Malaysia is becoming a world medical hub yet Malaysians are seeking treatment abroad. Sunday Star talks to stakeholders about growing the domestic medical market.
BEST Country in the World For Healthcare in International Living’s Global Retirement Index 2015. Medical Travel Destination of the Year 2015 in the International Medical Travel Journal. The 2015 Public-Private Partnership Medical Travel Destination of the Year at the 8th Annual World Medical Tourism & Global Healthcare Congress.
Guess which country won all these accolades? Would you believe, Malaysia?
Not only do our hospitals and healthcare facilities meet international standards but they do so at rates cheap enough to have foreigners flocking here to use them.
Malaysians, however, are going overseas for medical and aesthetic procedures.
Health Ministry director-general Datuk Dr Noor Hisham Abdullah acknowledges that many Malaysians don’t know about the world-class healthcare treatments available within our borders. Or that Malaysian private hospitals also bagged prestigious global awards despite being up against hospitals in countries like Belgium, Britain, France, Indonesia, Italy, Kenya, Thailand, and Turkey.
And, says Dr Noor Hisham, there are many premier healthcare facilities outside of Kuala Lumpur featuring some of the most advanced treatments and medical facilities in the world, most notably in Penang, Malacca, Johor Baru, Kota Kinabalu, and Kuching.
But many Malaysians are unaware, he says.
Indeed, 27-year-old Even (real name withheld upon request) says if she had known that the procedures she travelled to South Korea to undergo were available locally, she would have had them done here.
She did spend RM14,000 locally for double eye-lid surgery, eye-bag removal, fillers, chin reshaping, and fat burning injections but went abroad for rhinoplasty, implants, restructuring of the nose, face augmentation, and liposuction. In South Korea, she paid US$13,000 (RM57,000).
“In Seoul, the medical centres are very accessible. It’s easy with Google. I just did my own research and contacted them via real-time messaging. If the Malaysian medical centres were more open, maybe I’d have more confidence to get it done here but it’s so difficult to get information unless you korek sendiri (dig for information yourself).
“It’s too conservative. Everything is by word of mouth so people may think it’s not reliable and that’s why the local facilities are afraid to shout it out.”
Despite cheaper, equally good care here, Malaysians will go elsewhere for treatment if we don’t give them enough information, Private Hospital Association Malaysia president Datuk Dr Jacob Thomas says.
It’s ironic that we’re a medical tourism hub yet people are opting to go overseas for treatment, he muses, pointing to how advertisements are restricted here.
“Advertisement” under the Medicines (Advertisement and Sale) Act 1956 includes any notice, circular, report, commentary, pamphlet, label, wrapper, or other document and announcement.
So a doctor giving a lecture is not allowed to publicise his place of practice. Before and after pictures of patients aren’t allowed. And unlike us, countries like Singapore and Thailand allow the medical industry to publish patient testimonials which are easily accessible online. This means that Malaysians have access to information about treatments abroad but they know little about what’s available here, points out Dr Thomas.
Traditionally, medical professionals are discouraged from advertising to prevent abuse and to avoid misleading the public, to avoid raising illusory hopes of a cure, for instance, says Dr Noor Hisham.
But in light of changing trends, the Malaysian Medical Council is reviewing and revising the code of practice “in the interest of the profession and the public”, he reveals, stressing that patient safety and interest remain of utmost importance.
Dr Noor Hisham, who is also council president, says the profession holds strong views against a doctor who resorts to publicity, in any media, to promote his practice and skills, thus gaining undue advantage over his colleagues and scoring points in market competition.
But what if a facility has the latest advancements to repair heart valves or even reverse the effects of acute stroke – and we still can’t tell the public, laments Dr Thomas. He insists that giving information is not the same as soliciting business.
“Testimonials are very powerful. When patients hear all these good things being said about this doctor from that country, they will go – especially when they can’t find similar testimonials for local expertise.
“We have a patient from Abu Dhabi, a place where healthcare is excellent, yet he keeps coming back here, each time with friends in tow. Yet we can’t showcase his testimonial,” says Dr Thomas.
“Cut the red tape. Leave it to us to comply with advertisement guidelines. If laws are breached, then come after us.
“Give doctors and hospitals a detailed list of the specific words that can or cannot be used, and leave it to us to keep the public informed,” he says.
The laws are sufficient but they need to be more detailed, and the approval process for advertisements must be re-looked, he feels.
“Getting approval is a hassle. Is prior vetting needed? We aren’t out to hoodwink patients. If an advertisement is misleading or has breached the guidelines, then by all means come down hard on the hospital.”
