The full payment service, to be introduced next year in first class wards at selected Government hospitals, will need to be properly implemented in order for it to attain its objectives. WONG LI ZA reports.
DR K. Dylan (not his real name) who is in his sixth year of service with a Government hospital in Selangor readily admitted that he has often thought about moving to private practice.
“It is natural for people to look for greener pastures,” said the 36-year-old.
The recently announced move by the Health Ministry to implement full payment service at first class wards in certain Government hospitals which, among other reasons, was aimed at encouraging doctors to stay on, should therefore have been good news.
However, Dr Dylan has his reservations.
“What kind of increase (in salary) are we talking about so that doctors will still feel compelled to stay? And will it match that in the private sector in time to come?” he queried.
According to Dr Dylan, a specialist in the government sector earns between RM7,000 and RM7,500 while in the private sector, he or she can earn between RM10,000 and RM15,000.
“Private hospitals function because of medical insurance and the faster service they can provide. Government hospitals function because of government subsidies and taxpayers' money,” he said.
The full payment service, to be implemented next year beginning with Selayang and Putrajaya Hospitals, would see patients in first-class wards being able to choose the doctors and specialists to treat them, as is the practice in private hospitals.
These patients would be paying full doctors' fees according to the fee schedule drawn by the Malaysian Medical Association.
The Cabinet has also agreed to allow public sector doctors to do locum in government hospitals and clinics.
The full payment plan aims to provide services on par with that of private hospitals, improve overall efficiency and services, and increase competition in the healthcare industry.
It is also expected to increase Government medical services revenue.
The Ministry hopes to target those with insurance coverage and patients whose medical expenses are borne by their employers with this service.
It also assured that there would be no special attention for patients in terms of receiving faster surgery or treatment just because they were paying in full, and surgery or treatment given will be based on the medical condition of patients.
Dr Dylan admitted that the plan was a good move by the Government to help increase doctors' salary, Government revenue and to meet the people's need.
“The Government should sustain the needs of the people and doctors should work to support that. Whatever said and done, a doctor is supposed to save lives, whether you’re paid or not, but most of us will not have that service attitude,” he said.
The Federation of Malaysian Consumers Associations (Fomca) secretary-general Muhammad Sha’ani Abdullah raised some points about the potential success of the full payment service, however.
“Are there guidelines in place on its implementation?” he queried, saying that one problem in public medical service was doctors did not stay long because of the relatively low and fixed pay structure.
“With this new service, there should be procedures and guidelines on how to compensate doctors,” he said.
Malaysian Medical Association president Datuk Dr N. Arumugam said Government doctors have been pushing for the new scheme for some time.
“This new move targets doctors who are still unsure about whether they want to stay or leave public service,” he said.
Under this scheme, the Government might propose two different sessions a day in which doctors would be serving – one treating regular patients and the other, full paying patients, he explained.
“Supplementary income (from full-paying sessions) may help these doctors stay back,” said Dr Arumugam.
Many doctors enjoyed working in Government hospitals due to the variety of cases and job fulfilment but at the end of the day, the monetary issue factored in, for example paying for children's education, he added.
For patients, medical treatment is a personal thing and they may prefer and request treatment from certain doctors, which was presently not allowed in Government hospitals, he said.
With the new system, said Dr Arumugam, patients would be able to choose a better ward and the doctor of their choice while paying a lower price compared to that of private hospitals.
But, he said, there was one problem with the new move: first- and second-class wards in Government hospitals were currently already full most of the time. (There are over 1,680 beds in first-class wards in the country at present.)
“But the Government will try it out anyway, and may later build a private wing (if the response is good),” he said.
Malaysian Employers Federation executive director Shamsuddin Bardan said the Health Ministry should look at the availability of beds before fully implementing the system so that patients would not be pushed to other wards even though they were paying the full amount.
“Otherwise, promises would remain as that,” said Shamsuddin.
Muhammad Sha'ani also said the Ministry needed to stick to its promise that full-paying patients would not be given priority in the waiting list for surgery and treatment just because they paid in full.
“Government hospitals have to improve the overall waiting period of getting treatment so that there is no preferential treatment for anyone,” he stressed.
“And if the Government is seriously looking for extra revenue, then yes, it should give better service to paying patients to get the market,” he said, adding that the new service could lead to private hospitals lowering their fees to compete with Government hospitals.
Shamsuddin said private sector employees generally preferred private hospital services because of their less favourable experience with Government hospitals.
Among the grouses MEF received from employers were long waiting periods and that emergency cases were not immediately treated, he said.
“If we switch to Government hospitals, we might have a lot of objections due to the stigma already attached to Government service,” said Shamsuddin.
“But in the event that the full payment system is implemented and service is equivalent, if not better, than the private sector, then the perception may change, but that has yet to be proven,” he said.
On a positive note, Shamsuddin said it was a known fact that Government hospitals always have good equipment and facilities.
“And if charges are less than in private hospitals, it could attract private sector employers to come in (and use the new service),” said Shamsuddin.
Muhammad Sha'ani said the new move was another option to creating a separate, private wing in Government hospitals.
“I presume that this is to avoid complete privatisation of health services, which is something Fomca is against.”
Both Muhammad Sha'ani and Dr Arumugam concurred that the new scheme would need a lot of administration and paper work to make it work.
“People are also still sceptical. The Health Ministry has to have more awareness and education programmes about this (service). And the public needs more information about the whole system and how it works so that they will not misjudge it,” said Muhammad Sha'ani.
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