consultation?
Even the technician who services your air-con or washing machine requests a service charge of RM50-RM60.
GPs are faced with many challenges: increasing operating expenses, increasing rentals, minimum wages for their staff, increa-sing cost of medications (due to, among other reasons, the weak ringgit and inflation), maintaining universal precautions and infection control ... and the list goes on.
As such, the GP has many hidden expenses that patients don’t see.
Is their request for an increase in professional charges fair?
The reference point taken was the fees charged by non-specialists in private hospitals, which are RM35-RM125.
This fee range was approved in an amendment to professional charges for specialists and services offered in private hospitals in 2013.
The private GPs’ fee proposal is fair as it is harmonises with existing fees and is not asking for an increase. Unfortunately, currently, some are more equal than others.
However, the common kneejerk reaction by the public and consumers are that it is going to raise the cost of healthcare.
But, actually, the real rise in healthcare cost that we see today is not by the GPs, because for 27 years, their hands have been tied! It is instead caused by other players in the healthcare industry.
Bundling for savings
The private GPs have worked out a system where, although there will be a rise in their professional fees in line with what is being charged in private hospitals, they will be doing bulk purchasing of drugs and consumables, which will bring prices down.
These savings will then be passed onto the public.
This is a major shift from their old business model of being a stand-alone entity to a consolidated group where economies of scale will give them better purchasing power.
With this, they envisage that the total cost of a visit to a GP for a common ailment will still remain RM60-RM70.
This is as their professional fees will go up, but the cost of medicine will come down, and remaining true to the Hippocratic oath, they will pass this saving on to the public.
This, in fact, is known as bundling – a concept very similar to the value meals at fast food outlets.
The GPs have explained in detail the matrix of the fee schedule to all the various stakeholders, who have been reassured that there will be value for money and value for all, a true win-win situation.
However, in order to maintain international standards of developed nations and to ensure universal precautions to prevent cross-infection of infectious diseases like HIV or hepatitis, all consumables need to be disposed of, once used.
As such, there will be a small price to pay to know that the needle being used on you is sterile and will only be used once.
Even in this aspect, bulk purchasing of such consumables is expected to produce savings that can be passed on to the patients.
In the last few years, some private GP clinics have been forced to shut down, while others are barely surviving.
If their request for a reasonable increase in their professional fees after 27 years is not allowed, then more will be forced to close down and private healthcare will become more expensive as options for the public will be limited.
In keeping with other developed nations and to keep healthcare cost down, the private GP should be part of the integrated healthcare system, where in a patient-centred manner, not only will the GP treat common acute illnesses, but also be empowered to manage uncomplicated chronic NCDs and be the gatekeeper to the specialist by refering complicated NCD cases.
It is heartening to note that the Health Minister will be holding a townhall meeting with private GPs on June 11, 2019, to look into their challenges, and it is hoped that a happy solution will be reached based on reason and compassion.
Prof Datuk Seri Dr Jeyaindran Sinnadurai retired as the Health deputy director-general (Medical) in May 2018 and is currently a senior consultant in internal medicine at Hospital Kuala Lumpur.
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