LETTER | We write to congratulate Dzulkefly Ahmad on taking the helm of the Health Ministry.

In keeping with the objective to enhance private-public partnership in healthcare, the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) would like to urge the government to adopt and nurture the existing primary care system by private general practitioners (GPs) nationwide.  

Up to the year 2010, private GPs had catered for 60 percent of the total outpatient care burden of the nation. Private GPs had been the main factor for reducing queues and waiting time in government facilities.

It is known that our GP system is among the most affordable and most accessible in the world.  Studies from the Health Ministry itself have clearly shown that the cost per visit per episode for private GP care has been shown to be lower than in government facilities.

All this was before the advent of the middlemen in the delivery of private primary care.

Experience over the past 20 years has shown that the Managed Care Organisations (MCO) business model is that of cost control, not cost-containment. 

It imposes rationing, exclusions and limits access to choice to control cost so as to increase their profit margin, much to the detriment of patient care.

In addition, the GPs are also not paid in full in line with the existing government-approved professional fees schedule.

Over the years, GPs have to face losses with many cases of MCOs/Third Party Administrators (TPAs) closing shop leaving behind millions of ringgit of unpaid medical bills owed to doctors.

In simple terms, for the patient to see a doctor he has to go through an appointed middleman, and for a doctor to see a patient, he has to go through a middleman as well.

A fee is extracted from each party either in the form of co-payment, management or registration fee.

The access, choice and pre-approval Guarantee Letters (GLs) for patient care is determined by fine-print provisions in the master contracts between the middlemen and employers which are not revealed to the doctor or the patient.

The middleman has the inherent right to approve or disapprove the payment for care, much to the distress of the patient and the doctor.

In order to pay for the middlemen services, cost to the employers and patients and ultimately the rakyat have gone up instead of going down. The patient ends up paying more money for less care.

The Federation calls for immediate strict regulations under the Private Healthcare Facilities and Services Act 1998 and Regulations 2006 to protect the patients from the middlemen.

A draft proposal of this regulation was first submitted to the Health Ministry as far back as 2006.

The patients and their doctors have been waiting for these regulations for more than 12 years. Doctors feel that their patients must be empowered to choose their provider and option of essential medical care without undue influence from third parties like the middlemen.

For more sustainable, equitable, accessible treatment, and to be more cost-effective for the rakyat, the Federation urges the government to act immediately to cut out the middlemen from our GP medical service delivery.

DR STEVEN KW CHOW is president of the Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM).

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.