"Private Medical Care in Malaysia is getting out of control" - Part 1 By VM Chandran

"Private Medical Care in Malaysia is getting out of control"  - Part 1.

By VM Chandran.

As the country economically prospers and with growth in population, the demand for good affordable medical care becomes a key element in the cost of living.

Although the Government tries its best to provide a good backbone of medical services, demand and expeditious treatment creates space for private medical care to flourish. 

Whilst numerous private medical care providers have developed over the years , the cost in delivering  sure care has also escalated ie sky rocketed.

The perennial argument is that costs have gone up. Much too often what Private Medical practitioners do not state is that they want to watch their "bottom line" to cover the return on capital.  More so as Insurance claims become a "gold mine" that becomes a major factor in inflating medical fees. 

Obviously this puts pressure on those without insurance cover and medical practitioners do not differenciate between those with or without insurance cover. Compounding the issue is that most insurance schemes place limits on medical claims, thus further exacerbating the affordability issue. Those with chronic illnesses suffer such fates.

Another area that shocked me is how  hospitals treat their  various Departments  as "profit centres".  

For example the Pharmacy wants it's 40 to 50 %, whilst Imaging, Consultancy, Operating Theatre, Nursing care, Rooms, Physiotherapy etc all want their share of profit  margins. The cumulative costs  becomes an excellent "building blocks" for profit.

• Personal experience indicates that the margins for drugs is  usually  48%. 
• Room charges have an extra RM 100 per day for nursing care. 
• There are extra charges for checking blood pressure and sugar reading.
• All consumables are at the patients' cost. 
• Administrative charges for "retrieving medical files" are also added on.

What does it all mean? 

A day care surgery would set you back by RM 8000. 

A day care chemotherapy and immuno therapy  treatment with blood test and  doctor's consultant fee would be around RM17000 per cycle. 

Radiation treatment ranges from RM 500 to 1200. 

An interesting element here is that the one time planning charge is RM 6200. 

A PET Scan can knock you off by RM 3900. 

A day care cataract operation for one eye  with placing of intra-ocular lens is around RM 6500. 

An angioplasty with stenting is around RM30,000 to RM50,000. 

An Open Heart surgery is about RM75,000. 

In case of normal child delivery it's about RM5,000  to RM6,000.

A Caesarean birth is about RM15,000.

YES!!!!! These are killer charges. 

Indeed it is popularly said that "if the illness does not kill you,  the hospital bill certainly will."

Something has to be done, and expeditiously, if we want Private Medical Care to be affordable. 

If we do not intervene now, like in many developed countries, we will regret the price of medical care in the future. 

The responsibility rests with all stakeholders ie

1. Government 

2. Private Medical practitioners 

3. Public

4. Drug companies

5. A"Watchdog" Commission.

Part 2 will elaborate the "Way Forward" in making Medical Care affordable.

-V.M.Chandran.

My comments :  We need to make a comparison with private medical care in the UK and Singapore - vis a vis the government run NHS in Britain and also the Singapore model (which I believe is an offshoot of the British NHS) but with "less" subsidies. UK doctors speak highly of the British NHS.  

At the end of the day it all boils down to a simplistic supply and demand function.

Demand for good medical care - which is inexhaustible. People are getting sick every day.

The supply of medical services - public and private, the quantities available, the quality and most important of all the competitiveness.  Is there enough competition in the medical services industry. Yes it is an industry. 

My view is the government must provide top quality education and health care for free.

Education up to the university level for all its citizens (including to those free loaders who do not pay taxes because obviously they do not work) and also top notch free medical care for all its citizens (including to those free loaders who do not pay taxes because obviously they do not work).

In Malaysia we have a large and very succesful government health service which provides a full range of health care.  In some aspects like pre natal care Malaysia is world class. Ignoring the 'buang bayi' cases, our infant mortality rates are among the lowest in the world.   

But the quality and quantity of other health care (serious illnesses, surgical procedures, early detection of serious illnesses) etc has too much room for improvement. Many aspects of the government health services are also deteriorating. The efficiency and timeliness of providing good health care is also poor. If you go to any government hospital even for the outpatient clinic, make sure you pack food and clothes for a day. This deterioration has to be stopped.

Back to supply and demand.

There are 32 million people in the country. 

A sizeable number are poor. 

A goodly number are middle class. 

A good number are also well off, if not rich. 

Private medical care flourishes when the free (or almost free) government health services are not up to the mark. 

The middle class and the well off  are the first to seek out  private health care. Because private health care is much faster in its response time. The doctor can schedule you for surgery tomorrow morning at 7am. Thats how fast they are. Its all about money. 

Plus the duty of care at private hospitals is perceived to be better although this is debateable. I have had good and not so good experiences with both government and private hospitals. 

So how much should the private hospitals charge for their medical services? 

As much as the "market" is willing to pay.

If the free government hospitals improve significantly on the quality and quantity of their health care services, then of course the private hospitals will lose "market share".

To compensate they will have to lower their prices and/or increase the quality and quantity of health care for the same amount of money - which amounts to the same thing.

The equation is how many private hospitals are there versus how many people there are who are willing to pay higher fees for private medical care?  

The number of paying patients will sustain private medical services. 

The pricing mechanism is easy : charge the market to the highest amount that it can pay.

If private medical care is expensive (as detailed by Mr Chandran above) it is simply because the number of patients still able and willing to pay their high medical charges (the demand) far exceeds the supply of good quality medical care at the government hospitals. 

Things to do :

1. Improve the goverment health care system.

2. Encourage as many new private hospitals as possible - to increase competition.