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New Straits Times
a day ago
- Health
- New Straits Times
GPs: Outdated fees make practice a hard pill to swallow
KUALA LUMPUR: Outdated consultation fees and rising operational costs are squeezing general practitioners (GPs), forcing them to see more patients daily just to stay afloat. Consultation fees are regulated under Schedule 7 of the Private Healthcare Facilities and Services Regulations. The fees were last revised in 1992, before construction of the Petronas Twin Towers, and are fixed between RM10 and RM35. The government is currently studying a possible increase. Federation of Private Medical Practitioners' Associations Malaysia president Dr Shanmuganathan T.V. Ganesan said a typical clinic needed at least RM40,000 a month to operate. This covers rent, wages, utilities, maintenance, medical supplies and statutory contributions, excluding the GP owner's or doctors' salaries and loan repayments. Dr Shanmuganathan said based on a flat RM30 consultation fee per patient, and excluding revenue from medicine or additional services, a GP would need to see about 53 patients a day to break even — nearly three times the actual average. "Unfortunately, consultation fees are no longer sufficient to sustain clinic operations. "Rising costs in wages, medical consumables, digital systems and regulatory compliance, especially with new price display mandates, have compounded the financial burden," he told the New Straits Times. The Malaysian Medical Association has called for a minimum RM60 consultation fee. On Thursday, the association urged the government to expedite cabinet approval for the revised rates, warning that continued delays could threaten the survival of private clinics nationwide. On May 3, Health Minister Datuk Seri Dr Dzulkefly Ahmad indicated that revisions would be finalised within a month. Dr Shanmuganathan said many patients required time-consuming consultations, counselling and emergency care, services that are often uncompensated. Clinics are also required to stock life-saving medications, many of which have short shelf lives and go unused. Former Johor assemblyman and practising GP Dr Boo Cheng Hau said a sustainable clinic needed to see at least 15 patients a day, five to six days a week, charging RM70 to RM100 per visit, including medication. He said the public must be educated on what constitutes a fair consultation fee. "For instance, for uncomplicated cough and cold cases, the market price in my area is about RM70 to RM80, inclusive of consultation and medication." he said. "Often, doctors have to lower their consultation fees to meet market demand, as medication costs exceed the consultation fee itself." PROFITS FROM MEDICINES Dr Shanmuganathan said many clinics were not operating on conventional "profits", as current consultation fees alone cannot sustain operations. To stay afloat, clinics often rely on modest profits from medicine sales. "This is not profiteering, but a pragmatic workaround in a system that restricts doctors from transparently charging for other professional services, such as nursing care, regulatory compliance, equipment use or consumables," he said. He estimated that a clinic spending RM12,000 per month on medicine stock might generate RM15,000 to RM17,000 in revenue, leaving a slim profit margin of RM3,000 to RM5,000. Additional revenue comes from procedural fees, health screenings and medical report preparation, but these are irregular and often underpriced due to market pressure. Dr Shanmuganathan said the recent implementation of medicine price display mandates had worsened matters. The Galen Centre for Health and Social Policy previously warned that the rule could lead more consumers to request prescriptions and buy medicines at lower prices from pharmacies. Its chief executive, Azrul Mohd Khalib, said while patients had every right to do so, this trend could undermine clinics' sustainability, as consultation fees remained low. "GPs hesitate to itemise every charge — nursing, registration, equipment use — for fear of alienating patients or appearing to overcharge," he said. AN ALTERNATIVE SOLUTION Both Dr Shanmuganathan and Dr Boo said Malaysia should adopt a national health scheme to address the crisis. In the United Kingdom, the National Health Service is funded primarily through general taxation, supported by National Insurance contributions. These fund services such as GP visits, hospital care and prescriptions. In November 2023, then health minister Datuk Seri Dr Zaliha Mustafa said Malaysia was exploring a national health insurance scheme involving contributions from employees, employers and the government. However, it has yet to materialise. Dr Boo said insurance policies must also cover outpatient management and GP visits, not just hospitalisation. He urged the government to raise its health spending from four per cent of the gross domestic product to between five and 10 per cent, in line with advanced nations. Dr Shanmuganathan added that such a scheme was necessary to strengthen healthcare financing and service delivery. He also proposed revising the GP consultation fee range to between RM50 and RM100, depending on case complexity. "It is important to recognise that these fees represent payment for the doctor's professional services and should not be subject to arbitrary discrimination," he said. "Doctors with the same qualifications should be paid fairly and equitably for the same scope of work."
