Middlemen in private medical care: A detriment to patient care, says Dr Mohd Tajuddin Shafee

September 25, 2023

Healthcaretoday, Private medical care, GPs, managed care, patient access, health policy, public health, healthcare reform, medical ethics, health equity, patient rights, Private public partnership, healthcare system, health care providers, Dr Mohd Tajuddin Shafee, Malaysia Healthcare, Medical care,

Up to 2010, private GPs had catered for 60% of the total outpatient care burden of the nation.

Opinion by Dr Mohd Tajudin H Shaffee,
Retired Private Practitioner, Kedah

In keeping with the objective to enhance private-public partnership in healthcare, the government should treasure and nurture the existing primary care system by private GPs nationwide. Up to 2010, private GPs had catered for 60% of the total outpatient care burden of the nation. Private GPs had been the main factor for reducing queues and waiting time in government facilities.

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

All this has changed with the entry of the middlemen, the Managed Care Organizations (MCOs) in the delivery of private primary care. Experience over the past 20 years have shown that the MCO's business model is that of cost containment is by “rationing of care”. It 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. 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 owned to doctors.

In simple terms, for the patient to see a doctor he has to go through an appointed middle men and for a doctor to see a patient, he has to go through a middlemen 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 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. The middlemen has 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 (i.e 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 this regulations were first submitted to the 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 middle men.

EXPLORE FURTHER

MORE UPDATES FROM THE SPOTLIGHT