Lower The Barriers To Entry For Newer, Smaller, Private Hospitals. The Private Medical Care Act Now Serves The Vested Interests. Not For The Benefit Of The People.

Ok you have read all the articles about private health care written by Mr VM Chandran.  Useful views have been expressed and ideas exchanged.  The useless views have been discarded.

Please keep this in mind when you read this - there is no free market competition in Malaysia, including in private health care.  I see this as the single largest contributor to the very high cost of private medical care.  Similar to many other sectors of the Malaysian economy, it has been cartelised. Private medical care is now big business.

And the government sits on both sides. 

The government is the regulator and rule maker.

The government (via the GLCs) is also the owner / operator of the large private hospitals. 

This is a serious conflict of interest. 

When the government sits on both sides of the equation, it does not do disservice to the interests of the government if the service quality deteriorates at taxpayer funded government hospitals which then causes the public to spend their money at the GLC owned private hospitals.  The government makes money from the GLC owned private hospitals. 

Just like school teachers in government schools (and there are many of these as well) who 'encourage' their students to attend 'extra' tuition classes conducted by them if the students want to achieve good grades. 

We are finding out now that doctors' fees at the GP clinics have been frozen for the past 27 years - consultation fees are RM15.00. (Veterinary clinics charge more consultation fees for cats and puppies than GP doctors).  

This is not the worse part. The worse part is some half educated civil servant or worse some cebuk dale sungai politician who has no understanding of money, finance, economics or business has the decision making authority on setting prices. 

Prices are not set by the free and fair market forces that arise from healthy competition. There are over 20,000 GPs in the country. That is more than enough to create a competitive environment that can determine consultation and other doctors' fees. 

But because of government interference in price setting, over 20,000 medical GPs throughout the country are becoming an endangered species.  

I perused an interesting research paper by a local university  (cannot relocate it) on WHY the private medical care act was needed urgently.   Beginning about 25 years ago the service standards at private medical care providers (clinics, private hospitals, medical centers etc) was seeing an erosion in quality.   

The study said that the declining standards was also caused by :  

i. the ethnicity of the medical practitioners 
ii. whether they were trained locally or overseas.  

It was a long pdf and I did not read it in full.  The ethnicities were not identified.  So this means that instead of fixing the tidak apa attitude of one group of people and the low quality training provided by some medical schools, our legislators went the other way - they decided to burden the entire 32 million Malaysian population with higher private medical care costs.

Of course at that time they had no idea what they were doing. They had no idea that their meddling will send costs of medical care to the sky. Cebuk dale sungai morons. 

(Remember years ago I was screaming that the GST and the Minimum Wages will send prices skyrocketing and kill the economy.  Well it has happened. The economy is dying.)  

The BN government certainly hired consultants who perhaps photocopied some health care act from somewhere around the world and reproduced it here in Malaysia. 

Anyway here is something about the Private Health Care Act. Much of it is quite impractical and tak masuk akal.  But here is the catch - it adds to the costs.  

1. License renewal and the size of doctor's door.  

All private medical care providers now need to be "inspected" prior to renewing their licenses. Among the things inspected will be the size of the door in the doctor's office.  If the door size does not comply the doctor can be fined and forced to 'renovate' his office.

But this is not always the case. There is 'kelonggaran'. If the clinic is in a high rise building where it is illegal to break the walls for the renovation, then the doctor is let off - even with a regular sized door. Tak ada masalah pula.   Or it depends on the MOH inspector - sometimes they  say yes, sometimes they say no.  ALL this adds to the doctors' / medical practitioners'  costs of maintaining their facilities. The medical bills have to go up.  The people have  to pay more for medical bills.

2.  One private hospital (occupying five 2 - storey shoplots) has lifts that can accomodate 15 people each. The lifts work perfectly and patients on stretchers have been transported up and down for years.  Now under the Private Health Care Act  the hospital has been told that they must install 24 Person capacity lifts.  Why? What is the rationale?  'Itu adalah mengikut kehendak Akta'.

Bottom line - can the private hospital afford to install a brand new 24 person lift?  And of course it will add to the medical bills charged by the private hospital.  The people have  to pay more for medical bills.

3.  A smaller private hospital has to "apply" to the MOH to increase the number of hospital beds.  By 10 beds.  The Private Health Care Act says for every hospital bed, there must be TWO new nurses.   So the private hospital must employ 20 NEW nurses.  

Two new nurses per bed?  Why?  On what basis? With so much automation (like online banking replacing bank branches ha ha ha),  new monitors, Bluetooth, wifi equipment etc the whole idea is hospitals need less staffing to monitor more patients.  This is the 21st century ok. So let the hospitals decide. 

