By K. Haridas

The recent announcement by Deputy Health Minister Hilmi Yahya that the Full Paying Patients (FPP) Scheme would be extended to cover eight other government hospitals has raised concerns among the public. We have yet to understand how the pilot project launched in 2007 at the Selayang and Putrajaya hospitals have progressed.

What were the highlights, drawbacks and lessons learned that can make the scheme’s extension to other hospitals more practical and valuable to the public?

Currently 70% of citizens avail of the services provided by public hospitals. Under the FPP scheme, specialists in government hospitals have the option to participate by providing consultation and treatment to anyone who is willing to pay full fees as is the case in private hospitals.

Has this been well subscribed in these two pilot project hospitals?

The ‘raison d etre’ of private hospitals is different and their target audience covers those who can afford, those who are well insured and those who come under the medical tourism initiative. Those with money have choices and options while those who are unable to opt for private hospitals rely solely on public hospitals.

One of the key reasons for implementing this scheme is to curb the migration of specialist doctors from government hospitals to private hospitals where these doctors get better remuneration and benefits. However, in attempting to address this challenge, is the government caught in a web of confusion? Surely this issue could be addressed differently and in a focused manner. How many specialists have since resigned despite this programme?

There are better options to deal with this issue than to introduce the FPP approach. While we understand that the cost of medical care is increasing, is this the way a government that professes ‘People First, Performance Now’ responds to this challenge. This is going to deny the public the already challenging quality of services they presently receive at these public hospitals.

Has due diligence been done on the pilot programme to validate the extension to another eight hospitals nationwide? We need data and information that addresses issues like the quantum of people who used these services, income generated by the hospitals under the pilot programme and the quantum of warning in general by the specialist doctors who participated in this programme.

Without understanding these details it will only increase the confusion and lack of clarity to other public hospitals. Public hospitals are for the public at large and their target audience is clear. By introducing such hybrid schemes there will be issues of conflict and ethics that need to be addressed.

Surely the specialist doctors who benefit from this scheme will support this initiative. At the same time what checks and balances are in place to ensure that runaway greed will not shift the focus with a bias towards private patients at the expense of ordinary Malaysians?

Those opting for such treatment will have the option to choose their specialist doctors and it is but natural for them to go for experienced specialists while the others with about three years of service will attend to the non-paying public. This deprives public patients of the expertise they need.

If 30% of the patients opt for the FPP then the resources and facilities taken up by them will be at the cost of services that would have otherwise been available to the public at large. While the specialist doctors will earn their keep, what about the services rendered by all the other support staff?

Are they also remunerated under the scheme? If not, would this not give rise to issues of conflict and jealousy? If the specialist doctor now makes about RM15,000 he could be in a position to make an additional RM45,000, drawing nearly 65% of his takehome wages from this FPP scheme.

The clinics, the treatment facilities and even surgery in these public hospitals will be available to such private patients under this scheme. If the fees charged by the specialists in these public hospitals are about 20% cheaper than in private hospitals, would this not attract more private patients to consider this option, further denying services to the ordinary Malaysian?

Without such data it would be difficult to arrive at an informed decision.

It is in this context that Aliran joined several NGO’s, interested citizens and political parties such as Party Sosialis Malaysia and Amanah and presented a memorandum through Dr Michael Jeyakumar to the minister of health seeking an appointment to ensure that no further extension proceeds without a thorough study and results being presented.

Many of the issues stated in the guidelines issued by the director-general of health have serious implications and these have to be addressed. The issue of specialist doctors and high treatment costs have to be addressed and with nearly eight years of the pilot programme there would be enough data to justify the continuation or otherwise of this programme. We seek that this be placed in the public domain for discussion and debate.

K. Haridas is an FMT reader.

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