Paying for private patients

  • Letters
  • Thursday, 18 Apr 2019

I REFER to the letter “Protect private care patients” (The Star, April 4) by Datuk Dr S. H. Lee and the response from Health director-general Datuk Dr Noor Hisham Abdullah, “Patients free to choose paying service” (April 8)

Dr Lee raised some very relevant issues about the full paying patient scheme (FPP), where patients in some public hospitals can opt to become FPPs and be treated by

the consultant of their choice. Dr Lee’s contention was that the neediest patients, out of necessity, are being compelled to opt for this system.

On the other hand, the director-general of Health explains that all patients have this option and it is a completely voluntary scheme. He adds that those in the FPP scheme “are charged fully without subsidies”, they are admitted to the first class ward and pay first class charges as per the Fees (Medical) FPP Order 2007.” The scheme generated an income of RM20mil in 2017 and RM22mil in 2018, he says.

(This amount is a drop in the ocean and I would submit that there are better ways to optimise the healthcare budget.)

Dr Noor Hisham also says: “Generally, fees for the first class ward in MOH (Health Ministry) hospitals are much cheaper compared to private hospitals, as they are still highly subsidised.” This leads to the inference that the Health Ministry is actually subsidising the hospital stay of the FPP.

If this is so, why are we subsidising those who can afford to pay? Are we robbing Paul to pay Peter? It is a known fact that FPPs pay a much smaller total charge for the same procedure compared to a patient in a private hospital.

While Dr Lee is correct in saying that the FPP scheme was initially introduced in 32 government hospitals, the DG says it is only being carried out in 10 hospitals, which is true also. This is because the former health minister, reacting to complaints from various quarters, including Dr Michael Jeyakumar of the Socialist Party of Malaysia (PSM), instructed the ministry to conduct an in-depth study into the various issues raised.

The study revealed that non-FPPs were being marginalised, as they encountered delays in setting appointments or postponement of surgery. In fact, it could be said that “some patients were more equal than others”, which translates to a situation where consultants were spending more time with their FPPs than with public patients.

The study also revealed that the charges for FPPs did not reflect the actual cost and, due to various reasons, many items or procedures were not charged. As such, the then health minister made an executive decision not to extend the FPP scheme to the other 22 hospitals until all these issues were resolved.

One of the recommendations of the memorandum titled “Recommendations from PSM for the Public Health System”, submitted to the Health Ministry on Aug 29, 2018, was to freeze the FPP scheme and have a third party conduct a professional study on the impact of the scheme on non-paying patients and also the training of young doctors. Another recommendation pertained to fees for implants.

It is heartening to note that the current health minister has taken this into consideration and provided for it under the PeKa B40 and mySalam B40 health schemes. This is the right move to make healthcare affordable to the lower income group.

I hope the health minister will also review the studies conducted in 2018 on the FPP scheme and initiatives to plug the bleeding of public funds to subsidise the B40 but not the T20 (top 20% income group) and M40 (middle income group). The minister should also look at how some of the consultants are able to take home six-figure incomes monthly due to the FPP scheme. Is this possible without marginalising public patients and spending less time mentoring junior doctors? PSM’s concerns are not without reason.

Does raising RM22mil via the FPP scheme really help to contribute towards a health budget of RM29bil or justify the many issues raised, especially subsidising those who can afford to pay?

Finally, in keeping with both corporate governance and clinical governance, any one individual who has a vested interest in the FPP scheme should not be involved in the decision-making process. Only then can we ensure that the final decision will be made in a transparent manner, in keeping with the aspirations of Malaysia Baharu.

It is hoped that under the current health minister, Malaysia will fulfil the World Health Organization’s (WHO) concept of universal healthcare and that the WHO Astana declaration of 2018 – “No one is left behind” – will become a reality in Malaysia.


Kuala Lumpur

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