But it does not stop there.  The Private Health Care Act says BEFORE the private hospital applies to the MOH to increase 10 extra beds, they must FIRST already employ the 20 new nurses.  The application approval can take one month, three months, six months or more.  During that time the private hospital must already employ the 20 EXTRA nurses and pay them salaries - even though the 10 new beds have not been approved. This costs extra money. The hospital will have to increase its patients bills.  The people have  to pay more for medical bills.

The correct thing to do is to approve the 10 beds with full compliance.  The hospital will certainly know when to hire the 20 new nurses. 

4.   Manpower requirements

Another requirement that sends medical costs up are stipulations on manpower especially nurses.    

A doctor who runs an old  Maternity Hospital (including performing surgery) says the Private Health Care Act stipulates that for every certain number of beds, he must hire ONE Staff Nurse with a full complement of assisting nurses (to assist in surgeries etc).  Staff Nurses are paid  RM5000 per month. Again these stipulations often far exceed the service quality which has been provided by the hospital to its patients for a very long time.  And it adds to the costs.  The people have  to pay more for medical bills.

That particular maternity hospital is a private practise.  It is the doctors' bread and butter. He monitors his hospital 24/7.  There are also other doctors, locums etc employed. If there is a delivery in the middle of the night, the nurses call and the doctor rushes to his hospital. As I said this is their bread and butter.  To insist that such privately run and managed hospitals and medical practises must observe manpower requirements that are more suitable for large hospitals is just increasing the costs of smaller private hospitals.

For larger hospitals (the big ones with hundreds of beds) such rules would make sense. A hospital with 500 beds will NOT have 500 doctors. They may have 50 doctors. But they will have 500 nurses.  

(According to the Act they must have 500 x 2 = 1000 nurses, not including Staff Nurses who are paid RM5000 minimum).

All this adds to the costs.  The people have  to pay more for medical bills.

Even if you legislate service standards how do you legislate service quality? 

Ok the door to the doctor's office must be widened. But what if the doctor examines the patient with a pencil - refusing to touch the patient because one of them is of the other sex?   Or a doctor who does not "talk" to the patient because of  language differences?   All this and more have happened in Malaysia.  

Here is my suggestion.  

First the government hospitals must be cleaned out - remove the lazy heads, the tidak apa types, the corrupted pharmaceutical supply contracts and all the other crap. No more corruption in the system.

Increase the service quality, efficiency and user friendliness of the government hospitals. Increase the salaries of government doctors and nurses.  Push them towards super excellence.  And medial services must remain free of charge. 

(To the critics there is NO SUCH thing as free ok. WE have already paid for medical services at government hospitals through our taxes.  Every single syringe, cotton swab, antibiotic tablet at the General Hospital has already been paid for BY US the taxpayers. Dont be that stupid ok. It is NOT FREE. We have already  paid for it. Wotak ada faham kah?) 

Invest more in prevention of diseases and sickness and early detections.  The Klinik Kesihatan network must be really expanded and strengthened. Klinik Kesihatan must be COMPULSORILY staffed by Doctors and located in every neighborhood. Their duty must be focused on engaging with the local community (even outside the Klinik) for early screening, early detection and preventive measures against sicknesses and diseases.  Yes the Doctors must actually do walkabouts and go out to the public. Preventive care and early detection not only saves lives but it saves MONEY. 

The taxpayer funded medical services must be the backbone of an efficient (and free) health care system.

And ease up on the private medical health care act. 
The Act must be seriously amended.

Lower the costs for smaller hospitals (and larger hospitals) to go about doing their business.  

Why do you need a 24 person lift in a 2-storey shophouse hospital when a 15 person lift has already been functioning perfectly well for years? 

Pakai lah otak sikit. 

Lower the barriers to entry so that as many new private hospitals (of all sizes - 10 beds, 20 beds, 50 beds) can come into existence.

This will create a more open, free and healthy competition. 
Prices will then self regulate. 

MORE IMPORTANTLY PRICES WILL BE AT MARKET RATES.

Encourage and create small but 'niche' private hospitals. For example small private hospitals for psychiatric care, geriatric care, smaller "cardiac" hospitals.

A good example is the significant network of private "maternity hospitals" in Malaysia. They specialise in one thing only - delivering babies. So in Malaysia a mother can get the benefits of a safe delivery by a qualified doctor for around RM1,000 (in some places).

So there will be more competition in favour of the patients from : 

i. an efficient and high quality government health system. 

ii. competition from many private hospitals - of  all sizes.  

Regulation must be singularly focused to ENABLE.
Not towards making things UNABLE.
Kekawan cebuk dale sungai - boleh faham ke? 
Make things easy for people.
Jangan menyusahkan manusia. 

Kalau doctor pemalas atau tak tahu buat kerja take action against the doctors.
Dont take action against the people - by increasing the costs of medical care.