Healthcare at a crossroads

  • Letters
  • Wednesday, 18 Jul 2018

Used blister packets that contained medicines, tablets and pills are seen, in this picture illustration taken June 30, 2018. REUTERS/Russell Boyce/Illustration

I WOULD like to touch upon a disturbing phenomenon in the healthcare delivery chain in Malaysia. I refer particularly to doctors’ responsibility in how medications are prescribed and dispensed.

For years now, there has been talk about “dispensing separation” whereby doctors in private practice should only prescribe medications and allow patients to choose from whom they get their medications, be it the doctor or any registered pharmacist. This system has merit, and many countries have adopted it. And, ultimately, the patient benefits.

In recent times, in spite of the various delays in implementing this on a national and comprehensive level, the private sector has embarked on the initiative. Various private healthcare payors – companies with employee healthcare benefits, insurers, third-party administrators – have started to provide this facility to the beneficiaries of these managed healthcare programmes. They have made alternate arrangements with pharmacy chains to not only dispense but even deliver to homes their members’ medications.

Although this seems good and cost-effective on the surface, I would like to point out that danger lurks beneath this process.

Today, we are seeing patients coming in to GP clinics requesting, even demanding, prescription slips without even seeing the doctor. It does not help that there are plenty of unscrupulous parties who aid this. Walk in to some pharmacies today, and one can buy any medication merely by “consulting” the resident “healthcare expert”. Note that this new mode of seeking health care has completely bypassed one very central figure: the doctor.

There are laws in this country that prevent such practices. Laws that protect the health and wellbeing of individuals. Laws that do not have Google in the definition of healthcare delivery chain. To sum it up, laws that make it MANDATORY for any prescription drug to be prescribed by a registered medical practitioner, aka a doctor.

Today, private GPs are faced with such demands daily. Worse, GPs here are not being adequately reimbursed in terms of their professional fees. Ask any GP how much he/she is being paid to see a patient under a managed care setting. Then compare that with a barber’s fees. If this situation goes on, parents, don’t force your children to go to medical school. Make them go to hairstyling school – cheaper, with higher returns.

Till now, doctors have been fairly tolerant of this arm-twisting. It is no secret that GPs can still eke out a modest living from the margins obtained from medications dispensed. But not anymore. Unless doctors are paid according to the fee schedule approved by the Health Ministry and are not forced to give discounts and “negotiated rates”, private GPs in this country will cease to exist.

In these trying economic times, I empathise with corporations who have to manage costs. It has always been said that healthcare costs for private organisations form a large portion of their total costs. But to manage it in a way that completely removes the doctor from the equation is playing with fire.

Sure, you will see overnight savings. But I can assure you, it is only the calm before the storm. Ultimately, your healthcare spend will increase exponentially. Unmanaged long-term diseases, wrong medications, adverse drug reactions and interactions, liver and kidney impairment are just some of the things which could come back to haunt you later. Your hospitalisation rates will rise and the general health status of your employees will fall.

Agreed, companies should provide the best for their employees and take care of their health. But should companies do this by playing the doctor? Or should the cost containment come from stricter HR policies, or even a review of the company’s healthcare benefits policies rather than interfering with the doctor-patient interaction?

Take a moment to ponder this, because the current model only serves to feed and nurture the “subsidy mentality” that afflicts this nation. Whatever happened to the fact that an individual should be accountable for his or her own wellbeing?

To sum it up, healthcare delivery in this country is now at a crossroads. We are in danger of promoting self-medication and unrestricted and wanton supply and movement of medications. For decades now, the various stakeholders in this equation have been squabbling over who gets the spoils of the industry. I now urge these stakeholders to step out of their shells and smell the roses. We MUST come together to devise a strategy that will benefit all parties, especially the PATIENT.

Agreed, we must find a solution to manage employee healthcare costs but not at the expense of only one part of the entire healthcare delivery chain. GPs are not the cause of rising healthcare cost. The burden MUST be shared.

Dr Junaidi Ismail


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