Registered specialists should at least be allowed to provide factual information about their experience and background, Dr Thomas feels. If the doctor lies, go after him.
But the regulations are especially strict about something like that, as individual doctors aren’t allowed to advertise in any form, says Datuk Dr N.K.S. Tharmaseelan, past president of the Malaysian Medical Association and Medico-Legal Society of Malaysia.
While advertising regulations have been loosened over the years, it’s still not a level playing field, he says. GPs, and standalone and specialist clinics can’t advertise freely. He says the Malaysian Medical Council takes punitive action against doctors and individual clinics regularly but there are so many loopholes for the “big boys” and hospitals. This, he says, is a major hindrance in the development of a huge market.
“You see huge billboards promoting clinic chains and hospitals at major intersections, along highways and there are even advertisements in cinema, yet individual doctors aren’t allowed to advertise in any form. The council comes down hard on them for even distributing flyers to announce the opening of the clinic in the neighbourhood.”
Dr Noor Hisham, however, explains that a distinction must made between the advertisement of a doctor or his practice as an individual and the promotion of a health facility as a business entity. The billboards mentioned are health facility advertisements, it just so happens that some of these have registered themselves using the name of a particular doctor’s clinic, for example, “Klinik Dr X”, he explains.
Dr Mohamad Nasir Zahari agrees with Dr Thomas. The medical director of the Beverly Wilshire Medical Centre feels that doctors and medical centres should be allowed to dispense information more freely and in more detail.
But we still need regulations, he maintains: “We cannot be like pasar malam traders shouting and shining the flashlight on what we offer,” he says, warning that over-claiming can lead to lawsuits.
He sees some loopholes that need plugging. Beauticians can advertise anything under the sun. For example, a doctor and a beautician may be using the same treatment machine yet only the latter can shout about it, he says.
Malaysian Medical Association president Dr Ashok Zachariah Philip, however, sees no need for public advertisements. Patients see family doctors or go to clinics when they’re unwell. If their regular doctor sees a need for further investigation or treatment, the patient will be referred to where the doctor knows they can be properly managed.
It’s best to consult a trusted doctor who can guide you in what you need and ensure that you don’t undergo unnecessary investigations or treatments, he advises.
“So it’s the doctors who need to be informed about the latest machines and treatment techniques available. And such information can be disseminated through publications directed solely at the medical fraternity and at talks and seminars,” Dr Philip believes.
Allowing advertising, he thinks, may lead to patients believing that they need the latest, most expensive technology when something far more readily available and at a lower cost will suffice. It could also lead to patients seeking treatments they may not need.
“When someone advertises, he’s trying to sell something. I don’t think we should try to sell healthcare. The public’s lack of medical knowledge makes it easy for advertisements to worry them.
“Doctors are constrained in their actions by ethical codes but in private hospitals, the management may be under pressure to bring in the profits. So I don’t think advertising should be further liberalised.”
Federation of Private Medical Practitioners’ Associations Malaysia president Dr Steven Chow feels there’s enough leeway for effective advertisement but it cannot be a free-for-all situation. There are clear advertisement guidelines for everyone, from the individual practitioner to the hospitals. Cost, he says, is the main restriction.
Extensive advertisement costs millions of ringgit yearly and this eventually translates into higher service charges, he opines. A patient, he thinks, is the best advertisement.
“Be ethical and professional. Treat them well and with compassion. They will speak volumes for you,” Dr Chow advises.
Unlike private hospitals, doctors cannot advertise, whether directly or indirectly, to get patients or to promote themselves for public policy reasons, Medico-Legal Society of Malaysia president Dhinesh Bhaskaran says. They can, however, provide information on the advances in medical science or therapeutics. Self-advertisement can be a danger to the public, he adds, as a doctor successful at getting publicity may not be the most appropriate doctor for the patient.
He says patients who feel that they have been misled by medical-related advertisements can sue for misrepresentation. If the patient’s grouse is that they have been misled by a doctor, the patient can lodge a complaint with the Malaysian Medical Council.
All medical services and pharmaceutical products promoted in Malaysia are regulated under the advertising guidelines set by the Health Ministry regardless of their points of origin. This is to protect the public against untruthful or exaggerated representation of health benefits and services whether by local or overseas healthcare providers, Dr Noor Hisham adds.
The general rule is that advertising should not bring about undue advantage of a practitioner over his colleagues. The promotion of a doctor or his practice should also be made in a respectable manner and should not discredit or sully the image of the profession, he says.
“For this purpose, the council’s Code of Professional Conduct and the Guidelines for Good Medical Practice outline how a doctor may present himself and his practice to the public. Promotion of medical tourism must also take cognisance of the ethics in doing advertisements.”