Focus Malaysia
2 days ago
- Health
- Focus Malaysia
Delay on GP fee review: 'Face realities on the ground,' NACCOL told
A DOCTORS' group has expressed disappointment over the government's failure to to revise private general practitioners' (GP) consultation fees as promised. 'We note with deep disappointment that the Health Minister's promise to finalise the long-overdue review of private GP consultation fees within a month has now passed without action,' said Federation of Private Medical Practitioners' Associations, Malaysia (FPMPAM) president Dr Shanmuganthan TV Ganeson. 'Private GPs have been self-funding the essential primary care system for decades. Yet we remain shackled by consultation fees that have not changed in 33 years, while regulations and compliance costs continue to rise.' Recall that Health Minister Datuk Seri Dzulkefly Ahmad told reporters on May 3 that the issue about GP consultation fees would be resolved 'within one month at the latest', adding that he had already prepared a Cabinet memorandum and circular. During Dzulkefly's May 3 press conference, the Health Minister claimed that the National Action Committee on the Cost of Living (NACCOL) had already agreed to a review of GP consultation fees. 'The Malaysian Medical Association and other GP bodies have presented a clear, evidence-based case for a fee update that ensures the sustainability of primary care clinics and the quality of care for our patients,' Dr Shanmuganathan said. 'We understand that NACCOL has raised concerns about the impact of the fee update. We want to remind NACCOL that these concerns are misplaced. 'Patients who visit GPs choose to do so for immediate, quality care—often to avoid hospital queues and costly specialist visits. They are willing to pay a fair fee for this timely service. 'Past analyses by NACCOL itself showed no significant impact on the Consumer Price Index, even with proposed fee updates as far back as 2019.' Moreover, Dr Shanmuganathan noted that third-party administrators have for too long suppressed GP consultation fees for corporate profit, while the Pharmaceutical Services Division, certain pharmacy groups, and even Pharma Corporations have lobbied to undermine the integrated GP clinic model that has served Malaysians well for over 60 years. 'The government must not hide behind a narrative that keeping GP fees artificially low somehow serves the public good,' he stressed. 'In reality, it threatens the survival of primary care—the most cost-effective part of our healthcare system—and shifts costs to patients in other ways. 'NACCOL must face these realities. It must not deny GPs the means to sustain their practices and continue serving communities effectively. 'We call on the Health Minister to honour his promise and on NACCOL to remove its obstacles and allow this long-overdue correction. Anything less is a disservice to GPs and the communities we care for daily.' ‒ June 6, 2025 Main image: The Straits Times
The Star
26-05-2025
- Health
- The Star
Private clinics get final say on fees
Stakeholders: Advisories meant to help GPs find ways to cover rising operational costs PETALING JAYA: Although some doctors' groups have proposed new service charges in retaliation against the newly enforced rule for displaying drug prices, private clinics can exercise their own autonomy in deciding their fees, says a private practitioners' group. The Federation of Private Medical Practitioners' Associations Malaysia insists that the proposals made by some of its state affiliates were made in 'good faith', adding that they were meant to help GPs cover the rising operational costs. Its president Dr Shanmuganathan Ganeson said while advisories were issued, it is not compulsory for clinics to fix prices accordingly, and clinics are able to exercise full autonomy in setting their charges. He was responding to a Malaysia Competition Commission (MyCC) statement last Friday where the commission had cautioned private medical practitioners against introducing new service-related charges, as it could infringe the Competition Act 2010. Dr Shanmuganathan revealed that medical practitioners had a dialogue with MyCC in December last year, during which a proposal for a RM20 regulatory compliance charge was considered. Consequently, he said these state affiliates were mindful of not imposing fixed charges and opted to provide indicative ranges, but the move has since backfired. 'While the meeting with MyCC was constructive, the Competition Act now flags the decision to provide an indicative range as potentially problematic. 'At this point, we are compelled to ask: what are the government's real intentions toward private GP clinics? 'From where we stand, it appears the system is simply tolerating us until something more centralised and controlled is in place. 'Our profession is for patient care and the health of the rakyat,' Dr Shanmuganathan said when contacted. 'We want a sustainable, transparent GP ecosystem that patients can continue to trust. 'If there is no future for general practitioners in Malaysia's health system, we ask for honesty. 'Let us begin to responsibly wind down our practices so that our staff, medical suppliers, and patients are not blindsided when community-based private primary care collapses,' he added. Dr Shanmuganathan said what was more disturbing was the regulatory imbalance where independent GP clinics are being scrutinised while corporate third-party administrators (TPAs) continue to suppress fees without equivalent oversight from the authorities. GP Dr Roland Victor said it is not feasible for the price of medicines prescribed by clinics to be regulated as operating expenses may vary based on location. 'A shophouse in Mont Kiara will cost much more than (one) in Hulu Selangor. 'However, GP consultation fees have remained capped at RM35 for the past 30 years. 'Hence, GPs have no choice but to mark up medicine prices to manage their overhead costs such as rental, staffing and other facilities to sustain their clinics,' he said. Dr Victor said he was not against the display of drug prices but GPs need to see consultation fees fairly revised for sustainability. He agreed that TPAs contribute to the escalation of medical costs but they are not being monitored enough, nor are they regulated by the same laws imposed on GPs and clinics. 'These companies often dictate terms and conditions to GPs on how medical charges should be imposed,' Dr Victor said.
