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Why there should not be a 14% increase in doctors fees

August 13, 2012

FMT LETTER, From Victimised Ddoctor, via e-mail

The proposed 14% increase in doctors fees in the 13th schedule of Private Healthcare Facilities Act should not be approved by the cabinet as this will definitely lead to an increase in the cost of healthcare to the public and unwanted inflation. Therefore for the President of the Malaysian Medical Association, MMA, Dr Manalan to say that an increase of more that 14% is inadequate and instead asking for more than 30% increase is outright ludicrous and certainly does not reflect his position as the President of an association that is supposed to protect the rights of its members.

The current fees are definitely sufficient. However what is currently happening is that most doctors are not getting 100% of what they are charging based on 13th Schedule of the Private Healthcare Facilities Act. Most hospitals are charging a commission of between 10-40% of what the doctors are charging i.e. if a doctor were to charge RM100 for professional fees, the hospital takes between RM10-40 of that and the doctor concerned only takes home between RM60-90. This commission has been disguised as management fee, partnership fee etc. In actual fact, this is fee splitting! If one refers to the Private Healthcare Facilities Act page 1096, Fee Splitting is deemed illegal and Ministry of Health (MOH) on that basis can take action against the hospitals concerned. In addition MMA, being the umbrella body for most doctors in the country must take immediate remedial measures to rectify this situation. The only hospital, that I know of , that is not victimising the doctors through this method is a hospital in Penang Island.

In addition, another overt case of victimisation is that some hospitals in Malaysia are acting in collaboration with insurance companies’ Managed Care Organisations(MCO) to squeeze the doctors. These hospitals impose a limit on the fees that the doctor can charge e.g. let’s say the professional fee according to the 13th Schedule is RM100. However, the doctor practising in the hospital is not allowed to do that and may only charge RM80. The reason given is that the hospital concerned have signed an agreement with the insurance company concerned or Managed Care Organisation (MCO) concerned and to charge above that will tantamount to risking the loss of coverage by the insurance company/MCO for that doctor and of course with such a threat the doctor concerned has to comply. Some hospitals do not sign these agreements and indeed they have lost the coverage by the insurance company/MCO concerned.

So please allow me to provide a case scenario of a doctor who is practicing in a private hospital which has both the above restrictions in place. Let’s say this doctor is allowed to charge RM100 according to the 13th schedule but due to the agreement signed between the private hospital and the insurance company/ MCO the doctor can only charge RM80. In addition, the doctor is charged ‘management fee” or ‘partnership fee’ of 30 percent, the doctor will only get RM56 nett to take home. Thus there is a 44 percent discount of the doctor’s allowable fee. Therefore to allow a 14 percent increase in the professional fees of doctors is not going to benefit the doctors much and is definitely inflationary and a burden to the public. It is more important for the govenment and MMA to work together to plug the above mentioned leaks.

(A small note: Let’s say the doctors salary is in the 25 percent tax bracket, the doctor concerned will finally have a nett income of RM42 and on paper the doctor is supposed to earn RM100. It has always been a fallacy that private doctors earn a lot based on the amount of work that they put in)

Therefore, the 14% increase is definitely unwarranted and untimely. The MOH and MMA should take immediate steps to tackle the two issues of victimisation of doctors thus plugging the leaks! Its high time all doctors concerned should voice out this open secret!

MOH , MMA the ball is at your feet!


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