Friday, July 27, 2012


The mainline press to day carried an article from the YB MOH on doctor's fees schedule.  He announced that doctors' will be allowed to increase their professional fees by 14%. But although, he as a minister announces it, it has to get "Cabinet approval". He also said in some press reports, not in others, that the Dental Fees schedule is still not finalised. All these announcement, while opening a new healthcare facility in Bangsar. There are many points here that needs clarification. The truth be told. I was part of the Ministry Fees committee, representing the Private Medical Practitioners. I attended 100% of all the meetings for 6 years, at great cost to my practice, because meetings are often called at short notice and I had to cancell and re-schedule clinics frequently, for 6 years.

Firstly, this the PHCFS Act ( 1998 ) and Regulations ( 2006 ), contain a fees schedule. The fees schedule in the PHCFS Regulations ( 2006 ) was based on the MMA fees schedule 4th edition. It must be remembered that in 1998, when the PHCFS Act was drawn up and passed, the only fees schedule in the country was the MMA fees schedule, drawn up, incidentally, by Dr Sreenevasan ( the father of Datuk Ambiga ). Back to the story. So the MOH copied the MMA 4th schedule ( drawn up in 2002 ), with some minor adatptation, and called it the PHCFS Fees schedule.
Secondly, we began to negotiate amendments to the PHCFS Regulations in 2006, the moment it was launched by Dr CSL ( of VCD fame ), the YB MOH then. That was a good 6 years ago.
Thirdly, after 4 years of haggling and meetings, in Jan 2011, the YB MOH ( Tung Shin Liow ), called a big meeting to announce the "talking Points by the Minister" to declare that he has agreed to the amendments, and had approved a 30% increase in doctors' fees across the board. This is in black and white. To be specific, the dentist were with us all the while and their fees schedule had also been agreed upon. ( I cannot exclude a few outliers amongst dentist, who may have met YB MOH privately on the side ). I know that the Malaysian Dental association, and other Dental Specialist were with us at the discussion table.
Fourthly, I always thought that the Minister in the British Parliamentary system, speaks for the Government. If the minister speaks, it is the cabinet who is behind him, so he speaks on behalf of the cabinet. Now we have a Minister who speaks without cabinet authority, suggesting that he is not a real minister.
Fifthly, after 10 years ( MMA 4th schedule 2002 ), a 14% increase in fees is not even keeping up with inflation. It has already become obsolete, while awaiting cabinet approval.
Sixthly, amongst the many other important amendments in the PHCFS Regulations ( in conjunction with the Fees ) that is pertinent is the "Fees Splitting" regulations. The regulations that forbids fees splitting. He has remain silent on that.
Seventhly, there are many important amendments in the Regulations to protect patients, that is still being held up. Whoever drew up the PHCFS Regulations 2006 did a very bad job. they copied and pasted regulations from other countries, which are not applicable in Malaysia, and we sat through month after months, going through the regulations one by one to amend them and make them relevant for Malaysia. That was two ministers and one DG ago.

So now, we are still waiting after 6 years of negotiation, on a fees schedule that is already out of date, for implementation. God knows how long more. In the mean time, insurance companies are bashing doctors left right and center, to cut down their fees and collect kick-backs ( or called touting in the Regulations ).
So this is how fast the government works, 6 years of discussion on the amendment, agreement up to ministry level, and yet no Gazettement. Everything is politicised to suit the powers that be, without due regards to the population and the doctors.

It is obvious that once the cabinet approves this amendments to the Regulations, we will have to begin negotiations for the next fees revision, noting that we are always 10 years behind. Maybe we get to negotiate with a new government, who can be more efficient ( hopefully ) and trustworthy.

It is important to note that Singapore, as a signatory to the Competition Act 2008, has abolished the doctors fees schedule, in line with the Act. Malaysia, also a signatory of the Competition Act, has chosen NOT to comply. Even the Minister, in his statement note that the problem with private healthcare cost, is NOT the doctors' fees ( which forms about 15-20% of the overall fees ), but the private hospital's fees. We have shouted, till we are blue, at all our meetings for MOH to control private hospital fees and mark-ups, but they MOH refuse to act. Obviously, the Associations of Private Hospitals of Malaysia has more clout ( read more money ), then us. We even told them that 90% of the private hospitals in Malaysia are owned by Government linked companies. All it requires is for the government to tell Khazanah to tell their hospitals, and KPJ to tell their hospitals, and it shall be done. But still they refuse. On the one hand the government complains that private hospital fees are too high, on the other hand they bash the doctors ( the easy target ) and left the robber to keep robbing the poor patients.

This is the government of Malaysia, and the YB minister. What to do?

I think after 55years, it is time for change. This is another glaring reason why we need change. Let the other fella have a turn, so that this present, severely corrupt government can be given a rest and a break. maybe, they can then become a more responsible opposition and await their return.

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