Doctors are often blamed for high hospital bills, but their fee only makes up a small part of the charges, said the Malaysian Medical Association (MMA).

MMA president Dr NKS Tharmaseelan pointed out that the bulk of the bill comprises hospital charges which the government does not regulate.

"While the doctor's fee is fixed, other charges are not - bed charges, room charges, overtime charges, intensive care unit charges ...,” he told Malaysiakini.

"When one gets a massive bill, the doctor is blamed for the fee which forms only a minuscule portion of the total.”

The range of fees in the private healthcare sector has gone up after the government approved an amendment to the 13th Schedule of the Private Healthcare Facilities and Services Act 1998.

The revised schedule raised the range cap for the consultation fee from between RM10 and RM35 to RM30 and RM125 for general practitioners and from between RM30 and RM125 to RM80 and RM235 for specialist doctors.

Fees for medical procedures have risen between 14 and 18 percent.

Tharmaseelan has explained that the hike is the first in 12 years for doctors, while hospitals continue to enjoy a free hand in imposing charges.

He said the doctor’s fee is as low as 20 to 25 percent of the total hospital bill for a long stay. For short surgical procedures, about 40 percent goes to the doctor and 60 percent to the hospital.

Furthermore, Tharmaseelan said, doctors may not get the full fee as spelt out in the schedule.

"Insurance companies, third-party administrators and managed care organisations (MCOs) may have negotiated a discount on the doctor’s fee with the hospitals, very often without the consent of the doctor. This discount may be up to 10-15 percent," he said.

However, Tharmaseelan said there is no clear indication as to whether the discount at the expense of doctors is passed on to patients or whether hospitals retain this as profit.

"Whether this discount is passed on to patients or clients in the form of (an insurance) premium reduction is not known,” he said.

"What is known is that the medical insurance premium keeps going up every year or after a period of two to three years - but not the doctors’ fee.”

'Doctors have to pay hospitals too'

In addition, doctors' earnings are reduced by a further 10-30 percent as hospitals take a cut of the fee as a service charge.

Tharmaseelan blamed third-party administrators and MCOs for contributing to higher hospital bills.

"As a third party, the patient and the hospital pay an administrative fee, which is passed on to the patient. But most often the third-party administrators deduct this from doctors’ fee.

"There should be more transparency about the charges of MCOs, their business contracts and the criteria of various deductibles and co-payment and exclusion policy of MCOs.

"When doctors’ fees only form 15-20 percent of total hospital (charges), they (doctors) should not be blamed for the rising cost of healthcare (services).”

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