GPs under pressure yet again

AFTER facing down issues pertaining to consultation fees, dispensing separation, the national healthcare scheme and third party insurance (TPA/MCO), general practitioners (GPs) are being thrown another challenge, this time by Fomema.

FOMEMA Sdn Bhd was awarded a concession in 1997 by the Government to implement, manage and supervise a nationwide mandatory health screening programme for all legal foreign workers in Malaysia. The objectives of the concession are to ensure that foreign workers in Malaysia are free of an identified list of communicable diseases and that our public health facilities are not burdened by foreign workers with medical conditions or diseases that require prolonged and extensive treatment.

GPs have been the front liners since then in screening the health of foreign workers.

A GP under the Fomema panel is responsible for consultation, examination, taking blood samples, urine collection, review of results, data entry into the Fomema website, certification of suitability of foreign workers, dealing with employers, notification of disease, dealing with inspection from Fomema personnel (printing copies of forms, filing, documentation), dealing with unsuitable foreign workers (appeals, which involve more forms), payment of designated staff to handle Fomema matters, and chest X-ray (review, reporting, accountability of accuracy).

Why is all of this significant at this time?

Since the inception of the pro- gramme in 1997, there has been no revision of fees for the GPs involved. Recently, they received a new and revised agreement from Fomema, which requires them to pay a registration fee of RM255 (excluding 6% GST).

GPs are also required to diligently examine and perform a comprehensive physical examination within a suggested period of 20 minutes per foreign worker. In this suggested 20 minutes, the GPs are supposed to take a detailed history, do a thorough examination, which would now include systemic review, review of cardiovascular and respiratory system, rectal examination, full psychiatric evaluation, review of anaesthetic skin patch, assessment of limb deformity, assessment of hearing, vision test, abdominal examination, measurement of peripheral nerve size, and assessment of the nervous system such as power, reflexes and speech.

I would beg to differ on the suggested time of 20 minutes to do all these tests. Furthermore, the GP is even required to confirm whether a foreign worker has cancer or epilepsy.

How can one arrive at this diagnosis by just history and examination? Making such a diagnosis which then renders the foreign worker unsuitable may expose the doctor to medical litigation.

And then there’s the chest X-ray. Recently, GPs had to switch to digital X-ray machines which have incurred more expenditure. While this move may be beneficial in the long run, it increases the GPs’ overheads.

One would be shocked to know that the GP is paid only RM25 per X-ray, of which RM4 is deducted for transmission fee by a certain company. So, if we have 1.2 million foreign workers being screened annually, the GPs with X-ray facilities would be paying RM4.8mil per year to the company for transmission of X-ray alone! This does not include the required software, which costs a hefty RM5,000.

GPs with X-ray facility are also forced to attend a compulsory seminar on Foreign Workers’ Medical and Chest X-ray Examination, which is conducted by Fomema, and they are charged RM215 each time. Failure to attend this seminar is met with an implied threat of removal from the Fomema panel of doctors.

In a nutshell, all aspects of overheads are increased for the GP in the name of ensuring quality foreign worker screening without any increase in the stipulated doctor’s fee.

It is very unfair to push the new contracts with additional SOPs and administration fee on GPs. The new SOP even allows Fomema and/ or the relevant authorities to visit and inspect the clinic from time to time without prior notice. GPs in the private sector are already regulated by the Private Healthcare Facilities and Services Act 1998 and I therefore don’t see how Fomema has the authority to regulate a medical clinic.

I would like to express my concern given that Fomema is a TPA/ MCO. We demand transparency and fairness.