‘Full-Paying Patients’ scheme could lead to bias in favour of paying patients

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Before the government extends the scheme to more general hospitals, it should present data to show how the pilot project has fared, writes K Haridas.

Deputy Health Minister Hilmi Yahya’s recent announcement that the full-paying patients (FPP) scheme will be extended to cover eight more government hospitals has raised public concern.

We have not yet understood how the pilot project launched in 2007 at Selayang Hospital and Putrajaya Hospital have progressed.

What were the highlights, drawbacks and learnings that could make the coming extension to other hospitals more practical and valuable to the public? Surely, there must have been challenges and opportunities which could help tweak this scheme or make it necessary to cancel. Without such data, it would be difficult to arrive at an informed decision.

Has comprehensive due diligence that includes the views of the public and hospital nursing and support staff been undertaken? Does the Ministry of Health have a report on how the pilot project went? Many are concerned about how this scheme would affect the delivery of medical service to the ordinary person.

Currently, 70 per cent of citizens avail the services of public hospitals. Under this scheme, specialists in government hospitals have the option to participate by providing consultations and treatment to anyone who is willing to pay full fees as is the case in our private hospitals. Has this scheme been well subscribed in the two hospitals involved in the pilot project?

Why do we have to have this comparison with private hospitals? Their ‘raison d etre’ is different and their target audience covers those who can afford, those who are well insured and those who come under the medical tourism initiative. Those with money have choices and options while those who are unable to opt for private hospitals rely solely on public hospitals.

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One of the key reasons for implementing this scheme is to curb the migration of specialist doctors from government hospitals to private hospitals, where the pay and benefits are higher.

But in attempting to tackle this challenge, the government is caught in a web of confusion. Surely this issue could be tackled differently in a more focused way. How many specialists have since resigned despite this programme?

There are better options to deal with this issue that this scheme. While we understand that the cost of medical care is increasing, is this the way a government that professes “People First, Performance Now” responds to the challenge. This is going to affect the already challenging quality of services that patients now receive at public hospitals.

Lack of clarity and focus

There seems to be a lack of clarity and focus in dealing with key issues such as the migration of medical specialists and the increasing costs of medical treatment.

The scheme confuses and distracts public hospitals from their core concern and priority of providing quality healthcare to the 70 per cent of patients who rely on public healthcare. If from this, 30 per cent is reserved for “full-paying” patients, this will be a great disservice to many Malaysians.

Has a due diligence been done on the pilot project to justify the extension of the scheme to eight more hospitals? We need statistics on the number of patients who used these services, the income generated by the hospitals under the pilot programme and the earnings of the specialist doctors who participated in the scheme.

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Without understanding these details it would only increase the confusion and lack of clarity to other public hospitals. Public hospitals are for the public; their target audience is clear. Introducing such hybrid schemes will give rise to issues of conflict of interest and ethical considerations, which need to be addressed.

Surely, the specialist doctors who benefit from this scheme will support this initiative. But what checks and balances are in place to ensure that runaway greed will not shift the focus and result in a bias towards private patients at the expense of ordinary Malaysians?

Patients opting for the scheme will have the option to choose their specialist doctors. It would only be natural for them to go for experienced specialists. Less experienced specialists will have to attend to the public and this would deprive ordinary patients of more attentive care and time from more experienced specialists.

If 30 per cent of the patients opt for the scheme, then the resources and facilities taken up by them will be at the cost of services that would have otherwise been available to all patients. While the specialist doctors will earn their keep, what about the services rendered by all the other support staff?

Are they also remunerated under the scheme? If not, would this not give rise to issues of conflict and jealously. If the specialist doctor now makes about RM15,000, he or she would now be in a position to make an additional RM45,000, drawing nearly two thirds of take-home pay from the scheme.

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The clinics, the treatment facilities and even surgery in these public hospitals will be available to “private” patients under this scheme. If the fees charged by the specialists in these public hospitals are about 20 per cent cheaper than in the present private hospitals, would this not attract more private patients to consider this option, further denying services to public healthcare patients?

It is in this context that Aliran joined several NGOs, interested citizens and political parties like Party Socialis Malaysia and Amanah to present a memorandum through Dr Jeyakumar Devaraj to the minister of health. The memorandum sought an appointment to ensure that no further extension proceeds without a thorough study of the pilot project and its results being presented to the public.

Many of the issues stated in the guidelines by the director general of health have serious implications. The issues of specialist doctors and high treatment costs have to be tackled.

After nearly eight years of the pilot project, there should be enough data to justify the continuation or otherwise of this scheme. This data should be placed in the public domain for discussion and debate.

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