The government recently announced that it is looking into the proposal to start commercial private wings (CPWs) within the health facilities of the Health Ministry.

If the proposal is implemented, it will mean that public hospitals will have a private wing purely for commercial purposes. The whole idea is to increase remuneration for government doctors and other medical staff.

At the outset the idea seems novel and attractive to those working in the public sector. However, there are serious implications for consumers especially the poorer ones. There is also the possibility of discrimination, which might pit one set of professionals against another.

A look at our private health sector and how it operates profitably should be able to give us an insight into the repercussions of a move to encourage privatisation in parts of the public health sector.

For example, the general practitioner operates in a way that he profits from his consultation charges, the procedures that he does outside of the routine ones, like urine tests, blood tests, etc. He also makes money from dispensing medications where prices are marked up.

The private hospital makes its money from a whole list of services that it provides. The list is exhaustive and includes the charges for medicines, board and lodging, procedures (surgical), nursing, use of equipment and also administrative costs - all of which can be exorbitant and beyond the means of many. The above is likely to be duplicated if public hospitals set up private wings.

As it is, some hospital settings in the country already have a public-private mix. The University Hospital (UH) is one such setting while the other is the Institut Jantung Negara (IJN). What have been the consequences of such changes?

So far, they can be said to be discouraging, to say the least. The costs of medicines, procedures, and laboratory charges in the UH have shot up many times. The IJN is probably the costliest place for heart surgery. Also, the waiting time for heart patients who are unable to afford surgery could be two years or more.

There are other implications if the proposal goes through. Among them are:

1) Manpower shortage: There has been a perennial shortage of medical manpower in the country. In 2000, there were 6,429 medical vacancies in the public sector. At present, there are at least 3,000 critical vacancies. As a result of this shortage, medical officers are very much overworked in the public sector. For instance, a medical officer in the outpatient department in the major government hospitals could see up to 150 patients a day (The ideal number recommended by the Health Ministry is a maximum of 50).

How is this shortage to be addressed with the commencement of CPWs? If there is an overall manpower shortage, how are we going to deploy staff to the CPW and still cope with the ever increasing number of patients?

2) Inadequate infrastructure: There is a shortage of upper-class wards even in the general hospitals, so how do we accommodate the influx of CPW patients into the general hospitals?

This could lead to depriving the poorer patient and the converting of beds for the use of privatised wings.

In addition, there are already some of the big hospitals with insufficient medical equipment, for example, magnetic resonance imaging (MRI) machines. The patients who come in will have to be sent to another hospital to obtain services, thus inconveniencing patients.

3) Selection of hospitals for upgrading: The Health Ministry has different categories of hospitals ranging from the general hospitals, district hospitals and specialised units. How is the selection to be made?

4) Discrimination: Upgrading some hospitals and not others would create discrimination in terms of remuneration for staff and this might cause an exodus of staff to greener pastures.

5) The lure of the ringgit can also be a temptation for corrupt practices. There could be corrupt doctors who would see patients in the CPW and admit them to the public side for procedures. He could then pocket fees illegally by offering a concession to the patient. This practice is rampant in places like India and Egypt where there is a public-private mix.

6) Equity and accessibility: To remain competitive, charges over the years will escalate. The net benefit for the poor will be less access and further erosion of equity.

7) Sustainability: CPWs found not to be profitable might face a predicament unlike private hospitals. The latter can be closed down if seen to be unprofitable, but can the same thing be done for CPWs?

If the aim is to increase remunerations for medical staff, then there are some means whereby additional income for the government could be generated. Among these are:

1) Part payment by patients at government hospitals. Third-class patients should continue to be charged nominal rates for specialist and in-patient treatment. These charges can be raised slightly, where appropriate, to bring in more revenue. Those who cannot afford to pay full rates should be given discounts or, in the poorest cases, free treatment. Patients in the second class and those in the first class should pay a greater percentage of the costs of treatment.

2) Increase the charges for outpatient treatment. The current charge of RM1 for outpatient treatment at government facilities could be raised. Based on the 1998 total outpatient attendances at government health facilities, raising the outpatient rate to RM5 could bring in at least another RM100 million which could go towards financing the healthcare system further. The figure would be much higher with the present-day number of patients.

3) Extend Socso's services to include medical care in general. In other words, its services should not be restricted to only treatment for industrial accidents and occupational diseases. The annual 'profits' of Socso (which actually represents a significant subsidy to the state by workers) could thus be transferred to the Health Ministry through hospital payments. Since Socso covers all employees earning below RM2,000 per month, the poor and lower income wage-earners would be able to draw on their contributions to finance their medical bills in government clinics and hospitals, thus easing the financial strain of the Health Ministry.

If the existing Socso contributions are still insufficient, the rate of Socso could be raised marginally. An increase of only RM1 a month by employees plus another RM1 by employers would yield at least an extra RM200 million a year in Socso contributions, which could be used to finance medical treatment.

At the same time, the manpower shortage should be addressed. As a short-term solution, a fixed number of foreign doctors should be encouraged to take up permanent employment here. This measure could be halted once there is enough local staff to cater for medical needs, especially in the rural areas.

Introducing private practice in government hospitals has the potential to drastically change the face of the present healthcare system. CAP calls on the Health Ministry to scrap the proposal for introducing commercial private wings. The healthcare of patients should not be compromised for monetary benefits.

The writer is the president of the Consumers Association of Penang (CAP).