Public versus private on medical care

0

IN many advanced countries, staying healthy and avoiding getting sick is top priority as medical bills could be exorbitant. In some cases, the patients could even end up bankrupt.

In Malaysia, however, the people can consider themselves lucky for medical bills are cheaper compared to more advanced countries. And at government hospitals, only a minimal medical fee is charged while in some deserved cases, fees could possibly be waived.

But in recent years, medical bills charged by private clinics and hospitals in the country have increased due to various factors.

Peter Sibon posed practical questions to Malaysian Medical Association (MMA) Sarawak branch chairman Dr Soon Su Yang to seek some answers to this pertinent issue that is affecting us all.

Q: What is MMA’s view on the rising costs of medical charges, especially by private hospitals? If it is true, why?

A: MMA is, of course, concerned about the rising costs of medical care. The reasons for the rising costs are complex but I will try to summarise it.

1) An ageing population. Older people are more likely to have multiple medical conditions and require more complex and expensive treatments. This is a problem faced by all countries including Malaysia.
2) Advances in medical sciences meant that some illness and diseases that were previously incurable are now treatable. Doctors have also found new and better ways to treat common medical problems. These possibilities have put new demands on health services in both the public and private sectors.
3) With better medical care, patients can now living longer. Many of these patients require regular follow up.
4) New and better medicines are usually more expensive.
5) Doctors’ fee is governed by MMA fee schedule which has been incorporated into the Private Health Care and Facilities Act. The fee schedule has not been increased since 2002.
6) Over the years, the proportions of total medical bills due to doctors’ fee have become progressively smaller.

Q: Is there any guideline(s) on how patients would be charged, especially by private hospitals or private doctors?
A: The guidelines on charges by private doctors are governed by the Private Health Care and Facilities Act which I have mentioned.  However, there is no guideline on charges by private hospitals at the moment.

Q: It is a fact that most people prefer to go to public hospitals for treatment but because of their inefficiency/ slowness, many end up going to private hospitals. What is the reason doctors working in public sector tend to be slow but are very efficient when they are in the private. Are they not governed by the professional ethics to provide the best for all and not merely on monetary gain?
A: I am sure most patients would like to receive the best possible medical care available wherever the care is being provided.
1) The perceived the slowness in public hospitals is mainly due to the sheer number of patients needing treatment rather than inefficiency. Sarawak General Hospital has made considerable improvements in the care provided. For example, the pharmacy department is now open till late at night. The number of doctors and specialists has also increased over the years.
2) It is unfair to accuse doctors working in the public hospitals for being slow. The perceived ‘slowness’ is usually due to reasons beyond the control of doctors. For example, the long waiting list due to the sheer number of patients could cause hospitals to be congested and leading to patients waiting for scans, beds in intensive care units being fully occupied and some surgeries postponed.
3) Doctors in Malaysia are governed by the Malaysia Medical Council. An unethical behaviour may result in deregistration. Serious professional misconduct can result in criminal charges.

Q: Now there are some who alleged that there will be oversupply of medical doctors in near future. Will quality be compromised?
A: It is true that the number of medical schools have proliferated especially in recent years. There will be an oversupply of doctors in the near future. MMA has highlighted the problems many times to the government. We are seriously concerned about the quality of health care here. The sheer number of housemen in many hospitals now meant that it would be difficult to provide them with adequate experience. Many new doctors in the future will find it difficult to find meaningful employment.

Q: How far has Sarawak gone, as far as health care standard (in the content of our country and the world) is concerned?
A: The standard of health care provided is generally high, especially in Kuching. As I mentioned earlier, the numbers of doctors, especially specialists have increased tremendously.
We have very good cardiac and medical departments in Sarawak General Hospital.  The medical directorate has evolved from general internal medicine alone less than 20 years ago to one that consists of many specialties including cardiac, dermatology (skin), diabetes, nephrology (kidney), rheumatology (joints), infectious disease and haematolgy (blood disorder).
Other departments have also made considerable improvements. More specialties will be added in the coming years. Many researches are now being done at Sarawak General Hospital.
The numbers of doctors and specialists in Sibu, Miri and Bintulu have also increased especially in the past few years. Even the numbers of medical officers in the smaller district hospitals have increased.
Facilities in both the public and private hospitals have improved considerably especially in Kuching. Because of the good medical care available, we are experiencing an increase in patients from neighbouring countries seeking treatment in Sarawak.

Q: Do private hospitals give special discounts for the poor and less fortunate, especially in times of emergency?
A: Doctors in general will reduce or even waive their charges for the less well to do patients. Private hospitals may give some discount in certain circumstances.

Q: Can insurance companies be trusted to cover the medical expenses in times of need?
This question is best directed to the insurance companies. But from my experience and those of my colleagues, insurance companies usually cover in-patient treatment although pre-existing medical conditions are usually excluded.
So it is best to take up an insurance policy when you are still healthy.

Q: Is the number of medical practitioners adequate to take care of the whole state?
A: The total number of doctors in the state is still relatively low. But with the increase in number of new medical graduates, it would become sufficient before 2020.

Q: What’s your advice for the young people who wanted to become doctors?
A: Only those genuinely interested in medicine and have willingness to work hard and make sacrifices should apply to medical schools. This is especially true as the competition for jobs and training places for postgraduate studies will become a lot more intense. When choosing a medical school, try to speak to doctors who have graduated from that medical school and the medical students who are currently studying in that university. If a medical school seems extremely keen to recruit students, please analyse the reasons carefully.

Q: In your opinion, what must the public do to remain healthy?
A: The public should continue to eat healthily, exercise regularly, reduce their sugar intake and avoid smoking. Pay attention to the health advice from the Ministry of Health which is now very active in updating the public through the mass media. Always remember the golden rule: Prevention is better than cure.