Lately, there has been much ado and debate about raising professional fees for private general practitioners (GPs) in Malaysia.
Some parties believe that the fees should be harmonised between GPs in clinics and those in hospitals, while some are of the view that this harmonisation will affect the lower income group.
Let us look at the current situation.
When the Private Healthcare and Services Act (PHFSA) was introduced in 2007, a Fee Schedule was also rolled out.
This 13th Fee Schedule specifically mentions that the consultation rate for medical officers – who are qualified as GPs – in private hospitals can range from RM35 to RM125.
Unfortunately, at the same time, there is another Fee Schedule specifically for private GPs and the consultation rates are much lower than those in the 13th Fee Schedule.
This is the 7th Fee Schedule that states private GPs can only charge consultation fees of RM15 to RM35.
It can be observed that the consultation rates of GPs practising in private hospitals are much higher compared to those of their similarly qualified counterparts in private clinics.
The PHFSA requires that all private GPs, regardless of where they practise, uphold not only very specific practice requirements, but also maintain a very strict set of equipment and medication inventory.
Not only would GPs have invested both time and money to become qualified as medical practitioners, but those who choose to open their own clinic would have also invested a hefty amount to start it up and ensure that it is compliant with all regulatory requirements.
These investments are significant and are constantly increasing over time. So why should there be the discrepancy in their consultation fees?
The 7th Fee Schedule was introduced 27 years ago, back in 1992.
Today, the minimum wage has been set at RM1,100, which is a two-fold increase from over 20 years ago.
Thus, isn’t it a pickle that the earnings of the GP, who not only has to deal with a much higher personal cost of living, but also juggle high clinical care costs for his patients, while their consultation fees remain unchanged?
This is the sole reason for the request made by the Malaysian Medical Association to harmonise the two conflicting Fee Schedules.
After all, the place of practice should not matter and all GPs are not only similarly qualified, but equally equipped to treat patients without discrimination.
Third party influence
Having managed over 200 clinics nationwide within the medical group I founded, I must agree that Managed Care Organisations (MCOs) and Third Party Administrators (TPAs) play an important role in helping to build strategic partnerships with companies and adopting clinics under their purview as panel clinics.
They have provided systems that ease such areas like disease trend analysis, cost and utilisation systems, and even made it easier, to some extent, for GPs to collect payment from companies.
However, there are also instances when these third parties delay payments (some up to 90 days), affecting the cash flow of the clinic, not forgetting instances when a TPA ceases its operations, leaving clinics stranded without any legal recourse and costing them tens of thousands of ringgit.
On the patient front, more often than not, employees who have their medical costs covered by their companies have a higher expectation on the benefits that they are given.
Sadly, many are not aware on the arrangement between GPs and MCOs or TPAs.
In reality, GPs do not earn more through these partners, instead, they are committed to receiving a fixed consultation fee, while the rest of the payment needs to cover the patient’s medication and the administration costs.
Today, most MCOs typically agree to a doctor’s consultation fee of RM18 to RM20, although there are quite a number who only pay as little as RM10.
Thus, I would like to urge Malaysians to understand that the current rising healthcare costs aren’t due to the GPs’ consultation fees, as these have remained unchanged for more than 20 years.
There is also another aspect that has contributed greatly to the rising healthcare costs, and this is the lack of personal accountability for our own health.
The introduction of corporate medical benefits is partly to be blamed. Healthcare is “free” for employees as they do not feel any financial pinch with the costs being borne by their companies.
Some patients today are even demanding referral letters for admission into the most palatial private hospitals from GPs. The GP is paid a mere RM15, but is blamed for exorbitant cost.
Today, some MCOs even dictate what can or cannot be done by GPs, and would rather have them refer patients to private hospitals.
Indeed, such “bipolar” thinking must be rejected. These MCOs would rather have patients incur more costs in private hospitals, while private GPs take the brunt of the blame for rising healthcare costs.
Holding the first line
Even though the Health Ministry has yet to embark on the proposed dispensing separation system where doctors do not dispense medications and only charge professional fees, various organisations and tech start-ups have already begun to offer this service to the general public.
Today, just as in food, electrical items, toys and clothing, one is able to acquire medications with just a few clicks on his/her smartphone or laptop.
In this digital age, people spend less time in physical stores and more time online.
Patients today have access to long-term medications for chronic diseases such as hypertension (high blood pressure) and diabetes through user-friendly online platforms, which only require the prescription to be uploaded.
We are also in an era of “self-diagnosis” through online “consultation” videos or consultations via artificial intelligence.
Gone are the days when we relied on our family doctor or that go-to neighbourhood clinic.
This, however, may sometimes lead to misdiagnosis and further complications.
Sadly, many have disregarded the relevance of GPs as the first line of healthcare.
In spite of all this, your neighbourhood GP is still in existence today, albeit with their noses very barely above water.
It has reached a very critical point. More and more GPs are closing, more and more livelihoods are being affected.
We hope to see many more Malaysians realise that GPs are still very much relevant today and are not just here to merely run a for-profit business.
It is high time that all parties get together, with the highest level of urgency, determination and commitment, so that the practice of private GPs in this country does not disappear into oblivion.
After all, health matters truly matter.
Datuk Dr Noorul Ameen Mohamed Ishack is the founder, chairman and managing director of Qualitas Medical Group, a national network of private medical and dental clinics and medical centres. For more information, email firstname.lastname@example.org. The information provided is for educational purposes only and should not be considered as medical advice. 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.
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