Friday, June 30, 2006

More on the PHFCS

The PHCFS (Private Healthcare Facilities and Services) act and regulation is the latest medical controversy being debated by private doctors throughout the country. The forum for private doctors, organised by the PMPASKL and FPMPAM, was held with good attendance, on the 18th June 2006. It is not quite coffee shop talk, but perhaps private doctors shop talk.

The Act was gazetted in 1998 and the regulations, which works out the Act, was launched, and therefore came into effect on 1st May 2006. The declared aim of the Act was to improve the healthcare standards in the country as we prepare for vision 2020, modernising the private healthcare in Malaysia. Obviously, they also want to uplift our standards, to attract health tourism. All this sounds very good and it is something that all of us can agree with.

However, when you examine the regulations itself, one begin to wonder. It is easy to understand that we (doctors in private medical practice) should all register our practices although one could argue that we are already registered with the Ministry of Health (we already pay for an annual practicing certificate). The new registration fee is arguably high (RM 1,500) and the government stands to make millions of ringgit, as there are thousands of private clinics throughout the country. While we do not begrudge the government it's income, we have to wonder why the government begrudges us our daily bread. Portions of the Regulations cap doctor's fees. The caps are the same whether you are practising in an area with low overhead and rental, or whether you want to open a clinic in an area where rental is RM 20,000 per month and your staff overhead is high. How much thought actually went into this one?

Also, the regulations spells out specific sizes (to feet and inches) for clinics and how the toilet paper must be made available. It also outlines "fengshui" requirements like how the toilet door should face. Reading the act, you begin to wonder how that is going to improve medical care when you visit your family doctor. Undoubtedly, compliance with these regulations will require costly renovations, and more staff. All these would mean a rise in the cost base of owning a practice. Of course, the cost of care is not allowed to increase beyond the cap. There is also no formally enumerated process for requesting an increase in the fees schedule. They have this process for PLUS highway toll collectors, they have these for school bus drivers and they have this for taxi fares but God forbid that your doctor should ever need more money. With increasing petrol prices and stagnant wages, perhaps we will see more doctors pedalling to work on a bicycle.

The worst part of the act is that the entire tone is couched in very punitive terms. Penalties for failure to comply is very severe, including jail time and substantial fines, prompting one GP to comment at the meeting that the government (via the ministry) is treating us like robbers and criminals. The minister quite clearly knows that any conviction with jail time means autmatic loss of our license to practice. A man can take many things but such a blatant threat to his ricebowl is something that will make any person sit up and take notice. Are we bad bad men out to fleece the public or are we, by and large, people trying to save lives? Clearly our answer and the answer of the people who formulated this act are miles apart.

There is a little bit of light at the end of the tunnel where the Minister and Ministry of Health are on talking terms with us and they are very open to our suggestions for amendments. It requires much hard work to collate all the ideas and suggestion from GPs and private specialist to see what reasonable amendments to propose and convince the honourable minister to agree. Having obtain his agreement, to see that these amendments are also made public. There is still much work ahead. Wouldn't it have been easier for everyone if the act was open for comment and proposal prior to its unilateral passage? Then the doctors could have spent more time saving lives and not playing lawyer. Saving lives, after all, is the justification for such a law.

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