The Medical Practitioners Coalition Association of Malaysia (MPCAM) has been receiving complaints from doctors regularly through our online portal which has more than 10,000 doctors as members, regarding managed care organisations (MCOs) and third party administrators (TPAs) responsible in handling the payments of consumers’ health bills from corporate bodies - where these corporate bodies have appointed MCOs and TPAs to manage the health benefits of their employees.

The most recent has been a new trend by these MCOs and TPA who are forcing doctors to pay anything between RM2,500 (as in the case of a well-known institution of higher learning) and RM5,000 one-off on appointment as a panel clinics and RM250 annually (the most recent case) in order to be appointed as a panel clinic.

These new requirements in MCOs and TPAs in the healthcare industry is utmost disturbing and we are unable to accept this ‘donation’.

The MPCAM has on numerous occasions urged the Health Ministry to streamline and regulate MCOs and TPAs under the provisions in the Private Healthcare Facilities and Services Act 1998 (PHFSA).

In fact since last year, the we have been engaging the Medical Practise Division of the Health Ministry, to firm up the drafted copy of the regulation, but to no avail.

We have about 30 TPAs currently managing the health benefits of employees, and all of them have their own set of fees and rules to be followed by doctors.

The number of TPAs keep growing, as it must be a lucrative business to manage the business of others by just managing their employee benefits.

Different procedures

To be appointed as a panel clinic, some TPAs also require a ‘registration fee’ - which can range anywhere between RM100 and RM5,000.

The consultation fees for doctors as mentioned in the PHFSA, is not adhered to and conveniently sidelined.

TPAs determine the registration procedure of a client in a clinic. Each of the 30 TPAs have their own procedure and requirements for a patient to register. Moreover, they also have different procedures for submission of claims; some even have a mandatory terminal attached to the clinic, for which doctors are forced to pay a rental fee.

How many terminals are we supposed to have, and how many rentals do we have to pay? Can you imagine 30 TPAs having 30 different terminals, and collecting rentals for this?

We have registration fees on appointment as a panel clinic, admin fees every month to be paid to the TPA, submission fees for each claim submitted, and payment fees when the payment is made to the doctor (sometimes up to three to six months later).

Public health being compromised

These irregularities have lead to the compromise of healthcare of the public who visit private general practitioners in these following ways

1. TPAs determine which health facility a consumer would be able to go to. The choice or selection of the hospital/clinic is that of the TPA. Hence, the consumer loses out on his choice of doctor his choice of hospital/clinic, and his choice as to where he would receive his treatment. This is a fundamental right of the patient and it is being compromised

2. All added fees, as mentioned above, are paid by the doctor to the TPA. The guess as to who will inevitable bear this cost is as good as yours.

3. Each of the 30 TPAs have their own regulations concerning the fee to be paid by the employer, and the fee to be paid by the doctor in the name of ‘admin fees’ - which are determined by the respective TPAs alone. As we know, fee splitting is illegal in the medical industry.

4. Some TPAs only allow a maximum medical fee that a patient is entitled to for their daily visits, whereas the charges for the day are also limited.

Some even cap the number of medications which can be prescribed in a day.

5. By controlling the number of visits, as well as limiting the charges and number of medications, justice cannot be served to the sick. TPAs should not involve themselves in the care and treatments offered by the doctor to the sick. This puts the doctor under tremendous pressure and constraints.

The Malaysian Medical Council has not made a stand if it is indeed unethical for doctors to be involved in a private independent contract with MCOs and TPAs, which involves fee splitting at all levels, since the inception of this ‘middleman’ idea in the 1990s.

With these brief accounts as to what issues the doctors are facing, the Medical Practitioners Coalition Association of Malaysia strongly urges Malaysian Medical Council to make a stand if it is unethical for a doctor to go into a private agreement with a MCO and TPA.

We are prepared to throw our agreements into the waste paper basket if it is indeed unethical.

DR RAJ KUMAR MAHARAJAH is a member of the Medical Practitioners Coalition Association of Malaysia (MPCAM).