PETALING JAYA: The Malaysian Medical Association (MMA) lauded the move to finally increase medical fees after 12 years — but said it is still not enough for doctors in view of the rising cost of living.
Last year, the hike in medical consultation and procedural fees was gazetted by the health ministry under the Private Healthcare Facilities and Services Act 1998.
When a news portal highlighted the issue and questioned Health Minister Dr S Subramaniam for being “secretive” about the move, the minister denied it and said talks had begun before the last general election. He said the revision of fees, which sets a cap for the maximum charge, is intended to protect people from expensive medical fees.
MMA president Datuk NKS Tharmaseelan said that although the price hike was “acceptable”, it did not commensurate with the increase in the cumulative consumer index or reflect inflation rates since 2002.
“The fee increase is acceptable as we have been waiting for a raise since 2002. In the interim, everything has gone up — drugs, lab fees, petrol, sugar, wages, toll, taxi and bus fares, groceries, vegetables — except doctors’ fees.”
In a written statement, he said there was a misconception that doctors were “raking in” money. “The truth is they are scraping the bottom of the barrel these days. Over 500 individual standalone general practitioner clinics have closed down or have been bought over by large chain clinics or business corporations.
“A decade ago, more than 50% of doctors completing their compulsory service left for private practice, and now are facing a ‘drought’ like the present weather. With poor returns, the exodus to the private sector to become a general practitioner (GP) has become a trickle.”
Medical fees, which were to be revised every five years, he said, were last reviewed in 2002.
A task force set up by the Ministry of Health (MoH) had recommended an overall broad-based 30% increase of existing fees, similar to what the MMA had requested, as reflected by the consumer price index (CPI). But in the end, the Cabinet only agreed to a 14.4% hike.
Tharmaseelan said the association was taken by surprise when members of the press informed him that the Act had been gazetted at the end of last year. “The amendment was gazetted on Dec 16, 2013 without much fanfare, and even members of the clerical side at the MoH were unaware of it. The MMA too was surprised when alerted by the media.”
Following the revision in medical fees, a visit to a specialist may now cost up to RM235 for consultation alone, double from the previous cap of RM125, while fees for medical procedures will see a rise of between 14% to 18%.
Tharmaseelan said the fee schedule states the maximum price doctors can charge their patients, and consumers, who tend to “shop around”, will keep fees below the ceiling rates due to the fierce competition among GPs.
Nevertheless, he slammed the revised schedule for being “flawed”, as the description of the procedures were too vague and could give rise to more problems in the future.
“The MMA is disappointed that the schedule is incomplete and does not include the newer procedures in keeping in line with technological advancements in medicine, which the MMA had proposed. How doctors will charge for these procedures will be left to individuals, which will be not regulated.”
Medical fees, he added, may vary with the disease, complexity, the degree of difficulties experienced by the surgeon, the risks of the procedure, complications and so on. “It is a multi-factorial problem that requires constant monitoring and changes to reflect on justice, fairness and the technical and technological advances.
“Across the board percentage changes, whether too high or too low, encourages mediocrity and punishes innovation and excellence, and is inherently unjust and uncompetitive. It de-professionalises the medical profession and seriously erodes medical ethics.
“Please note that in nearly all hospitals, the doctors do not get the full fees as in the schedule,” said Tharmaseelan
For doctors stationed in hospitals, the bill for short surgical procedures is split 40:60 between the specialist and hospital respectively. Whereas for complex procedures and long stay patients, the specialist gets only 20% to 25% of the share with the balance being hospital charges, he added.
“The insurance companies, third party administrators and Managed Care Organisers (MCOs) have negotiated a discount to the doctors’ fees with the hospitals, very often without the consent of the doctors, and this discount may be up to 10% to 15%.
“Whether this discount is passed on to the patients/clients in the form of premium reduction is not known. What is known is that the medical insurance premiums keep going up every year or after a period of two to three years, but not doctors’ fees.
“Plus, doctors’ fees are further reduced by up to 10% to 30% when the hospital takes a percentage of the doctors’ earnings as service charges.”
Instead of blaming doctors upon receiving a massive medical bill, Tharmaseelan said it should be directed at MCOs and third-party agents (TPA), when charges imposed by them lack transparency.
“The MCOs and TPAs are the ones responsible for this. While the doctors’ fees are fixed, the other charges are not. There should be more transparency about the charges of MCOs, their business contracts and the criteria for various deductibles, and co-payment and exclusion policy of the MCOs.”
As a third party, he added, the patient and hospital pay an administrative fee, which is passed on to the patient, but more often the TPA deducts this from the doctor’s fees.
“As doctors’ fees only form 15% to 20% of total hospital fees, they shouldn’t be blamed for the rising cost of healthcare,” said Tharmaseelan.
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This article first appeared in The Edge Financial Daily, on March 06, 2014.