Patients free to choose paying service

REFERRING to the letter “Protect private care patients” (The Star, April 4), the Health Ministry (MOH) would like to inform that there are numerous misleading and inaccurate information in it which we would like to clarify.

The MOH’s full paying patient (FPP) service is offered by selected government hospitals to patients who can afford to pay. They are given the option and opportunity to be treated by an eligible specialist of their choice and would be charged fully without subsidies from the government for their medical treatment and services. This service is completely voluntary as it is entirely the patient’s choice to take it, and it is not to be commercialised as a profit-making scheme.

Apart from providing options for these patients to receive treatment in public hospitals, the FPP service was also set up as part of a retention package for government specialists to earn additional income while continuously serving in public hospitals. This service is able to lower the government’s healthcare expenditure by reducing the subsidy on health services to people who can afford to pay fully for their treatment.

In short, the FPP service does not abrogate the government’s responsibility towards the general public, especially the poor or B40 group. Actually, a large portion of revenue garnered from this service is channelled towards the government’s consolidated fund, which in turn will be used for annual budgeting by the Finance Ministry to continue the heavily subsidised public healthcare service for the general public.

Generally, around 4.6% of Malaysia’s Gross Domestic Product (GDP) is spent on healthcare, where 2.4% is spent on the public sector and around 2.2% on the private sector. From the total healthcare expenditure spent in the public sector, around 99% is subsidised and borne by the government, and patients only have to co-pay 1% or 2% of the cost.

The FPP service has not altered this status despite being offered for the past 11 years in selected MOH hospitals.

Currently, only 10 MOH hospitals have implemented this service – not 32 (including university hospitals) as mentioned by the writer, Datuk S. H. Lee. According to MOH data in 2017, only 0.09% of total patient encounters in MOH facilities were from FPP patients. Therefore, it is very inaccurate to say that majority of patients are channelled into the FPP service.

Despite this small number, the government in 2017 collected RM20mil in revenue from this service. This amount increased to RM22mil in 2018.

A portion of this revenue was channelled as additional income to FPP specialists as part of the retention package and the remaining went into the government’s coffers to be used to reduce the overall subsidised healthcare expenditure.

Since the introduction of the FPP service, the overall specialists’ resignation rate has reduced from 6.4% in year 2000 to 3.4% in 2017. But please bear in mind that there are numerous other factors contributing to this reduction in rate and not just the introduction of the FPP alone.

Data from Putrajaya Hospital (one of the pioneer hospitals for FPP) has shown that it has a lower rate of specialist attrition (2.2%) compared to the national average for public hospitals. Generally, this increasing number in the specialist pool in the public sector has enabled the MOH to reroute more specialists to smaller hospitals, hence more non-specialist hospitals are converted to specialist hospitals (such as Banting Hospital, Segamat Hospital and Bintulu Hospital).

This initiative complements the cluster programme by MOH, whereby more accessibility to specialists’ services can be provided to Malaysians. This growing number of government specialists has a snowball effect on the number of Houseman Training Centres and Master Programme Centres developed by MOH.

There were 47 and 33 centres respectively in 2018. These impacts are crucial for the development and training of professional health human resources in Malaysia.

The government’s subsidised healthcare services, which act as a “safety net”, will be further enhanced through various measures under the ministry’s health system transformation.

Although patients are subjected to some minimal charges (depending on the class of treatment and facilities provided), the charges are very low and affordable as they are still subsidised by the government. The government has also created many mechanisms to enhance the safety net for less well-to-do patients, such as Tabung Bantuan Perubatan, subsidised haemodialysis care and the PeKa B40 Scheme.

Patients referred from private hospitals have an option either to be treated under the FPP scheme and charged under the Fees (Medical) (FPP) Order 2007 or as a normal public patient under the Fees (Medical) (Amendment 2017) Order 1982.

Privately referred outpatients who do not opt for the FPP scheme are charged the first class rate based on clause 12(a) of the Fees (Medical) Order 1982.

However, those who choose to be treated as inpatients in a third class ward will be charged third class fees even if they are privately referred. Generally, fees for the first class ward in MOH are much cheaper compared to private hospitals, as they are still highly subsidised. To make inroads in amending these administrative rules, all registered PeKa B40 patients, including privately referred patients, will be exempted from first class rate fees. This will further enhance the safety net for public patients, especially those from B40 group.

Moving forward, MOH will continue to cut down the administrative hindrances in providing a safety net for public and private patients. It is aiming for a high quality, more cost-effective healthcare system and moving towards integration of the private-public healthcare sectors with better partnership and collaboration of services.

We admit that there is still room for improvement in the implementation of the FPP service, hence the implementation has been done gradually over the past 10 years. The aim is to improve it further without compromising the quality or hindering accessibility to patient care. In the long term, the ministry believes all of these measures would lead towards an integrated, efficient and cost-effective care that is accessible to all.

For details on FPP service, visit


Director-general of Health Malaysia

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