2 days ago
GPs: Outdated fees make practice a hard pill to swallow
KUALA LUMPUR: Outdated consultation fees and rising operational costs are squeezing general practitioners (GPs), forcing them to see more patients daily just to stay afloat.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."
