GPs struggling in times of managed care

THE past 12 months have been a very taxing time for our healthcare services in general. In the public sector, resources, including manpower, were stretched to the limit to combat the Covid-19 pandemic whereas in the private sector, normal visits to hospitals and clinics were drastically reduced.

A dichotomy was created where public healthcare services were overworked while the private sector was underutilised.

The authorities failed to use the resources of the private healthcare sector to combat the pandemic, and the worst hit were general practitioners (GP).

Throughout 2019, the Malaysian Medical Association (MMA) and other like-minded NGOs had asked the Health Ministry to harmonise the fee schedule for doctors, which was overdue by 14 years. When the schedule was finally revised, only the specialists fee was approved. For reasons best known to the powers that be, the fee schedule for GPs was left out. Since then, doctors have been asking the Health Ministry to approve the fee schedule for GPs.

Multiple meetings were held where senior officers at the ministry spent a lot of time listening to the doctors. A town hall meeting was also held by the then Health Minister, Datuk Seri Dr Dzulkefly Ahmad. At that time, the general feeling among doctors was they would finally see the resolution to this long-standing issue. But the decision was totally unexpected – the fee schedule was abolished, leaving market forces to decide how much doctors should charge for their services.

The issue now is that because of the deregulation of the fee schedule, third party administrators (TPA) and managed care organisations (MCO) are squeezing GPs on their consultation fees. GPs are not able to fight back and many among them are prepared to provide their services for next to nothing to TPAs/MCOs just to sustain their practices.

MCOs/TPAs have been operating in this country for more than 30 years and their current combined turnover annually is about RM1bil. They pay hospitals and doctors for services rendered on behalf of insurance companies and corporate bodies.

They are currently not regulated by any body, not even the Health Ministry, which has been trying to draft an act for MCOs in the past 20 years. I cannot understand how organisations managing healthcare and the payment mechanism involved are not regulated by any law or body.

TPAs have gone one step further by making arrangements with certain pharmacies for their patients to collect medicines after getting a prescription from doctors. In some cases, their own doctors write out the prescriptions.

If this situation remains unchecked, I think the healthcare sector, both public and private, would need to invest in rehabilitation and dialysis centres to take care of patients with chronic illnesses who did not get the proper treatment protocol and ended up with renal failure, blindness or stroke.

The selling point of TPAs/MCOs is they would be able to contain the cost of healthcare. However, the quality of healthcare should never be compromised. As such, there must be a drastic overhaul of the healthcare system in both the public and private sectors. GPs are just asking to be paid a reasonable amount for their services and be allowed to manage their patients without following the guidelines set by TPAs/MCOs.

Since the current Health Minister and his deputy are both GPs, they should understand the situation and realise that now is as good a time as any to fix this unacceptable situation. If nothing is done now, we will soon see family and general practices disappearing, leaving just pharmacies, specialists and hospitals to treat the sick.

A CONCERNED DOCTOR Petaling Jaya