New Straits Times
20-05-2025
- Health
- New Straits Times
Clinic bills set to soar: Doctors warn of 30pct hike under new pricing rule
PETALING JAYA: Private medical practitioners have warned that treatment charges at clinics and hospitals could rise by as much as 30 per cent due to the enforcement of a new pricing directive. The Federation of Private Medical Practitioners' Associations Malaysia (FPMPAM) said that patients would bear the brunt of the cost increase, as clinics were now required to itemise charges that were previously bundled under a single fee. Its president Dr Shanmuganathan T.V. Ganeson said that the new rule disrupted the existing billing system, in which consultation, treatment, and medication were charged together. "Clinics now have to unbundle costs, including operating expenses, which must be separately listed on the bill," said Dr Shanmuganathan. According to Utusan Malaysia, estimates suggest that patient charges could rise by between 10 and 30 per cent, depending on the type of treatment and medication. In some cases, a standard consultation may cost RM10 to RM30 more than before. On May 6, some 200 doctors gathered at Laman Perdana near Perdana Putra in Putrajaya to protest the new directive. The group assembled at 9.30am before a 10-member delegation, led by Malaysian Medical Association (MMA) representative Datuk Dr R. Thirunavukarasu, entered the Prime Minister's Office to submit a memorandum. The protesters urged the government to review Act 723 and place regulation of medical practice solely under the Private Healthcare Facilities and Services Act 1998 (Act 586), which they argued was sufficient for the sector. While protests continue, most private clinics have already begun displaying medicine prices, as required. Bundled billing remains in place at many clinics for the time being, pending a decision from the Health Ministry. Patients may begin to see higher bills as early as August if no changes are introduced during the grace period. "Once the grace period ends, clinics will be required to provide a full breakdown of all charges," Dr Shanmuganathan said. The price display requirement, gazetted on May 1, falls under the Price Control and Anti-Profiteering Act 2011 (Act 723) and is enforced by the Domestic Trade and Cost of Living Ministry. It applies to all private clinics, hospitals, and pharmacies.
Free Malaysia Today
01-05-2025
- Health
- Free Malaysia Today
Govt officers threatened clinics despite price display grace period, claims group
FPMPAM president Dr Shanmuganathan TV Ganeson called on the government to issue a gazetted directive confirming the grace period, legally binding on all enforcement personnel. PETALING JAYA : A private doctors' group claims domestic trade and cost of living ministry enforcement officers visited clinics today and threatened to issue them summonses for failing to display medicine prices. The Federation of Private Medical Practitioners' Associations Malaysia said the spot checks occurred despite the three-month grace period given by the health, and domestic trade and cost of living ministries yesterday. 'According to a Facebook post, the officers issued three-day ultimatums to the clinics they visited and warned them to comply or face legal summonses,' FPMPAM president Dr Shanmuganathan TV Ganeson said in a statement. He said the joint statement previously issued by the ministries specified a grace period, but the officers ignored this by conducting checks today. Shanmuganathan said the officers' actions 'confirm our worst fear that there is no real grace period. 'This is not policy reform, it is regulatory betrayal,' he said. He called on the government to issue a gazetted directive confirming the grace period, legally binding on all enforcement personnel. He also asked for an immediate halt to all punitive inspections until clear guidelines are released and disseminated to both clinics and ground officers. In a joint statement yesterday, health minister Dzulkefly Ahmad and domestic trade and cost of living minister Armizan Mohd Ali promised a three-month grace period of 'educational enforcement'. The medicine price display order under the Price Control and Anti-Profiteering Act 2011 came into effect today. Contravention of the order is punishable with a maximum RM50,000 fine for a person and a fine of up to RM100,000 for corporate bodies. Shanmuganathan said the federation plans to begin documenting enforcement actions and providing legal advice to clinics for 'professional survival under arbitrary power'. He reiterated its support for transparency in medicine pricing, but said such policy goals must not come at the cost of legal uncertainty, administrative bullying, and public confusion. Earlier today, an individual complained on Facebook that ministry officers visited his clinic today on Labour Day. 'Not bad, working on a public holiday. Asking for medication price and why I did not display it! 'They gave me a warning. They will be back in three days time! They will fine us if we don't display prices,' wrote the person in a post on the Malaysian Primary Care Network, a closed Facebook group. However, he did not specify if the visit was by domestic trade and cost of living ministry officers alone or with the presence of health ministry officers.
