Friday, August 24, 2007

What of the PHFCS

The PHCFS Act 1998 and Regulations 2005 was launched by YB MOH with pomp and ceremony on 24th April 2005. That sent many GPs into a frenzy, as the Act had stringent (read as un-Malaysian) requirements. The "feng shui requirements" in particular, including the size of doors and whether the toilet doors should swing out or in, meant the need for renovations in many existing clinics in order to comply.

Along with the act came a big stick. The penalty for failure to register was RM 300,000 fine or six months in jail or both. If you register and do not comply, the penalties are also very punitive. In addition to the big stick, they shrink your carrot to be a doctor. The Act spells out a fees schedule for doctors' fees, ostensibly so that there is no "overcharging". Nothing is mentioned about inflation and how doctors will get to sick people when the price of petrol hits 5 ringgit a litre.

Back in those days in 2005, we travelled across the country trying to gather feedback and also pacify the many fears that GPs had. I remember that some of the meeting across the country were very heated and some doctors even advocated industrial action, including downing tools (which I thought was quite funny. Can you see our kiasi GPs downing tools?). We were then so fearful, that the ACT and Regulations will give overzealous "little Napoleons" great opportunity for "side income".

With a touch of good luck, we established a channel of communication with MOH (remembering YB MOH is from MCA), and we were able to negotiate some toning down of the Regulations. We were advised that the Act 1998 was not negotiable, but the Regulations (and enforcement), we could amend.

It is now 15 months after the Act came into force and we just had a meeting (23rd August 2007) with MOH to "finalise" the amendments to the regulations. So far it has taken 15 months to have 3 rounds of negotiations.Do not be surprised that nothing in the amendments had been decided (after 15 months). MOH is very pleased (also the Cabinet, as we are told), that 90 over percent of GPs have registered (in other words the act is a success).

The enforcement arm had made 20 raids to nab those in breach of the Act. As Dato Khairi of MOH Jabatan Amalan, puts it, "we will continue to act on our intelligence, and go after the bad guys. You good guys have nothing to fear ". So far, we have not heard of any instances of the "little Napoleons" who may come by, with overzealous enforcement. To cut a long story short (we spent 2+ hours in MOH), we realise that the MOH officials were severely overworked, and it is very likely that we will not see any of our agreed amendments in print anytime soon. My personal hope is to see it in my lifetime. We were reminded that they are still trying to process the 6,000 over registrations (they have now process 4,000+), and with the recent passing of the Pathology Bill 2007, the same people in MOH are also doing the enforcement, so "they do not know when the PHCFS Regulations 2005 amendments will be done". In the meantime, "you good guys don't have to worry. we will go after the bad guys ".
So what of the "feng shui requirements"? We are told that the toilet doors must swing out. Looks like the AG chambers feel that this is very important for a medical facility. The emergency medicine clause is still undecided. We continue to press for basic life support as the basis, with no need to keep IV drugs, ECG and defibrillators. They even said that the doctors fees schedule could be negotiated (No word yet on whether we have to wait for petrol to hit 5 Ringgit before this happens).

I thought that that was one of the main reasons for the Act. Doctors were "over-charging". What surprised me at the whole afternoon, is the MCOs (Manage Care Organisations). Although their role in private healthcare is stated in the Act, there is no regulations for them, and they cannot be held accountable. We all can tell all kinds of horror stories about the MCOs, but there are laws to control them. We were told that they may need to have a "MCO Act". Please see MCOs as very rich and powerful people who are very influential, and out to make a quick buck. So I really doubt that I will see a "MCO Act " anytime soon. Anyway, we have done our part in trying to get a fairer deal for our private practitioners. Let us see what will come about, in print, I hope, for posterity.

1 comment:

Bushido said...

Thanks Dr Ng for keeping up the good work.