It's time to settle the GP fee disparity


General practitioners operating in private clinics were informed that the disparity between their fees and their compatriots practising in private hospitals remain unresolved. — Filepic

Two recent incidents raised the angst, and in many instances, anger of many doctors and dentists. The general practitioners (GPs) practising in private clinics were informed that the disparity between their fees and their compatriots practising in private hospitals remain unresolved. Then the dental graduates from seven Taiwan universities were informed that their qualifications have never been recognised. Both issues raised fundamental questions about the implementation of policy decisions and their processes. General practitioners’ fees The Private Health Care Facilities and Services Act contain two Regulations – one for clinics; and another for private hospitals and other facilities. Doctors’ fees are found in Schedule 7 in the former and Schedule 13 in the latter. Schedules 7 and 13 contain fees for GPs practising in clinics and hospitals respectively. Any change to the Regulations has to be gazetted. The government approved the amended doctors’ fees in 2012 after protracted discussions by the Fee Amendment Committee of the Health Ministry. The health director general’s press statement on March 6, 2014 explained the rationale for amendment to the GPs fees. The amended Schedule 13 was gazetted on October 10, 2013 but the amended Schedule 7 was not. The effect was disparity between the fees of GPs practising in clinics and in hospitals i.e. higher fees for the latter, who, in general, have fewer years of experience than those practising in clinics. That was the first time that an inconsistency in a healthcare law was created. The question arises as to whether the bureaucrats knew there were many more GPs practising in clinics than in private hospitals, and whether they knew about Schedules 7 and 13. Additional questions are inevitable if they claimed that they did not know or if they knew but did not gazette the amended Schedule 7 at the same time that the amended Schedule 13 was gazetted. The omission was pointed out to the Health Ministry but nothing was done. The amended Schedule 7 has yet to be gazetted till today.

Doctors and dentists know that it is very difficult to regain the patient’s trust when it is lost. Photo: Relaxnews
The non-gazettement of amended Schedule 7 raises the inevitable question as to whether unseen hands were involved. The Health Minister announced that a memorandum on the rectification of this disparity was tabled at the Cabinet on April 24, 2019 and that the Cabinet had recommended the matter be discussed at the National Cost of Living Council meeting, after which the matter would be brought up again for the Cabinet’s consideration. Was the Cabinet informed of all the facts? Was the Cabinet misled? Why was the Cabinet’s precious time spent revisiting part of a decision that had not been acted upon by the Health Ministry’s bureaucrats?Recognition of Taiwan dental qualifications It was alleged that dental qualifications from seven Taiwan universities were removed from the list of recognised qualifications by the Malaysian Dental Council in the amended Dental Act 2018 (www.thestar.com.my/news/nation/2019/07/17/taiwanese-dental-schools-removed-from-approved-list-and-supp-wants-to-know-why). The President of the Dental Council’s response was that the qualifications have never been recognised in the first place (www.thestar.com.my/news/nation/2019/07/17/health-dg-dental-qualifications-from-taiwan-not-recognised). The Federation of Alumni Association of Taiwan Universities, Malaysia (FAATUM) produced a copy of a letter from the Public Services Department dated February 3, 1996, confirming recognition of these qualifications and pointed out that the recognition in 1995 was never gazetted. This was also stated in a Parliamentary reply in 2000. Since then, there has been a deafening silence from the Dental Council and Health Ministry. Deep state in healthcare? A deep state, also known as a “state within a state” comprises hidden or covert networks of power, operating independently of a state’s political leadership, in pursuit of their own agenda and goals. The examples often given include state organisations such as the police, armed forces or governmental bureaucracy. It could also be in the form of entrenched, career civil servants, acting in a non-conspiratorial manner, to further their own interests. The objectives of a deep state include continuity of the state itself, job security for its members, greater power and authority, and pursuit of ideological or commercial objectives. The deep state can operate in opposition to the agenda and decisions of elected officials by obstructing, resisting, and subverting their policies and directives. It can also take the form of governmental or private organisations acting independently of regulatory control. A minister and a senior member of the current ruling coalition has raised this issue and even stated that the deep state has hampered governmental reforms. The reader can decide whether there is deep state involvement in the two healthcare policy decisions above. Going forward Healthcare is different from other spheres of human activity in that altruism and trust are fundamental. The objectives of any health policy cannot be achieved if it is implemented without the active participation of all stakeholders. Doctors and dentists know that it is very difficult to regain the patient’s trust when it is lost. Similarly, when there is distrust of health officials, the tasks of the political leadership become all the more difficult with consequences, which can even reach the ballot box. It is time that the political leadership in the Health Ministry take the necessary measures to ensure that there is strict adherence to rules and processes; transparency and accountability in policy decisions. Rectifying the non-gazettement of the issues above will go some way towards narrowing the trust deficit that may have developed between the medical and dental professions and the ministry. In summary, there is no place for a deep state in healthcare. Dr Milton Lum is a past president of the Federation of Private Medical Practitioners Associations and the Malaysian Medical Association. The views expressed do not represent that of organisations that the writer is associated with. For more information, email starhealth@thestar.com.my. 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 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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