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Regulate third party administrators, Health Ministry told

With reference to a letter titled, ‘Panel doctors feeling the squeeze’ published in The Star on Jan 20, the Medical Practitioners Coalition Association of Malaysia (MPCAM) has received many similar grouses from doctors, regarding managed care organisations (MCOs) and third party administrators (TPAs) handling the payments of consumers’ health bills from corporate bodies - which had originally appointed said MCOs and TPAs to manage the health benefits of their employees.

The highlight of the letter that doctors were allegedly being forced to pay RM2,500 in order to be appointed as a panel clinic of a well-known institution of higher learning, is disturbing.

The article seemed to suggest that there may be some amount of irregularities involved, as no one has ever charged us doctors RM2,500 for a “registration fee”.

We urge our members to lodge a complaint with the Medical Practice Division of the Health Ministry, or directly to the Malaysian Anti-Corruption Commission (MACC), for further action.

It would be advisable if doctors would not pay the said sum, until the authorities have conducted and completed their investigations.

The MPCAM has on numerous occasions urged the Health Ministry to streamline and regulate MCOs and TPAs under the provisions in the Private Healthcare Facilities and Services Act 1998 (PHFSA).

We have about 30 TPAs currently managing the health benefits of employees, and all of them have their own set of fees and rules to be followed by doctors, immaterial of what is written in the PHFSA. Furthermore, the number of TPAs keep growing, and attempts must be made to merge them into one entity.

TPAs determine which health facility a consumer would be able to go to. The choice or selection of the hospital/clinic is that of the TPA. Hence, the consumer loses out on his choice of doctor his choice of hospital/clinic, and his choice as to where he would receive his treatment. This is a fundamental right of the patient and it is being compromised.

Different procedures

To be appointed as a panel clinic, some TPAs also require a "registration fee" - which can range anywhere between RM100 and RM 2,500. Thus, the consultation fees for doctors as mentioned in the PHFSA, is not adhered to.

TPAs determine the registration procedure of a client in a clinic. Each of the 30 TPAs have their own procedure and requirements for a patient to register. Moreover, they also have different procedures for submission of claims; some even have a mandatory terminal attached to the clinic, for which doctors are forced to pay a rental fee.

How many terminals are we supposed to have, and how many rentals do we have to pay? Can you imagine 30 TPAs having 30 different terminals, and collecting rentals for this?

We have registration fees on appointment as a panel clinic, admin fees every month to be paid to the TPA, submission fees for each claim submitted, and payment fees when the payment is made to the doctor (sometimes up to three to six months later).

All these fees are paid by the doctor to the TPA. Who ultimately pays for these added costs?

Each of the 30 TPAs have their own regulations concerning the fee to be paid by the employer, and the fee to be paid by the doctor in the name of “admin fees” - which are determined by the respective TPAs alone. As we know, fee splitting is illegal in the medical industry.

Some TPAs only allow a maximum medical fee that a patient is entitled to for their daily visits, whereas the charges for the day are also limited. Some even cap the number of medications which can be prescribed in a day.

By controlling the number of visits, as well as limiting the charges and number of medications, justice cannot be served to the sick. TPAs should not involve themselves in the care and treatments offered by the doctor to the sick. This puts the doctor under tremendous pressure and constraints.

With these brief accounts as to what issues the doctors are facing, we once again urge the Health Ministry to intervene and regulate the MCOs and TPAs so that doctors can maintain a healthy working relationship with them - while not compromising on the healthcare of our patients.


DR RAJ KUMAR MAHARAJAH is a member of the Medical Practitioners Coalition Association of Malaysia’s (MPCAM) central committee.

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