JULY 17 — There has been a lot of buzz about the integration of public and private healthcare in Malaysia, though no one has ever clearly highlighted on when this will take place, and when it does, what it will actually entail to the end-user i.e. the Malaysian public.
Eminent experts and academics have put forward some of their thoughts on this; including the creation and implementation of a national social health insurance system, among others. Many of these solutions proposed require long-term strategies to be put into place, alongside investments in delivery-driven infrastructure.
However, at the ground level, the National Cancer Society of Malaysia would like to highlight a large problem being faced by many patients, including those with cancer, due to the existential divide between the public and private healthcare systems in Malaysia today. Fixing this problem would be relatively easy, and would be taking a large step towards integrating the public-private healthcare divide in this country. In addition, it will be a tremendous boon to the patients especially those in the economically-challenged groups.
The problem the National Cancer Society of Malaysia would like to highlight is in terms of the existence of dual referral charges for specialist clinics/services at Ministry of Health Malaysia hospitals.
The Ministry of Health Malaysia website clearly details the dual charge system for referrals. Patients referred from a government centre or government doctor need to pay nothing for the first visit and RM5 for every follow-up (which includes all medication and investigations). However, when referred from a private doctor or centre, the patient needs to pay RM30 for the first visit and RM5 for subsequent visits (exclusive of any investigations done). On the surface, this seems to be a minor issue of only RM30, which many may declaim as ‘so what’s the fuss?’.
I would like to put forward one real example put forward by a patient during a patient forum just last week. The patient, a housewife, felt a lump in her breast and went to her general practitioner. He referred her for a mammogram to be done at the nearest government hospital. Because this was a private referral, she was charged not only the RM30 for the first visit but also some hundreds of ringgit for the investigations which included mammography and a subsequent biopsy. The poor lady, a Malaysian, ended up paying so much simply because her referral letter was from a private doctor!
At that same patient forum, many of our volunteers who work with patients across Malaysia put forward that one suggestion to avoid this was to revisit a government ‘klinik kesihatan’, get another referral, and then proceed to the specialist clinic for their original appointment. This is tiresome, time consuming and in some cases, has led to some patients abandoning the whole process of seeking care in the first place.
For patients who are waiting anxiously in some cases to be diagnosed and treated for severe conditions like cancer, this barrier of dual referral charges is serious and real. For people who are economically-challenged this is another additional hurdle to overcome in order to obtain healthcare. It is disappointing and sad that merely a division between the public and private systems allows for this problem to exist.
I do not even touch on the implausibility of reasoning as to why equally qualified Malaysian private doctors’ referral letters have to be treated differently from their government counterparts. In fact, many private doctors are ex-senior government doctors, even specialists and consultants. Neither do I insinuate that this is a form of ‘punishment’ for patients who dare to seek private care before turning to the government sector for help. It is also weird when you think about how counter-productive this move is in terms of decongesting the public sector’s workload, reducing the public sector ‘waiting time’ especially in the ‘klinik kesihatan’ and not leveraging on national health expertise via the trained, experienced private practitioner.
More importantly than all the factors mentioned above, I make this plea as a doctor, for my patients. All of them. As we continue complex discussions about integration of public and private healthcare, the National Cancer Society of Malaysia urges our government to take this first, real, easily-carried out step towards true integration by removing dual referral charges. This is so that all Malaysians everywhere, can receive the same quality treatment from government specialist services… at the same price.
*Dr Murallitharan M. is a public health physician and Director of the National Cancer Society Malaysia.
**This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
