Materia Medica Malaysiana

Debate on private wings

Having private wings in public hospitals to stop brain drain may leave the poor with inadequate healthcare, reports LOH FOON FONG.

PUBLIC hospitals all over the world have to deal with the problem of brain drain. In Malaysia, it has become more acute in recent years and to discourage doctors from leaving the civil service, private wings in Government hospitals have been opened to improve the incomes of doctors.

However, public interest groups say setting up private wings will overstretch the already limited resources in government hospitals and possibly jeopardise the health of poorer patients.

S.M. Mohamed Idris, president of the Consumers Association of Penang (CAP) says concerns regarding the set-up have been raised to the Health Ministry but they have not been addressed. For instance, there are at least 3,000 vacancies for government doctor positions. As a result of this shortage, medical officers are overworked.

There is concern that patients' healthcare may be compromised for monetary benefits with the advent of private practice in government hospitals.
“If there is an overall manpower shortage, how is the hospital going to deploy staff to the private wing and still cope with the ever increasing number of patients?” he asks.

“There is also a shortage of first-class wards in the general hospitals, so how do we accommodate the influx of private patients into the general hospitals? There is concern that the beds may be converted for the use of private wings,” he says.

In University Malaya Medical Centre (UMMC) which has public and private wings and the corporatised Institut Jantung Negara (IJN), the cost of medicines, procedures and laboratory charges has gone up. The waiting time for heart patients who are unable to afford surgery in private hospitals can be two years or more, he says.

CAP has called on the Health Ministry to scrap the system. “Introducing private practice in government hospitals has the potential to drastically change the face of the present healthcare system. The healthcare of patients should not be compromised for monetary benefits,” says Mohamed Idris.

Citizens’ Health Initiative coordinator Dr Chan Chee Khoon fears that the needs of the poor will be neglected even more under the system.

He cites the case of a janitor at Universiti Sains Malaysia who underwent colorectal cancer surgery at Penang Hospital in 2002. She earned RM500 monthly and received no hospitalisation benefits from her private sector employer. When she was discharged from her third-class ward, she was billed RM1,662 for a stapler device for re-joining her colon after surgery and RM141 in ward charges.

“Some months later, I brought this up with the hospital director, who in turn replied that this was in line with a government directive to increase cost recovery to about 20% of the operational costs of the Health Ministry’s hospitals,” he says.

As part of the Malaysian government’s corporatisation policy, government hospitals were directed to increase the rate of their cost recovery, he says. That is because patients at government hospitals contributed about 5%-10% of the hospitals’ actual operational costs. The government’s medical services were being subsidised up to 95%.

“It is clear that our under-financed public healthcare will become even less effective for the poor when more private wings are set up in government hospitals as human and material resources are re-allocated in line with the market needs rather than the desire to serve the needs of the poor,” he says.

It is predictable that private wings will soon be encouraged to service the regional health tourism market as well, he says.

“The Citizens’ Health Initiative has repeatedly voiced its concern over such developments. We are not against foreigners benefiting from our healthcare capabilities. Indeed we can take pride in this, but we are concerned when more and more of our local health resources are diverted to serving regional and national healthcare priorities as dictated by market demand, rather than on need basis,” he says.

“The proposal to introduce private wings in government hospitals is an unworthy idea which is rife with conflict of interests. It should be definitively scrapped,” he says.

A doctor who does not want to be named says setting up private wings does not guarantee that specialists will not leave the public sector.

“There are specialists who earn a lot of money from the private wing of UMMC but some of them still leave for private practice. One reason is that they have to work long hours. The specialists can only serve in the private wing after 5pm. So they serve in the public hospital during the day and continue to work at night to earn the extra income and find that they have no life,” says the doctor.

Moreover, he says, research work that is commonly carried out in teaching hospitals may be neglected when doctors do not have time or earning incentive to carry out the task, he says.

“In Singapore, this system seems to work better. The Singapore government is more successful at keeping doctors possibly because there are more direct rewards for them. The doctors are paid well.

“The best way to retain doctors in the public sector is to give them a better salary,” he says.

Although the Malaysian government subsidises more than 90% of public healthcare costs, Chan notes that it only spent 2.04% of the Gross Domestic Product (GDP) on public healthcare in 2001. The World Health Organisation recommends that national health expenditures be 4%-8% of GDP.

He urges the Health Ministry to implement the Prime Minister’s call for transparent, accountable healthcare governance, where there is open, competitive tendering to ensure cost-efficient use of public finances for healthcare, and that resources are directed to those areas which can deliver better gains in primary health care.

He adds that the fees schedule in the private sector should also be regulated to reduce the disparity in earnings between the public and private-sector doctors.

Mohamed Idris says charges for specialist and in-patient treatment at government hospitals can be raised slightly to bring in more revenue. “Those who cannot afford to pay full rates should be given discounts or in the worst case, free treatment. Patients in the second and first-class wards should pay a greater percentage of the costs of treatment.”

Raising the current charge of RM1 for outpatients at government facilities to RM5 can bring in another RM100mil which can go towards financing healthcare, he says.

At the same time, the Social Security Organisation’s (Socso) services can be extended to include medical care in general, rather than just restricting it to industrial accidents and occupational diseases. The annual profits of Socso can be transferred to the Health Ministry through hospital payments, thus easing the financial strain of the ministry, he says.

If the contributions are still insufficient, employers and employees can each contribute RM1 a month and that will yield at least an extra RM200mil a year in Socso contributions which can be used to finance medical treatment, he says.

The United Kingdom experience has shown that the private wing system is detrimental to the rights of poorer patients. In 2002, The Observer discovered that of the more than 10,000 private patients treated in Britain’s National Health Services’ hospitals, around half came from overseas and were treated in preference to local patients, who were left on waiting lists. The private patients were treated by the same NHS doctors and nurses and often slept on the same beds and used the same equipment.