The HEALTH | November-December . 2024

Insights from the MMA forum on reforming doctor remunerations for a sustainable future

BY KHIRTINI K KUMARAN

RECENT medical forum in Kuching addressed the historical context of remunerations for doctors , their impact on healthcare delivery , and the urgent need for timely revisions to ensure a level playing field for doctors across Malaysia .

The forum , hosted by the Malaysian Medical Association ( MMA ), was titled ‘ Fee Schedule : Reforming Doctor ’ s Remunerations for a Sustainable Healthcare ’.

Through insightful discussions and interactive audience participation , the forum highlighted the pressing challenges faced by medical practitioners and the importance of reform for the sustainability of the healthcare system .

The event was part of the National MMA Convention & Scientific Congress 2024 and the 64th MMA Annual General Meeting , bringing together key stakeholders to address the complexities of the Doctors ’ Fee Schedule and the pressing need for its reform .

HISTORICAL CONTEXT

Opening the discussion , the Ministry of Health ’ s ( MoH ) Medical Practice Division Head , Dr Mohamed Iqbal Hamzah , clarified the concept of a ‘ fee schedule ’.

“ The fee schedule is to look into the proper , the right payment to be paid by the patient to the doctors . Every profession has a standard fee .”

The impetus for regulating medical fees began in 2005 when the then Health Minister mandated the establishment of a fee structure for medical practitioners . This regulation aimed to create a standardised payment system , ensuring fairness for both doctors and patients .

MMA Honorary General Secretary Dr Vasu Pillai Letchumanan provided a historical overview of the fee schedules : “ When we first released the fee schedule in 1997 , it was for reference . It is not compulsory to follow that , but it was a guideline for doctors .”

He elaborated that subsequent editions , particularly the fourth edition known as the 13th fee schedule for specialists , were incorporated into the Medical Act in 2010 . However , significant delays in updating the 7th fee schedule for general practitioners ( GPs ) have left many in the field feeling undervalued .

“ The GP fee schedule has been pending for review and deregulation for years ,” he noted , highlighting the MMA ’ s advocacy for deregulation that was announced but not implemented after a change in government in 2020 .

IMPACT ON GENERAL PRACTITIONERS

Representing GPs , MMA President-elect Datuk Dr Thirunavukarasu Rajoo stated : “ The biggest victim of this entire inefficiency in the system of fee scheduling is the GPs .”

He pointed out that the consultation fees , which were last gazetted in 2006 , were based on rates established back in 1992 , ranging from RM10 to RM35 .

“ This means there ’ s a lapse of 32 years ,” he noted , urging the government to recognise the importance of GPs in the healthcare system .

“ If they want to enhance primary care , they need to invest in the existing infrastructure of 11,000 GPs ,” he insisted , emphasising that rising costs necessitate a re-evaluation of fee structures to promote preventive care .

FEE SCHEDULING

Representing the Society of Private Medical Practitioners Sarawak , Dr Liew Shan Fap reinforced the critical nature of a structured fee schedule : “ Medical healthcare is a profession , not an industry . The fee schedule ensures fair healthcare access .”

He warned that without a transparent fee structure , the potential for overcharging could lead to underservice in private healthcare , pushing patients towards government facilities .

“ If fees are too low , it leads to underservice as doctors may seek alternatives due to lack of incentive ,” he cautioned , advocating for a balanced approach that would allow for fair compensation while maintaining accessible healthcare .

MMA President Dato ’ Dr Kalwinder Singh Khaira echoed these sentiments , asserting that the MMA represents a significant number of doctors who feel disadvantaged compared to other professions .

“ Doctors are supposed to be righteous people and do service , but they also have to earn a living .” He highlighted the need for harmonisation between the 7th and 13th fee schedules , calling it a ‘ low-lying fruit ’ that could be quickly addressed .

“ There must be a system in place for regular reviews every three to five years ,” he suggested , emphasising the need to avoid long gaps that leave the fee structure stagnant .

THIRD-PARTY ADMINISTRATORS

The discussion also touched on the role of third-party administrators ( TPAs ) in the fee scheduling system .

Specialist representative Dr Gunalan Palari pointed out that while a consistent fee schedule ensures uniformity across the country , it can also lag behind advancements in medical procedures .

“ The last fee schedule we had with a 14.4 per cent increment was in 2013 ,” he said , highlighting that the procedures listed were all from 2006 to 2008 .

There were only new procedures listed once the exercise was completed in 2021 when about 1,500 new procedures were added .

“ But by the time we gazetted these new procedures in 2025 , we will have fallen behind again .”

He called for a more dynamic approach that allows for the incorporation of new technologies and procedures into the fee schedule . Association of Private Hospitals of Malaysia ( APHM ) President Datuk Dr Kuljit Singh highlighted the complications that arise when rigid fee schedules bind doctors .

“ If the fee schedule is too low , doctors may not want to perform certain procedures ,” he warned .

This rigidity can often result in patients being referred elsewhere for necessary care , which ultimately hampers the quality of care provided within the private sector .

“ In a litigious environment , if a procedure is not in the fee schedule and a doctor charges differently , it can lead to legal issues ,” he explained , underscoring the need for an updated fee structure that reflects current medical practices .

As the forum concluded , a clear consensus emerged regarding the urgent need for reform in Malaysia ’ s medical fee scheduling .

The MMA looks forward to facilitating further discussions , aiming to address these critical issues within Malaysia ’ s healthcare landscape and ensuring that doctors can provide high-quality care while receiving fair compensation for their services . – The HEALTH