General practitioners must organise, unite

Photo: IZZRAFIQ ALIAS/The Star

THE role of primary care general practitioners has been debated and recognised as an important component in a holistic healthcare ecosystem. A well-structured primary care system is the backbone of a good cost-effective healthcare delivery system. While this has been advocated by the Health Ministry and all stake­holders, nothing is being done by any responsible body to create a pathway or structure to ensure such a sustainable system.

The cost of healthcare will definitely go up due to newer techno­logy, increasing drug prices, and increases in other costs like wages, rental and disposables. The sensible way is for the authorities to find ways in which healthcare needs can be met effectively at a lower cost. For this, primary care has to be empowered to provide more ­rather than fewer services, and create a gatekeeper system to ­secondary and tertiary care.

Everyone knows this but over the years there has been no bureaucratic or political will to support such a system. I am not sure about the reason for the reluctance or the inability to implement it.

In recent times there has been a lot of news about the rise in insurance premiums and the cost of healthcare in hospitals. I believe it is a domino effect: claims will dictate future ­premiums. The problem is many consultations and procedures which can and should be done in an outpatient setting are now being done in hospitals. Since the patient is covered by insurance, he or she will want to go to the most posh and expensive hospital. There is no gatekeeper system to channel these patients.

Recently, an order was issued for clinics to display drug prices, yet the consultation charges for the general practitioner have not been revised since 1992. That is, for the last 33 years the charges have remained the same despite inflation. Current Health Minister Datuk Seri Dr Dzulkefly Ahmad held two town hall meetings when he previously held the portfolio to discuss consultation fees; he has also had discussions with doctors representatives about the matter recently – but nothing has been forthcoming.

Doctor’s organisations, especially the Malaysian Medical Association, should realise by now that the authorities might engage with them but they don’t resolve problems – the fees issue has been around for three ­decades after all.

The time has come for all doctors to realise that we have a duty to help ourselves and at the same time protect the private primary care delivery system from collapsing by coming together and dicta­ting what we truly deserve.

There are more and more ­general practitioners closing down their clinics, and this will continue at a faster pace if ­nothing is done.

If there are no immediate changes, our system will become like those in some developing countries where no primary care exists. The local pharmacy will be the first point of contact, followed by the hospital or specialists. This will not only increase overall healthcare cost but, importantly, hospitals will be seeing chronic cases at later stages, thus increa­sing mobility and mortality. ­(Pharmacies in Malaysia have started treating both chronic and acute issues.)

The irony is that third-party administrators who are playing a major role in the private healthcare delivery system are not regulated by any authority. Drug companies that increase their prices two to three times a year are not regulated. The whipping boy seems to be the general practitioner. The only reason for this that I can think of is that we are disorganised and not united.

DR N. AMEEN

Petaling Jaya