Watch on errant hospitals

Star: PETALING JAYA: Private hospitals will be monitored to ensure that they do not put patients through unnecessary procedures just because they have medical insurance, said Health Ministry director-general Tan Sri Dr Ismail Merican.
“The ministry will continuously direct private hospitals, managed care organisations (MCO), insurance companies and other interested parties to ensure that the cost of healthcare is reasonable, detailed and transparent.
“This will help patients make informed decisions on getting treatment as they will be more aware of the charges that will be incurred,” he said in a statement here yesterday.
He said the ministry would also look at ways to address the discrepancies between charges for self-paying patients and those with insurance policies as this problem had also contributed to overall healthcare costs.
He said the problem was also compounded by some private hospitals being pressured by their shareholders to charge more to fulfil their key performance index.
His statement came following a meeting last Friday with the Association of Private Hospitals Malaysia, Malaysian Medical Asso­ciation, Malaysian Medical Council, hospital chief executive officers, private hospital and MCO representatives, insurance companies and several healthcare professional groups and independent professionals.
“The purpose of the meeting was to explore ways of curbing increasing private healthcare costs,” said Dr Ismail, adding that several points were agreed upon, including making insurance policy holders aware of the medical coverage they were entitled to.
Hospitals, he said, must also inform patients about all professional and potential charges before they were admitted or treated.
He said it was also agreed that MCOs must not interfere with the clinical judgment management of patients by medical practitioners, including by general medical practitioners.

D-G: Private hospitals must report all irregularities

Star: PETALING JAYA: All private healthcare facilities are required, beginning Jan 1, to report incidents that jeopardised patients’ safety to the Health director-general.
These could be cases such as unexplained deaths, brain injuries during a hospital stay, fire causing deaths, assault or battery of patients and haemodialysis patients detected with Hepatitis B or C, Health director-general Tan Sri Dr Ismail Merican said.
“These incidents and deaths will be evaluated by special committees to ensure that lessons are learnt and disseminated in order to prevent a recurrence,” said Dr Ismail, who is also the Patient Safety Council of Malaysia chairman.
Under the Private Healthcare Facilities and Services Act, individual offenders can be fined up to RM10,000 or RM30,000 for a corporation and/or jail for not more than three months, he said yesterday.
He added that he had issued a directive to all private healthcare facilities and services following a national briefing conducted by the Medical Practices Division and Medical Care Quality Section on Dec 17. A document that outlines the processes necessary for patients’ safety titled “Achieving Excellence in Clinical Governance” was launched at the council’s meeting on Tuesday.
It would be distributed to healthcare facilities for implementation.
“The council would monitor the implementation progress on a regular basis,” he said, adding that senior management in hospitals should continue talking to front-line staff on patient safety while he and his team would conduct surprise visits to inculcate a safety culture.
The Patient Safety Council will announce the Patient Safety Goals and Targets that need to be achieved by all healthcare facilities in Malaysia in the near future, he said.
“These goals will cover key safety issues such as medication safety, safe surgery, clinical governance, infection control, prevention of falls, blood transfusion safety, clinical incident reporting, clinical care bundles, patient safety research, patient safety projects; all of which are expected to make the patient care experience a safer one,” he said.
Dr Ismail also said that initiatives to ensure medication safety must be targeted at all levels of the healthcare system since drug therapy or pharmacotherapy was the main form of treatment.

Liow: More docs need to treat obesity

Star: BANTING: The Health Ministry wants 50 new nutritionists to be roped in every year to overcome the shortage of food specialists in government clinics, Minister Datuk Seri Liow Tiong Lai said.
He added that there were only 283 nutritionists registered with the ministry although there were 800 clinics available nationwide. The ministry, he said. aimed to achieve a ratio of one nutritionist to every 10,000 people.
“Our country is deprived of nutritionists, and this may cause an increase in obesity cases in the country,” Liow told reporters after handing over 25 food hampers to a government clinic here yesterday.
Asked on the ideal number of nutritionists that should be employed in government clinics, Liow said his ministry wanted at least 5,000 of them to be employed over the next few years.
“Previously, doctors would advise patients on their diet plans. But now, we want a specialised department for nutritionists to combat obesity,” said Liow, who himself is a food science and nutrition graduate.
He said three local universities provided nutrition training courses and expressed hope that they could produce more qualified nutritionists.
He also said the country had the most cases of obesity compared to its Asian neighbours.
However, he said number of children under the age of five with ideal body weight had increased since 1999.
“In 1999, there were only 79.1% of children under the age of five who had the right body weight, but the percentage has increased to 93.2% in 2009,” he added.
Liow also advised new mothers to breastfeed their babies at least during the first four months, adding that mothers should ensure that their infants received proper nutrition.
“Awareness campaigns will be held to highlight the importance of breast-feeding,” he added.
Liow said that in 1990, 16 out of 1,000 infants born had died because they were not breast-fed, but the number had dropped to six in 2008.

