Saturday, July 03, 2010


I have always grappled with the issue of rising healthcare cost and what to do about it. Whenever we go to the ministry of Health for our meetings, we are constantly reminded the private doctors are expensive and private hospitals are expensive, and the cost keeps rising. One survey in the " Personal Money " July issue, rates healthcare cost inflation at about 27% yearly. It is no longer cheap to fall sick. Yesterday morning, the DG of Health, held a dialog with doctors about reviewing the professional fees. Doctors are asking for a rise in fees.
The June 28th issue of the Archives of Internal Medicine, carried a survey by Dr Tara Bishop and colleagues from the Mount Sinai School of Medicine, New York City ( good USA hospital ). Dr Bishop and colleagues surveyed the practice patterns of 2,416 physicians in New York to see how many are practising defensive medicine. Guess what - 91% are. Their reason, fear of litigation. It is fair to say that this survey was carried out to pressure the government to limit medical suits and awards, as the fear of litigation, is driving doctors to be ultra cautious, and to carry out more test and do more ( sometimes maybe unnecessary ) procedures, so as to " play safe ". When medical legal suits award rises, the medical indemnity for doctors also rises. This year, I paid RM 4,600 for my medical indemnity. I understand that my O&G colleagues are paying about RM 40,ooo for medical indemnity. PriceWaterHouse Coopers, in 2008 estimated that 10% of healthcare cost is contributed by defensive medicine.
When medical indemnity goes up, doctors practice in a very insecure envirinment. So they become defensive and do all that they can, to avoid missing any thing ( as if that is possible ) and so avoid law suits.
One of my patients, who is PR in USA, but Malaysian citizen told me the other day, that in USA, the lawyers will come to you, when they hear that you are unhappy with your medical treatment to encourage you to complain and sue. If they win the case for you, the awards is shared. If they lose, no charge.
How do you practice medicine in that environment. Physicians are not the worse hit. It is the O&G, orthopedics, neuro-surgeons, or mainly the interventionist.
We are seeing more and more legal suits being filed against doctors, in Malaysia. Not a healthy trend. The notion that when something go wrong with a patient, it must be the fault of the doctor, may not be correct. Yes, an agrieved patient must have the right to complain, and the medical authorities must hear the complain and look into it ( if possible with independent local experts assisting ). A reasonable explanation must be given. Lets avoid law suits and unreasonable awards, as in the USA. Maybe, we can, in a small way ( 10% ), reduce medical cost.

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