LETTER | Having middlemen in private medical care a bad idea

LETTER | In keeping with the objective of enhancing private-public partnerships in healthcare, the government should treasure and nurture the existing primary healthcare system through private general practitioners (GPs) nationwide.

Up to the year 2010, private GPs had catered for 60 percent of the total outpatient care burden of the nation. Private GPs have been the main factor in reducing queues and waiting times in government facilities.

It is known that our GP system is among the most affordable and accessible in the world. Studies from the Health Ministry itself have clearly shown that the costs per visit per episode for private GP care have been lower than in government facilities.

All this has changed with the entry of the middlemen - the managed care organisations (MCOs) in the delivery of private primary care. Experience over the past 20 years has shown that the MCOs' business model is based on cost containment, that is, “rationing of care”.

The model imposes rationing by using broad exclusion clauses and limits access to choice so as to increase their profit margin, much to the detriment of the patient.

Unpaid medical bills

In addition, the GPs as well as specialists are often not paid in full months and sometimes years later.

Over the years, GPs have to face losses when some MCOs close down or are sold away, leaving behind millions of ringgit of unpaid medical bills owed to doctors.

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.

In the process, a fee is extracted from each party either in the form of co-payment, management, or registration fee, and hefty joining fees for the doctor.

The access, choice, and pre-approval guarantee letters for patient referral to specialists are determined by fine-print provisions in the master contracts between the middlemen and employers which are not revealed to the doctor or the patient.

Less care for the money

The middlemen have the inherent right to approve or disapprove the payment for care - much to the distress of the patient and the doctor.

The employer pays the middlemen in full, but the employee (that is, the patient) gets shortchanged and ends up getting less care for the money.

The government should immediately enact regulations to protect the patient from the middlemen. The draft proposal of these regulations was first submitted to the Health Ministry as far back as 2006. The patients and their doctors have been waiting for these regulations for more than 17 years.

It is only fair to ask where is the political will to protect the sick rakyat from the crutches of these middlemen.

MOHD TAJUDIN BIN H SHAFFEE is a retired private practitioner.

The views expressed here are those of the author/contributor and do not necessarily represent the views of Malaysiakini.