Regulate all sellers of health or none

A few days ago, the National Cost of Living Action Council (Naccol) met, chaired by Domestic Trade and Consumer Affairs Minister Saifuddin Nasution Ismail.

The meeting could not reach a conclusion on whether or not to increase general practitioners’ (GP) consultation fees. The issue has been thrown back to the Cabinet.

I have been accused of flogging a dead horse when talking about GPs and the issue of their consultation fees.

Unfortunately, as a health system professional, I and countless other colleagues who are not GPs remain seriously concerned on the state of the country’s health system if the issues afflicting GPs are not resolved or shoved under the carpet as they have been in the past.

If we manage to fix the issues pertaining to GPs’ delivery of healthcare, then – and only then – will we be on the right foot towards reforming Malaysia’s health system.

GPs working out of shop lots have been allowed to only charge between RM10 and RM35 for consultation (a rate that remains the same for the past 27 years), while their hospital-based counterparts have been allowed to charge between RM30 and RM125.

A colleague raised an interesting question to me on this and it got me thinking about it.

She asked, “Why are GPs being bound by this Naccol committee? Why are their fees being controlled? Why can’t they charge what they want to whomever they want? If they charged very high fees, people won’t go to them lah, simple as that right?”

Well, it’s not as simple as that. Fees charged by professionals, doctors included, are regulated by the government in order to ensure that their practices as essential services are carried out keeping the larger public interest in mind.

In the case of GPs, the regulation to control their fees is based on the idea that since the common man needs to access their services, their prices need to be reasonable, with this threshold of reasonable charges being determined by the government.

I understand and support the reasoning behind this, as this tries to make healthcare a public good (a term in economics where a public good is something that needs to be available to each and every member of the public without restrictions).

The government is rightly concerned about the rising costs of healthcare, and the main reason behind justifying the non-harmonisation of GP consultation fees is so that it will not stress the already beleaguered, cash-strapped average Malaysian.

The problem is like the idea of price controls. It does little to address the underlying problem.

I am sure that everyone is aware that the reason GPs are fighting for the increase of their consultation fees is due to only one fact: currently many of them don’t or can’t charge a proper consultation fee.

They have to disaggregate what constitutes their actual fee within the cost of medications or tests to make up for their inability to charge a decent consultation fee. Hence the opposition to drug price controls, unless they are legally empowered to be able to charge rightful consultation fees for a genuine consultation provided.

Let me also bring up another set of circumstances in a similar Malaysian landscape.

The reasoning used by the government of healthcare being a “public good” does not make sense when you consider that other than the doctors, there are many people who are selling healthcare, who are not being governed by the same rules.

The question is: What about all those other “sellers of healthcare” who currently do not come under the purview of the government? You may wonder who these other sellers of healthcare are.

Let me enlighten you.

The first group of healthcare sellers that immediately come to mind are physiotherapists and chiropractors. They are professionals who provide health services. Pull out any advertisement or walk into any of their increasingly mushrooming services even within the same city suburb and you can see how varying their service charges are.

The second group of healthcare sellers are beauticians and cosmetologists. Some would argue that they are not within the realm of healthcare services.

I beg to differ. Walk into any one of these establishments and they offer services on par with any dermatologist or aesthetic medicine physician, claiming to heal your skin. Well, the skin is still part of the human body and if you’re healing the skin, you are a seller of healthcare as well.

The third group of healthcare sellers are wellness and supplement sales outfits. They sell remedies and supplements for any ailment known or unknown, and they have nutritionists who play the role of product specialists to provide you with a “free” consultation on which product you need to purchase and use to improve your health (with you the customer, not knowing, of course, that the cost of the free consultation is already included into the price of that bottle of supplement).

The fourth group of healthcare sellers are physical trainers.

Yup, with the advent of the new branch of “exercise medicine”, physical trainers are also selling healthcare, and along with their personalised fitness plans come a whole range of protein shakes and “magic-boosts” driven towards making you as healthy as a horse.

All of these healthcare sellers are closely involved with the delivery of healthcare services, yet they are not regulated although they too provide what is termed as an essential “public good”. And that’s my point of contention.

If we are going to ensure that the quality and prices of healthcare services need to be controlled, I am all for it.

But to just handicap the professionals via price-control mechanisms while others touting their services in the same field are allowed to as they wish in the name of “market economics” is just nonsense.

Regulate all the sellers of healthcare, or regulate none of them and leave it to the market to decide!

The views expressed are those of the author and do not necessarily reflect those of FMT.