FI­NAN­CIAL AR­RANGE­MENTS

New Straits Times - - Letters -

more than a decade now, it has be­come the norm and is now an in­te­gral part of health­care.

The time has come for MMC to re­view the Eth­i­cal Code and Eth­i­cal Guide­lines, which ad­dresses fee-shar­ing be­tween doc­tors, to also ad­dress fee-shar­ing be­tween doc­tors and TPAs.

The guide­lines must ad­dress the is­sue of fi­nan­cial ar­range­ments in man­aged care, which may lead to a com­pro­mise in the care of the pa­tient. With the MMC Coun­cil said to meet next week to de­lib­er­ate this is­sue among oth­ers, we rec­om­mend the Ethics Com­mit­tee of the MMC and its coun­cil­lors zero in on the fol­low­ing is­sues to safe­guard the rakyat and to guide doc­tors.

IN­CON­SIS­TENT EX­PEC­TA­TIONS OF THE PA­TIENT

Pa­tients seek­ing treat­ment from com­pa­nies usu­ally have higher ex­pec­ta­tions of their med­i­cal ben­e­fits than what the man­aged care sys­tem al­lows for. Most of the time, pa­tients do not know the lim­i­ta­tions of the doc­tor, as dic­tated by the em­ployer or by the MCO/TPAs. There ought to be leg­is­la­tion to make it com­pul­sory to dis­close to pol­i­cy­hold­ers and em­ploy­ers any fi­nan­cial im­po­si­tions made on the doc­tor. This will avoid un­nec­es­sary mis­un­der­stand­ings when one seeks treat­ment.

KICKBACKS AND FEE-SPLIT­TING MASKED AS AD­MIN­IS­TRA­TIVE FEES

Some schemes im­pose ar­bi­trary ad­min­is­tra­tive fees rang­ing from 10 per cent to more than 15 per cent of the to­tal billing for a pa­tient, which, on closer ex­am­i­na­tion, ap­pears to in­di­cate that most of­ten, the higher the claim, the higher the ar­bi­trar­ily im­posed ad­min­is­tra­tion fee.

There are oth­ers who take a fee per pa­tient seen per day, and more re­cently, a form of in­duce­ment to be ap­pointed to be a panel doc­tor of the MCO, a one-off com­mis­sion fee of be­tween RM2,500 and RM5000 (ex­clud­ing a yearly re­newal fee). With ad­min­is­tra­tion fees, cheque de­po­si­tion fees, trans­ac­tion fees, an­nual fees, com­mis­sion for ap­point­ment fees and ter­mi­nal fees, what else is in store?

LIM­I­TA­TIONS ON THE DOC­TOR

Pri­mary care med­i­cal ser­vice providers are paid pal­try con­sul­ta­tion fees, with the least be­ing seek­ing treat­ment at IJN were in­versely pro­por­tional to the racial mix at the trail. This was an eye-opener.

Dur­ing work­ing years, the “health is wealth” mes­sage is not mean­ing­ful as the go-get­ter fo­cuses on mak­ing as much money as pos­si­ble. Al­though mind­ful that ex­er­cise is good, many over­look their health when caught up RM15 (be­fore the ad­min­is­tra­tive fee is de­ducted) and we can be im­posed un­rea­son­able lim­its on medicines, in­ves­ti­ga­tions and pro­ce­dures.

We have to jug­gle be­tween giv­ing the best to the pa­tient, ris­ing cost of medicine and over­heads and to do all that within a limit im­posed and also, very much de­layed pay­ments.

IN­CEN­TIVE FOR CUT­TING COST

Dif­fer­ent man­aged care schemes pose dif­fer­ent chal­lenges. In gen­eral prac­tice for ex­am­ple, cer­tain schemes pro­vide a fixed re­mu­ner­a­tion of, say, RM40 per pa­tient visit, in­clu­sive of cost of med­i­ca­tion and con­sul­ta­tion. Re­im­burse­ment for medicines and in­ves­ti­ga­tions is some­times pegged at such a ridicu­lously low price that it can even be below their cost to the clinic in some in­stances.

PA­TIENT HAS NO CHOICE, LOSS OF CON­TI­NU­ITY OF CARE

TPAs de­ter­mine which hos­pi­tal/clinic a con­sumer would be able to go to by only ap­point­ing cer­tain clin­ics as pan­els. Hence, if the em­ployer de­cides to ap­point a MCO/TPA that is not the reg­u­lar with work com­mit­ments.

Reg­u­lar phys­i­cal ac­tiv­ity im­proves one’s health and fit­ness.

Mind­ful that phys­i­cal in­ac­tiv­ity among cer­tain com­mu­ni­ties in this coun­try will be a ma­jor pub­lic health is­sue in the years to come, the gov­ern­ment needs to cre­ate more green spa­ces where Malaysians can work out.

The parks should be equipped doc­tor of a pa­tient, the pa­tient loses out on his choice of doc­tor or hos­pi­tal/clinic. This fun­da­men­tal right of the pa­tient is be­ing com­pro­mised.

BEGGING FOR PAY­MENT

Re­im­burse­ment can take place any­where from three to 12 months af­ter the doc­tor has seen the pa­tient. Some MCOs/TPAs pay when prompted, while oth­ers oth­ers “in­ad­ver­tently” miss a pay­ment or two in be­tween. The doc­tor has an ar­du­ous task au­dit­ing and trac­ing pend­ing pay­ments and in ex­treme cases, beg for pay­ment.

These busi­ness prac­tices ap­pear to demon­strate a lack of re­spect for the med­i­cal pro­fes­sion.

The Health Min­istry and MMC should con­sider leg­isla­tive changes to truly guide doc­tors and safe­guard pa­tients.

An ur­gent reg­u­la­tion on MCOs/TPAs from Health Min­istry is in­evitable and crit­i­cal.

DR PETER CHAN TECK HOCK, DR RAJ KU­MAR MAHARAJAH AND THE EX­EC­U­TIVE COUN­CIL OF THE MED­I­CAL PRAC­TI­TION­ERS COALI­TION AS­SO­CI­A­TION MALAYSIA

Kuala Lumpur

with ap­pro­pri­ate and well-main­tained fa­cil­i­ties.

En­cour­age chil­dren to ex­er­cise so that they grow up with work­outs as part of their life­style.

Shouldn’t all Malaysians em­u­late the Chi­nese in terms of stay­ing healthy?

POLA SINGH, Kuala Lumpur

Peo­ple en­joy­ing a good work­out at Bukit Kiara Park, Kuala Lumpur.

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