Saturday, June 05, 2010


Thanks saudara MBI. I do not know how to reply to you, except through this blog. I hope you dont mind me sharing openly, your comments.
I am very interested in your way of trying to monitor and regulate private hospital bills. You may have a point here. Please teach me more. What constitute " fixed cost " and what constitute " variable cost". Can I assume that fixed cost is capital cost like land, electricity, etc? and variable cost is like for the treatment of that particular treatment? Where does HR cost ( a significant portion ) factor into? I will certainly discuss your approach at our next meeting on fees and see if it is workable. The last meeting scheduled for 4th June, the " Association of Private Hospital Malaysia " representative said that he cannot make it, so the meeting was postponed.
I was thinking more in-line with trying to suggest that we monitor and collect bills, to see the trends, and then try and cap the " mark-up". I have learn that mark-ups are so arbitrary, that it is like a free licence to increase profit margin.
You may wish to know that when I did the first angioplasty in private practice, the cost of angioplasty was about RM7K. I pitch it that way because coronary bypass surgery at that time was about RM15K. (This was back in 1998 ). This was because of the risk of re-stenosis with angioplasty. so basically 2 angioplasty for the cost of one bypass. When the stents came ( 1992 ), and these were bare metal stents, angioplasty + stents cost about RM 10K. The bare metal stents cost RM 3,500 each. At that time, the private hospital ( citing uncertainty that the venture will take off-this was in 1992 ), refuse to buy the stents, so I had to physically buy each stent for each patient, and carry them in. Johnson & Johnson ( the maker of the first stent ) was very kind to me, sold me the stents at cost, also gave me some stents to go to China to show them how to do it. When the drug coated stents came to us in 2002, although we implanted the first again, we lost oversight of the market. By 2002, angioplasty was very established and many, many interventionist were implanting them, using various mix of stents ( some FDA approved, and many not ). You may wish to know that FDA approved drug-coated stents, on the average, should cost about RM 5,500 to RM 7,500 ( before hospital mark-up ). Currently. an angioplasty with one drug coated stent ( FDA approved ), should be about RM 20K ( RM 12K for the cost of angioplasty, basic, and RM 7,500 for the cost of one drug coated stent ), before the mark-up. ( I assume that the procedure was straight-forward and uncomplicated ). The rest of the money collected is pure profit. Plain and simple. I would like all of you to know this, as we have observe the whole scene as it developed from 1998.
Dear MBI, if you wish to discuss further, please email me, then we can discuss privately.


Anonymous said...

春冰薄,人情更薄;登天難,求人更難。 ............................................................

MBI said...

I was away for the weekend, away from internet. I am happy to develop further and together the broad points I raised in earlier comments, if that benefits our medical services landscape and, by extension, our country. I am contactable at

dHarjma said...

what is your experience with regards to the use of bare metal vs drug eluting stents in Malaysia? Has the trend changed recently. Also do we in Malaysia still intervene on stable angina patients with 70% or more lesions or is it aggressive medical therapy?