EXCLUSIVE: The Government is urged to intervene to keep healthcare costs reasonable.
Federation of Malaysian Consumers Association secretary-general Datuk Paul Selvaraj says that cost containment is in the Government’s hands, adding that it’s time the Government steps in.
He feels healthcare costs have reached excessive levels because medical service is market-driven.
Unlike other businesses, he argues that healthcare is an essential service and cannot be left to market forces. Echoing the Health Ministry’s proposal for private hospitals to adopt the bundle payment system, he says it will ensure transparency.
“Malaysians have been made bankrupts because they cannot pay their medical bills. It’s only fair that they know what to expect before getting treatment at a private hospital,” he says.
While he’s concerned that private hospitals are overtreating patients and conducting unnecessary tests for profit, he stresses that the ministry mustn’t compromise on patient care in its bid to slash expenditure on tests.
“We worry about overtreatment in private hospitals. But in public hospitals, it’s the reverse. Getting rid of unnecessary tests is fair but patients must get what they need. They must get adequate and proper treatment regardless of costs,” he says.
Last month, Health Ministry deputy director-general Datuk Dr Jeyaindran Sinnadurai led a group of senior consultants to find ways of optimising hospital costs.
The task, he tells Sunday Star, was to ensure whatever measures they recommended were both evidence-based and value-based. These principles would ensure the delivery of care to patients isn’t compromised.
Citing an example, he says where generic drugs are available, there’s no reason not to use them.
Studies by the World Health Organization (WHO) show that globally, up to 30% of healthcare costs can be saved by being more judicious in ordering investigations, prescribing medications, getting the diagnosis right the first time, and cutting down on utilities.
The Health Ministry, he says, has already taken steps in the direction but to further optimise the delivery of healthcare in a more cost-efficient manner. The introduction of the new test and investigation guidelines in January is a leap in that direction.
Often, too many tests were ordered, or ordered too frequently.
Sometimes, patients were treated even before some of these results come back, meaning that the test results didn’t influence the clinical decision, he says.
“We also have some doctors who tend to rely on results and not their clinical acumen.
“And at times, tests ordered by another doctor weren’t even made available to the treating doctor,” he says.
He was responding to Sunday Star’s Nov 27 exclusive on insurance premium hikes of up to 30% because of rising healthcare costs.
In 2014, the paper front-paged the over-treatment of ailments which pushed up medical bills in the country after the British Medical Journal launched a “Too Much Medicine” campaign to highlight the threat of overdiagnosis and the waste of resources on unnecessary care.
Dr Jeyaindran expects private hospitals to raise their charges by 10% to 15% next year although studies show that 30% of healthcare costs was due to wastage and unnecessary tests.
“Despite an estimated medical inflation rate of 15%, private hospitals won’t need to burden patients if they manage their costs better by having bundles like the Government.
“Patients too would benefit as bundling lets them know how much their entire treatment would cost so that they can compare charges between hospitals. Competition will lead to cheaper treatment,” he offers.
He warns private hospital operators that charging medical card holders more than cash-paying patients was against the Private Healthcare Facilities and Services Act 1998 (Act 586).
Insurers have complained of this, he says, adding that patients who have been overcharged should ask for a breakdown of the bill.
Lauding the ministry’s efforts to bring costs down, Malaysian Medical Association president Dr John Chew says any measure to reduce medical treatment costs must be supported and encouraged.
The RM1 and RM5 public hospital consultation fees don’t reflect the actual costs borne by the public taxes, he says.
Describing the country’s healthcare system as complex, he says patient choice, timeliness, accessibility and affordability of treatment, management companies’ profits, and insurance, are among the factors that must be considered when discussing emergency care, primary care, long-term care and tertiary care.
“Policyholders paying higher charges will increase their utilisation of private healthcare, thinking that the medical service is paid for by their insurers. In reality, all costs are passed on to policyholders,” he says.
What are bundled payments in healthcare?
Under a bundled payment model, providers and/or healthcare facilities are paid a single payment for all the services performed to treat a patient undergoing a specific episode of care. An “episode of care” is the care delivery process for a certain condition or care delivered within a defined period of time.
For example, if a patient undergoes surgery, payers would traditionally reimburse the hospital, surgeon, and anesthesiologist separately for their part in the treatment. Through a bundled payment model, the payer would collectively reimburse the providers involved, using a set price for the episode of care, which is usually based on historical costs.
Read more at http://www.thestar.com.my/news/nation/2016/12/11/cutting-costs-not-care/#LrlfOzpvC5YHvGVZ.99
