A horrendous Medical Bill for a common surgical procedure!!!!! By VM Chandran

One of the largest chains of Private Hospitals which is owned by a State  Government, seems to have a knack of billing its patient a horrendous bill for a surgical procedure which  many regard as common and basic.

The modes operandi for such a procedure  has changed with time. In yester years, it used to be an open large incision surgery, but it has  transformed to a laparoscopic procedure these days.

Laparoscopy is a procedure of  operating through 3 small keyholes while watching an enlarged image of the internal organs on a monitor. One of other keyholes would be used to complete the procedure.

The advantage of laparoscopy is that:

1. It shortens hospital stay.

2. There is less post-operative pain

3. It results in a faster return to normal activities

4. It facilitates easier bowel movement.

5. It has better cosmetic results.

Such procedures are used on a number of surgical cases and on this particular subject matter it was for Appendicitis.

The storyline in this case is that a patient had an appendix removed by way of a laparoscopic procedure. She was hospitalised for 2 days and the full bill was around RM 20,600. She reveals that the Doctor's procedure itself was about RM6000. There were follow up Consultant  charges of which she raises some interesting comments.The medicine charges were not of any significant value.

The patient has also voiced her disappointment on the overall medical care in the hospital. Indeed she was so frustrated because she was sent on a "wild goose" chase around the hospital when she questioned the billing and there was no resolution.

Today, totally disgusted, there is a chat message on the social media highlighting the agony this patient had gone through. This does not seem to be a "one-off case". Numerous such cases of " horrendous" billing has become a common feature these days. Such grievances seem not confined to just this hospital but rather across the board to other hospitals.

Can you imagine that it cost RM 20,600 to do an appendix removal with a 2-day hospitalization? Is this amount going to grow with time to uncontrollable levels for future cases? If RM 20,600 is for the removal of an appendix, which is a basic surgical procedure, what would be the cost for other more complex surgeries? Is this the "new yardstick" of measurement for surgeries these days? 

It is not only the Hospitals that seem to be the culprits but also the Insurance companies. Are they knowingly  permitting such excessive charges? The Insurance companies must take responsibility and play their role for their client ie the patient. It would seem that Insurance companies are seemingly aiding and abetting these horrendous billings.

Effectively it means there is a failure of  "self-regulation" in both the Private Hospitals and Insurances. Both seem to be complimenting one another and allowing the prices of medical procedures to escalate.

This is fodder for unnecessary upward spiralling in medical inflation and ultimately cost of living. The whole Nation has to pay the price for such perils.

This is where the Government especially the Ministry of Health (MOH) has to intervene by creating a  mechanism for patients to channel such grievances. I have repeatedly called for a Tribunal. It would seem the Government bureaucracy or maybe the lack of enthusiasm at MOH officials seems not to "kick start" this process. Maybe it is the lobbying of the Private Hospitals that may have "dulled" the idea.

The other big issue which MOH must recognise is that they seem to lack the "bite" ie enforceability. Stories after stories have been told and it seems to repeat so frequently that it provides the impression of  a "tidak apa" attitude in MOH of not seriously attending to such matters. I have not heard of Private Hospitals being summoned to justify such billings or stern warning letters issued or fines being levied or worst case operating licenses being suspended.

When such things are not undertaken, Private Hospitals seem to have "happy days" everyday on their billings and standard of service. Again an independent self-financing Commission of experts  is required to monitor  and perform continous audits on Private Hospitals to ensure affordability and that quality of service is managed properly. This would keep the Private Hospitals on their "toes"

These matters are not difficult to undertake and implement. The key question is whether MOH has the courage and determination to see it through. The public want positive changes and it is incumbent of the Authorities to fuifill the people wishes. Is that too much to ask????

V M Chandran

June 2019.