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Title: Doctors eyeing bundle system to cut rising medical costs
Date: 22-Jan-2017
Category: the star online

The Star Online, January 22, 2017

PETALING JAYA: Taking the Health Ministry’s lead, doctors are looking to implement the bundle system in clinics to cut medical costs.

GPs would adopt the system to ensure fair, transparent and stan­dardised charges, better care, and patient safety, Health Ministry de­­puty director-general Datuk Dr Jeyaindran Sinnadurai told Sunday Star.

He said GPs were in discussion with the ministry to charge accor­ding to the severity of the cases and time spent with the patient.

Simple, moderate and complex cases, would have different rates, he said, adding that the bundling of consultation, diagnosis and treatment, would reduce the overall medical costs.

The Malaysian Medical Asso­cia­tion (MMA) has proposed that common ailments be packaged into bundles to simplify procedures and contain the costs.

It is working with Third Party Administrators and insurance companies to standardise fees and drug prices, said MMA president Dr John Chew.

The Medical Practitioners Coali­tion Association of Malaysia (MPCAM) vice-president Dr Raj Kumar Maharajah said recent bundling simulation exercises for over 130 common cases seen in GP cli­nics had resulted in lower overall costs for nearly 80% of patient vi­sits.

If more diseases were managed at the primary care level, health care costs and insurance pre­miums would be low because it would prevent unnecessary hospital visits, he said.

Last month, Dr Jeyaindran told Sunday Star that new guidelines recommending appropriate test and investigation bundles for the “Top 10” causes of patients being admitted to public hospitals would keep costs down.

The bundle system refers to cost and care provided for a medical condition across the entire care cycle.

On Monday, the MPCAM met with the ministry to discuss increasing the role of GPs to provide home visits in emergencies and for the aged.

“We also talked about senior doctors practising from home instead of a registered clinic, rates for follow up visits, credentialling and privileging for certain procedures like circumcision,” said Dr Raj.

However, he added that the professional fee for doctors must be increased.

With rising overheads, consu­mables, medicine, medical devices, staff salaries and licensing fees, standalone GPs are struggling to stay afloat, he said, adding that many have closed down.

“Medicine prices increase every six months but GP fees haven’t increased for decades because we empathise with patients.”

In countries such as Australia and South Africa, consultation fees are between RM100 and RM250, excluding medication.

Here, consultation plus medication is RM50, he said.

Dr Chew said GP fees must be reviewed as Consumer Price Index has gone up by 40 points in the last 20 years.

Then there’s the GST which GPs can’t pass on to patients, and the rising medical liability insurance premiums.

In 2012, the Cabinet approved a 14.4% fee hike under an amendment to the 13th Schedule of the Private Healthcare Facilities and Services (Private Hospitals and Other Private Healthcare Facilities) Regulations 2006.

But, the fee revision, said Dr Raj, was for specialists, not GPs.

A GP’s fee is still based on the 1997 MMA Fee Schedule.

“Although RM25 is the maximum we can charge, GPs are only char­ging between RM10 and RM15 so as not to burden the rakyat.”

MPCAM is proposing that GPs be allowed to charge between RM30 and RM125, depending on time spent on the patient and the seve­rity of the medical problem.

“But even with higher GP fees, patients won’t have to pay more if we standardise medicine prices and implement bundling,” he said.

Dr Jeyaindran said the ministry was studying the proposed fee revision.

He, however, assured patients that they won’t have to pay more even if the fee was revised.

“What they’re asking for isn’t exorbitant.

“It’s in line with what other professionals are charging,” he said.



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