When doctors can't even afford a Proton

In the old days, doctors drove Volvos but now they cannot even afford a Proton, says Qualitas Healthcare chairman and managing director Datuk Dr Noorul Ameen.

Having treated patients for 20 years, he knows what he's talking about.

"I told my only child: 'no way are you going to become a doctor'.

"Ten years ago our consultation fee was RM15 (S$6)  and today it's still the same - it's insulting what doctors earn here.

"Most general practitioners with standalone clinics earn between RM7,000 and RM9,000 per month but spend about 70% of their revenue on overheads," he claims, adding that cost of healthcare delivery worldwide has increased and that Malaysia is no exception.

He feels the Government should either support the private healthcare industry or allow the free market to determine healthcare pricing in the country.

Qualitas is a chain of over 200 clinics, dental clinics and pharmacies in Malaysia, India, Singapore, New Zealand and Australia.

Dr Noorul says Qualitas has acquired many clinics in the Klang Valley because GPs cannot sustain their practice.

The Government, he feels, "has no business" telling doctors what to charge if it is not offering tax breaks or incentives for the private sector which provides more than 50% of the nation's healthcare needs.

"In Australia, the private sector is given grants and incentives to ensure quality and better clinical outcome for our patients.

"Here, many cost-incurring conditions are imposed on us, yet we receive no support from the Government.

"Instead of fault-finding and telling doctors this is the minimum you can charge, the Government should be telling patients what is the minimum they have to pay," he says.

Dr Noorul, who spent a decade managing hospitals, denies that private hospitals are making huge profits, saying they need to constantly invest in the latest medical advancements.

Poor investment

"Hospitals are the worst investments one can make because the returns don't justify the huge amounts spent," he laments, adding that treatment here is cheaper than in Bangladesh.

On claims that doctors are also earning from dispensing medicine, he says the amount is peanuts.

In asking for higher fees, the Malaysian Medical Association (MMA) claims that their 15,000 members comprising general practitioners (GPs) and specialists are "hardly making ends meet" amid rising operations costs.

Patients are expected to pay between 10% and 30% more if the association's "Medical Procedures and Services Nomenclature and Schedule of Relative Values" is accepted by the Health Ministry (MoH).

The new comprehensive proposal, to be submitted to the MoH by December, will not contain any fees, only relative values (which will be converted to Ringgit) for specialist procedures.

According to MMA president Datuk Dr N.K.S. Tharmaseelan, GPs currently get between RM30 and RM50 per consultation while specialists charge between RM50 and RM80.

"The MoH has approved a 14.4% increase for our consultation and specialist procedure fees but even that hasn't been gazetted yet," he says.

Medical Practitioners Coalition Association of Malaysia (MPCAM) and Malaysian Primary Care Network (MPCN) president Dr Jim Loi says the MMA's call for a 30% hike in doctors' consultation fees may not be feasible in a sluggish economy.

He adds that together with the Federation of Private Medical Practitioners Association of Malaysia (FPMPAM) and other related bodies, a plan to form the country's first medical union is underway.

Association of Third Party Medical Claims Administrators Malaysia (TPA) vice-president Paul Cheok says he sympathises with GPs.

He says most GPs are charging rates that are much lower than what's allowed in the 13th Schedule of the Private Healthcare Facilities and Services (Private Hospitals and Other Private Healthcare Facilities) Regulations 2006.

"The reality is that some GPs are charging as low as RM5 for consultation because competition is too steep.

"For example, if a GP charges a flu patient RM35 for consultation, the bill for cough and cold plus medication could reach RM150. Who can afford that?

"Whether the professional fee hike is 14.4% or 30% is irrelevant because charging what is allowed will result in them not having any patients," he observes.

To improve the welfare of GPs, the MMA has made several proposals to the MoH.

Dr Tharmaseelan says the MoH is considering allowing all non-communicable disease patients to do follow-up checks at GP clinics.

"The Government will supply the medicine and the GPs are paid a fixed consultation fee.

"We've also vociferously opposed the plan to build more 1Malaysia clinics in urban areas where many GP practices are located and requested that existing clinics be manned by private doctors.

"Pilot projects are now being conducted where GPs run the 1Malaysia clinics after office hours," he says.

To prevent clogging up public hospitals and also to help GPs, the MMA is urging the MoH to foot the bill for public servants who visit private clinics.