Miri folk can get medicine posted to them

Star: MIRI: A home-delivery service for medicine — the first of its kind in the state — has been launched here.
Initiated by the Health Ministry, patients registered with the Miri Hospital will be able to ask for their medicine to be delivered to their home address using Pos 1Malaysia service at RM6 per delivery.
Miri Divisional Health and Medical Services director Dr Faizul Mansor said the service would eventually be extended to other towns in the state.
“Under the system, anyone who goes for medical check-ups in the Miri Hospital and gets registered as a patient and is treated by a doctor, will qualify for the service.
“When he is at the hospital, he is eligible to get one month’s medicine supply from the pharmacy after his treatment. After that, he can ask the hospital for the home-delivery service,” Dr Faizul explained.
He said the medicine can be delivered to patients for two months.
He added that there were several strict conditions including that the medicine be delivered directly to the patient concerned, and not through a third party; the address of the patient must have a government-recognised postcode; and the medicine must be in tablet form.
“Liquid medicine and powdered medicine will not be delivered in this manner,” said Dr Faizul.
He pointed out that the Miri Hospital was the nucleus hospital for the northern region of Sarawak, serving some 400,000 patients in Sarawak’s northern districts of Miri, Niah, part of Bintulu, Marudi, Limbang and Lawas.
Energy, Green Technology and Water Minister Datuk Seri Peter Chin, who launched the service, said: “This service is a big step forward in improving healthcare in Sarawak.
“Patients living far away from Miri have to spend a lot of money just to come to Miri Hospital to get their medicine. Now that this new service is in place, it will help them save travelling expenditure.”
Chin also said riverine folk living along the Baram River would soon be able to get medical treatment and health checks from mobile clinics.
He said the new and innovative services were part of the community-transformation programme initiated by Prime Minister Datuk Seri Mohd Najib Tun Razak to help improve the quality of life of people living in the far reaches of the state.
Starting next year, the Health Ministry will deploy boats equipped with proper treatment facilities and trained medical staff on the Baram River so that people living in riverine settlements can board them for health checks and medical attention.

Associations lament severe shortage of medical frontliners

Star: PETALING JAYA: Paramedics are the frontliners in the medical services industry but a severe shortage of those qualified in this field is affecting the lives of the people in emergency cases, particularly road accidents.
There have been cases where hospitals could only send out ambulances with just a driver and a junior nurse, thus depriving victims of the crucial medical aid before they reach the hospitals.
Malaysian Medical Association (MMA) president Dr David Quek said:
“Trained paramedics should be in the medical team because they are the frontliners. Unfortunately, the lack of paramedics has made the situation less than ideal for patients in cases of emergencies.”
He said there had been cases where lives could have been saved if they had been given pre-admission medical attention before reaching the hospital.
“Paramedics are needed to perform timely and life-saving emergency medical aid to the seriously wounded while they are being sent to the hospital,” he told The Star.
He said the acute shortage of trained and qualified paramedics to provide on-the-spot treatment to stabilise patients could make a difference between life and death.

St John Ambulance Malaysia (SJAM) commander-in-chief Da­­tuk Dr Low Bin Tick concurred, saying paramedics were difficult to come by.
He said based on SJAM estimates, there were only 50 qualified paramedics in the country.
Expressing concern over the startling figure, he called on the Government to train more paramedics to overcome the shortage.
“The problem arose because of the lack of career opportunities for paramedics to pursue the specialisation full-time and the low salary,” said Dr Low.
He added that there was no clear-cut career path for paramedics.

