Raise doctors’ fees before taking out dispensary, says think tank

Doctors are concerned over their odds of survival given their stagnant consultation fees if they are restricted to diagnosing and prescribing medicine. (Bernama pic)

PETALING JAYA: A think tank says it will be impossible to separate the roles of doctors and pharmacists until consultation fees for general practitioners (GPs) are adjusted, as doctors call for the harmonisation of the fee schedule between those at private clinics and hospitals.

The Galen Centre for Health and Social Policy said until the consultation fees agreed on in 2013 are gazetted, such separation will not be a realistic consideration.

Consumer groups like the Federation of Malaysian Consumers Associations and the Consumers’ Association of Penang had in the past called for a separation of doctor and pharmacist roles as is done overseas.

The previous administration proposed a Pharmacy Bill which would see doctors restricted to diagnosing and prescribing medicine, with dispensing done by pharmacists.

However, some doctors voiced concern over their survival if such a bill were to be passed, given their relatively low consultation fees.

Galen CEO Azrul Mohd Khalib said most private clinics are small businesses with overhead costs, staff, bills and fees to pay. He added that consultation charges for GPs have remained stagnant since 1992.

“That 27-year-old fee is paying for all of that, including the salaries of the doctors themselves. It is honestly unreasonable to expect that fee to pay the costs of operating a modern clinic in 2019,” he told FMT.

Currently, doctors are allowed to charge consultation fees of RM10 to RM35. They are seeking parity with the RM35-RM125 rate charged by doctors at private hospitals.

Until the fees are adjusted, Azrul said, separation of dispensation will not be feasible.

“The medicines are currently the GPs’ main source of revenue. Not permitting them to sell medicines would definitely cause the closure of most private clinics which are already operating on razor-thin margins.”

Malaysian Medical Association president Dr Mohamed Namazie Ibrahim said separation of dispensation should only enter the picture once there is national health insurance and the roles of pharmacists and doctors are clearly defined by law.

Once this is established, he said, doctors would only offer consultation and provide prescriptions, and receive their fees from a national health financing authority.

He said pharmacists would be reimbursed by the same authority when they present the prescriptions, which would prevent them from dispensing scheduled medicines without one.

“This would also prevent over-prescription by doctors for monetary gain, and pharmacists would not switch to more expensive drugs without consulting the prescribing doctor, as happens now,” he said.

“The proper dispensing practice is that when pharmacists do not have a prescribed medicine but a substitute is available, they must consult the prescribing doctor on whether the substitute is acceptable.”

Pharmacists could therefore act as another layer to check that doctors have prescribed the appropriate medication and dosage, he added.

“Until then, dispensing separation will not be suitable.”

Health Minister Dzulkefly Ahmad recently assured more than 800 GPs who attended a heated town hall meeting that he would fight for a hike in consultation fees.

The GPs who attended the town hall were unhappy that the Cabinet had decided against reviewing the consultation fees.