PETALING JAYA: The Federation of Private Medical Practitioners’ Associations Malaysia has called for the government to enact regulations to cut out middlemen from healthcare service delivery.
In a statement today, federation president Dr Steven Chow said there had been many examples of managed care organisations (MCOs) and third party payers (TPPs) closing down and leaving behind millions of ringgit in unpaid medical bills owed to doctors.
“Experience over the past 20 years has shown that the MCO’s business model is that of cost control, not cost containment.
“It imposes rationing, exclusions and access to choice in order to control cost so as to increase their profit margin, much to the detriment of patient care.
“The end result is to pay for the middlemen services, resulting in higher cost to the employers and patients, and ultimately the rakyat, instead of reducing costs.
“The patient ends up paying more money for less care.
“In simple terms, for the patient to see a doctor, he has to go through an appointed middleman and for a doctor to see a patient, he has to go through a middleman as well.
“A fee is extracted from each party, either in the form of co-payment, management or registration fee.
“The access, choice and pre-approval guarantee letters for patient care is determined by fine print provisions in the master contracts between the middlemen and employers, which are not revealed to the doctor or the patient.”
He was responding to Health Minister Dr S Subramaniam who had said on April 16 that the health ministry would study possibilities to regulate MCOs and TPAs under the provisions in the Private Healthcare Facilities and Services Act 1998.
Subramaniam said this was because the ministry had received numerous complaints on TPAs who currently managed the health benefits of employees, who had their own set of fees and rules to be followed by doctors.
He admitted that the health ministry did not monitor the issue since TPAs and MCOs were not under its purview and the service offered by them was a contract between doctors and the said entities.
Today, Chow said the middlemen had the inherent right to approve or disapprove the payment for care, much to the distress of the patient and the doctor.
He said the federation supported the call for strict regulations under the Private Healthcare Facilities & Services Act (PHFSA) 1998 and Regulations 2006 to protect patients from middlemen.
According to him, a draft proposal of this regulation was first submitted to the health ministry in 2006.
“The patients and their doctors have been waiting for these regulations for more than 10 years.
“Doctors feel that their patients must be empowered to choose their provider and option of essential medical care without undue influence from third parties like the middlemen.”