Malaysian Red Crescent Selangor branch training director S. Rama­nuja Muniandy agreed with Dr Low, adding that paramedics needed the support of the authorities in terms of career advancement.
“Paramedics would usually be employed at emergency units of hospitals and are not sent out on the field,” he said.
Ramanuja said there were many first-aiders or lay-rescuers but not qualified paramedics in the country.
“We give a lot of on-the-job, first-aid and emergency training to employees in factories and ambulance drivers in the private sector.
“However, they are not pursuing it full-time.
“A highly-trained paramedic would need to undergo at least three years of certified intensive training in these areas and be able to give efficient on-the-spot emergency treatment,” he said.
Ramanuja said Malaysia was still lagging behind Western countries like Canada and Britain in terms of giving emergency rescue and medical response to victims of a disaster.
“In Canada, paramedics have a degree in pre-hospital care,” he said.
He said ambulance services would normally focus on transporting patients to a hospital instead of giving them the crucial on-the-spot medical attention.
“The authorities should look into this matter very seriously to prevent unnecessary loss of lives,” he said.

Ministries order five-year moratorium on medical courses

Star: PETALING JAYA: The Government will impose a five-year moratorium on medical programmes as an immediate measure to prevent the glut in housemen from becoming worse.
The moratorium will prohibit the launch of new medical programmes in the country. Existing medical schools will be encouraged to focus more on quality.
It is hoped that this would put the brakes on the rise in the number of housemen.
The move – a joint effort between the Higher Education and Health Ministries – is similar to a moratorium in July which stopped the establishment of new nursing colleges and prohibited the launch of diploma programmes in nursing.
“It should stop more higher education institutions from offering new medical programmes,” Higher Education Minister Datuk Seri Mohamed Khaled Nordin said.
“We will be able to meet the national target to have a doctor to population ratio of 1:600 by 2015 and 1:400 by 2020 with the present capacity,” he told The Star.
Mohamed Khaled was referring to existing medical programmes in Malaysia’s 10 public universities; 12 local private providers; foreign medical schools; as well as students who were studying at about 50 accredited foreign universities.
The 1:400 ratio has been achieved by many Organisation of Economic Co-operation and Development member nations and is often regarded as the benchmark for a developed nation.
Mohamed Khaled said the ministries would examine the effects of the impending moratorium from time to time as private medical schools were bringing in foreign students and this could not be disrupted.
Both ministries, he said, had always worked closely to ensure quality at medical schools.
This was done through regular joint meetings to resolve issues related to healthcare, accreditation panels, professional development activities and the sharing of hospitals and support staff, among others.
He added that his ministry was committed to ensuring the quality of medical graduates and local medical schools had to possess the “appropriate resources”, such as healthy operating budgets; good infrastructure; competent and experienced medical lecturers; and a commitment to student welfare.
On Nov 27, The Star highlighted concerns about a glut on the number of housemen and the quality of fresh medical graduates.
Subsequently, Health Minister Datuk Seri Liow Tiong Lai told the Dewan Rakyat on Dec 6 about plans for the moratorium.

Delist poor quality med schools

Star: PETALING JAYA: The Malaysian Medical Association wants the Government to stop issuing licences to new medical schools and de-recognise existing ones which are of poor quality.
Its president Dr David Quek said stringent quality mechanisms should also be imposed on existing schools to ensure students are not short-changed.
“If medical schools do not have sufficient teachers or cannot offer adequate patient contact time, their student numbers should be reduced,” he said in an e-mail interview.
Recently, The Star reported that a high number of medical students graduating each year had crowded limited resources resulting in many housemen not having enough patients for adequate training with supervisors being overworked.
Sources also voiced concern that many graduates from lesser-known medical schools did not have adequate core knowledge to treat patients.
Dr Quek urged the Health Ministry to act quickly by sending “weak” new graduates for re-training.
In his blog on MMA News December 2010, he said there were 31,000 doctors and housemen and the Ministry wanted to reduce the doctor-population ratio by achieving 85,000 doctors for a projected 35 million population by 2020.
“This goal of trying to achieve so many doctors in so short a time is happening way too fast and too soon,” he said, adding that the issue was not about doctors wanting to protect their ‘turf’, rather their concern over patient safety.
While there were complaints of a glut in some hospitals, in rural hospitals in Sabah, housemen were complaining of being overworked.
A houseman, who declined to be named, said rural hospitals suffered from a severe lack of doctors and housemen had to work round the clock to care for patients.
“We have to be ‘on-call’ continuously for a whole week and go without sleep on some nights,” he said in an e-mail.
A mother of a houseman based at Hospital Universiti Kebangsaan Malaysia in Cheras also complained that her daughter’s feet had swelled after having to stand for long hours every day.
Acknowledging that there was a severe shortage of doctors in certain hospitals, Dr Quek said the Health Ministry should work out a better distribution mechanism to overcome the problem.