Messing Up The Private Medical Clinics : Price Controls, More Regulations, More Restrictions. No Free Market In Malaysia.

Hi folks. The Pakatan government is just going about things in the wrong way. 

Now they are messing with the private clinics especially the GPs or General Practitioners.  Making more enemies.

This news is about a week old already but recently I met with Dr Namazie Ibrahim the president of the Malaysian Medical Association who told me about what is going on.  

(I must declare that Dr Namazie is related to me - second cousins. We are Ipoh mali.)

First here is a Press Statement by the Malaysian Medical Association (truncated).

*PRESS STATEMENT : GOVERNMENT URGED TO FURTHER ENGAGE WITH STAKEHOLDERS ON FEE SCHEDULE AND DRUG PRICE CONTROLS*

MMA feels more engagement between govt, stakeholders needed 

before enacts drug price controls 

these measures have severe impact on healthcare delivery

hoped govt will reconsider decision of not increasing GP fees

two issues need to be discussed in greater depth, closely intertwined 

MMA earlier agreed to price controls for medicines 

provided govt harmonise Sched 7 with current Sched 13

With Sched 7, with drug price controls, GPs severely hit by lower margins 

no longer able to sustain operations and close shop

Last year alone, over 300 clinics closed down

rising rental, costs of medicines, equipment, salaries, expenses 

for past 27 years having to subsidise these costs 

common knowledge GPs depend on gross profit from drug sales

GPs charge Sched 7 -  RM10-RM35 per patient 

GPs at hospitals charge Sched 13, RM30-RM125 per patient

Sched 13 RM30-RM125 result of revision in 2013

however, Sched  7 RM10-RM35 not revised since 1992

MMA appeal to govt to harmonize Sched 7 with Sched 13 

President Dr M Namazie Ibrahim

Malaysian Médical Association

My comments :  The bottom line is the GPs consultation fees have not changed since 1992.  That is 27 years ago. 

The GPs can charge consultation fees of RM10 - RM35 per patient per visit.

Of course other costs like rentals, cost of medicines, cost of equipments, salaries or nurses etc have gone up tremendously since 1992.  

The GPs survive by marking up the prices of the medicines and drugs that they prescribe. 

Still many GPs have shut down - last year alone 300 GP clinics have closed down. Costs are too high.

Dr Namazie says that there are up to 7000 private clinics in the country.  

Assuming each private clinic sees on average 10 patients a day, that is about 70,000 patients who go to the private GPs every day. That is over 25 MILLION per year.  

That is a very large number of sick people who would otherwise be flooding the government hospitals and government klinik kesihatan. 

Without the private GPs, the government health services will most likely have to deal with an extra 25 million sick people every year.

What is the reply from the Health Ministry?  It is difficult to understand what they are talking about. 

Here is one news report from the Malay Mail :

Cabinet approves drug price controls

2 May 2019

Health Minister says ministry will use external reference pricing 

to benchmark medicine prices in Malaysia 

against cheaper drug prices in certain countries 

so that local drug prices do not exceed the benchmark

The countries that will be referenced have yet to be decided.

(OSTB :  Oops looks like its too late. The Cabinet has already approved the price controls. What does this mean? Benchmark against which countries? Japan? Bangladesh? Germany? Zimbabwe? Singapore? Uganda? These are not apples with apples. Drugs are cheap in India because many are generic. But quality wise, generic drugs have only about 80% or less of the potency of the real drugs. Cheaper price yes but what about quality and effectiveness?)

Health Ministry will work with (KPDNHEP) to regulate medicine prices

Cabinet approved, two ministries to gazette regulations 

under Price Control and Anti-Profiteering Act 2011 

price controls fall under KPDNHEP

private sector may not be comfortable 

we are forced to take a solution that fits all

We cannot be selective

If private is too expensive, public hospitals will be congested

Give a breather for people to go private,” Dzulkefly said  

Health Ministry yet to decide when drug price control regulations gazetted 

it wants to go for another round of consultations with pharmaceutical industry 

to discuss price control mechanism

OSTB : Consult with the pharmaceutical industry? That would be the big money pharmacy companies. 

What about consulting with the consumer? 
And consulting with the GPs?

ceiling price derived from average of three lowest prices 

imposed at two points

wholesale and retail at clinics, pharmacies, hospitals 

“So they cannot charge more than that,” Dzul said

OSTB : Consultation fees are capped (since 1992) and medicine prices are controlled.

private hospitals do not publish prices of various (other) procedures

“Medicine price controls will be done in phases,” Dzulkefly said.

price controls to ensure medicine at appropriate prices for people

besides encouraging innovation, healthy competition for industry growth

Dzul said price controls would expand access to expensive new medicines

Malay Mail reported about lack of new cancer drugs at public hospitals

Here is another report from FMT :

Controlling medicine prices will see private clinics closing warns MMA

May 3, 2019 

MMA says > 300 private clinics closed down last year

MMA warned private clinics could close shop with drug price controls 

MMA president Dr Namazie said private clinics hit by lower margins 

no longer able to sustain their business

Currently, private clinics charge RM10-RM35 per visit.

Last year alone, over 300 clinics closed down he said 

https://www.freemalaysiatoday.com/category/nation/2019/05/03/controlling-medicine-prices-will-see-private-clinics-closing-shop-warns-mma/

My comments :  

Here is an initial reaction (also from another doctor) to the Health Minister's comments about price controls on drugs.  I must say again that the doctor who made these comments here is another cousin of mine,  a specialist doctor.  (There are over 20 doctors in the clan and still increasing, the youngest being my son as well.)

My doctor cousin says (about the Health Minister's comments)

"What an idi_t.    GP's are the ones absorbing a huge load of patients, relieving them from going to hospitals in the first  place.  

If you regulate medicine prices then there's no competition.   Is this his grand solution to reduce congestion at government hospitals?

Provide improved infrastructure for clinics, longer hours opening times, better flow of follow up of patients, empower nurses etc

Instead this regulation of prices of ubat to reduce cost of treatment at GP's ??   300 GP closures in one year b_d_h .   Memang la ramai akan pergi ke hospital.  B_d_h.

GP's margins are going to be smaller.   Impossible to survive. 

This is the problem when you get a non Dr or non qualified person talking c_ck about something of which he has no knowledge."


MY comments:

This is the problem with almost every aspect of Malaysia, especially the Malaysian economy. Everything is over controlled. Everything must be approved by the Minister, by the Cabinet, by the Government etc.

There is no market economy in Malaysia.  Market forces and free competition are non existent. 

So in another sector ie the private clinic GPs and ultimately the consumers are facing so many difficulties.

And people who do not understand the simple basics of business and economics are making haphazard decisions that will affect the lives of not just 7000 private clinics but of millions of sick people.

Bila tengah malam anak sakit demam or you have a very bad cold or kena some food poisoning most people who seek medical treatment will rush to the nearest private medical clinic. They are closeby, convenient and affordable.  In small towns private GPs are also part of the local communities where they know their neighbours as well.

In the 1960s in Ipoh my uncle was a doctor (the father of that doctor cousin above).  Once they lived in Birch Garden. Around the corner was a family which had a child who suffered epileptic fits. Sometimes in the middle of the night they would come running asking for assistance. I recall my uncle would go in his sarong and shirt (in the middle of the night) to help the child. 

Late 20th century when we ran into our family dentist at the TMC in Bangsar, he would give our young sons a quick dental inspection between the cereals and the milk.

What I am trying to say is that there is a balance that has come into existence. GPs, private clinics, the local dentist are part of the landscape that services the health needs of the communities they live in.

I was surprised to find out that GP fees have been "fixed" since 1992.  No revision for 27 years !

And still no revision.  Dr Namazie tells me that the Malaysian Medical Association seeks a review of GPs consultation fees to what they proposed in 2002 !!  They will be happy even with the fees proposed in 2002 !!    This is 2019 !

Kesian nya doktor klinik.

And now with the price controls over medicines the GPs are going to be hit even more.

300 GPs closed shop last year. With these new price controls more GP clinics will shut down.

So where will people go when their child sakit demam in the middle of the night? Big cities have hospitals. What about smaller towns, villages and even far corners of big cities?  The government hospitals are already overflowing with sick people. If more GPs close down can the government hospitals cope with an even greater influx of patients?  

Life is going to become more difficult.

Why not just let market forces decide the prices of medicines? 

Ada AP kah? There must be APs to import medicines too.  There must be artificial barriers that are forcing the prices of medicines up.

As another example,  things began to go wrong when the corrupted BN government franchised Pharmaniaga as a monopoly to supply medicines to the government. This monopoly is still there and it will most likely be extended. By the new batch of corrupts.  Yes folks - its back to the same old dirty tricks.  That is why the price of medicines is so expensive. 

Now government hospitals do not have many medicines which were prescribed to patients before. 

The government has no more money. Yet they still have to buy drugs from the Pharmaniaga monopoly. 

Apa ke jadah punya bodoh? 

Just abolish ALL these stupid blood sucking monopolies.   

Malaysia is the Land of Monopolies.  

Pasai apa lah kau orang ni bodoh dunggu susah nak faham sangat? 

MONOPOLIES ARE BAD.  

CONTENG TANG MUKA -  MONOPOLIES ARE BAD.

Over regulation, too many controls are all bad.

Just break open the market. Let market forces decide. 

Let the market source whatever drugs they wish from the world market.

Let market prices decide. 

Dato AP,  Dato commission agent etc semua sudah cukup kenyang - kasi chan lah kat orang lain.

The government is not only making enemies with 7000 private clinics (and maybe 20,000 GP doctors or more)  but most dangerously you are jeopardising the availablity of medical service which is now available around the corner from your house, especially when your old father or young daughter falls sick in the middle of the night.

I hope the Health Minister can understand simple things like this.