In this day and age, healthcare is seen as an endless opportunity for profit making rather than a basic necessity. To an extent, there seems to be some truth in the saying “Medicine is a profession, but healthcare is a business.” With the rising cost of living, having good health seems to be a privilege for the wealthy—where access to outstanding facilities will require a substantial amount of money, may it be through high insurance premiums or own savings.

Doctor-patient relationship is supposed to be pure and without prejudice. But, a concern for making money has gradually moved to the heart of healthcare—the once charitable institution, whose sole purpose is to serve the community.

Even more worrisome are physicians who own the facilities that they operate. Doctors owning dialysis centres or private practices, have their own targets to achieve. Perhaps, putting patients on earlier or prolonged dialysis will be more profitable than referring them for a transplantation. In clinics, there is a need to finish up old stocks of medicine before the expiry date, or be ready to suffer losses.

Such centres will encourage doctors to promote profit-producing surgeries, tests, drugs and treatments. Medical treatments and counselling which lack profit potential will be discouraged, regardless how effective they may be.

Doctors are constantly in a dilemma over pure patient care and the business of healthcare.
Doctors are constantly in a dilemma over pure patient care and the business of healthcare.

“Today, it makes good sense to be in the largely under-regulated business of medicine rather than to be the practitioner in the over-regulated practice of medicine,” expressed Dr Steven Chow, president of the Federation of Private Medical Practitioners' Associations Malaysia (FPMPAM), who shared his views with The Malaysian Insight.

Doctor’s decisions on patient management are being questioned – not because of the effectiveness of the treatment – but, whether the treatment will generate any profit. This puts patients in a vulnerable position, as they believe that their medical care is guided solely with their best interest at heart.

On top of that, the “standard operating procedure, guarantee letters, membership cards, exclusion clauses, pre-approval before treatment, unilateral denial of payment for honest work done and the many other administrative hurdles are creating major divide between the good doctor and his patient,” pointed out Dr Chow.

Healthcare is a right, not a privilege

The World Health Organisation defines universal health coverage (UHC) as “ensuring that all people have access to needed promotive, preventive, curative and rehabilitative health services, of sufficient quality to be effective, while also ensuring that people do not suffer financial hardship when paying for these services.”

The government has a responsibility to ensure that the people have access to clean water, have a good sanitation system, proper immunisation programme, affordable healthy food and accommodation, and to manage environmental issues such as floods and pollution.

However, if a person with the utmost healthcare awareness does not have access to reasonable facilities, then his efforts are in vain. And, this is where patients need their doctor’s intervention.

“Healthcare is a basic right of the rakyat and not a commodity to be bought and sold in the normal market place. Healthcare policies and decisions must encompass the views of the doctor and their patients and not just those dressed in business suits secretly huddled around financial spreadsheets in corporate boardrooms around the country,” emphasised Dr Chow.

The Harvard School of Public Health study

The Harvard TH Chan School of Public Health conducted a study for the Ministry of Health (MOH) Malaysia and came with a report in March 2016.

“Malaysia’s health system is at a crossroads. The system has very effectively countered the health challenges it was designed to address, namely, high levels of maternal mortality, infant mortality and under-five mortality, and has achieved excellent outcomes.

“But, the health system faces new challenges in the face of a rapidly evolving context characterised by demographic and epidemiological transitions, a shifting socio-cultural environment, technological changes and rising income levels, which have contributed to a nutritional transition, increasing health risks and new user expectations.

“In effect, Malaysia demonstrates a classic case of asymmetric transition, where the rapid transitions in context have not been matched with a corresponding transition in the health system to better address the current and future needs of the population.”

“While transformative change cannot be achieved overnight, Malaysian policymakers would be wise to implement stepwise innovations which will strengthen the Malaysian health system in order to more effectively address population needs and changes in the national context.”

With this statement, there is a need for the “establishment of a Royal Commission on health and healthcare to inquire into and report upon the existing and future need for safe and quality healthcare services, and the resources to provide such services; and to recommend the necessary measures to ensure that everyone stays healthy and continues to have access to UHC, and that no one is left out,” urged former president of FPMPAM Dr Milton Lum Siew Wah, in his article, which was published on The Star.

“The voice of one doctor is stronger than what many may think. Each doctor seeing a mere 35 patients daily works up to almost a 1,000 patient-doctor encounters per month. There is easily more than 10,000 of us in the private sector. In a year, we are talking about hundreds of million, if not a billion, of one-to-one opportunities to express our concerns for our patients’ welfare and help guide public opinion,” highlighted Dr Chow. He further concluded that “2018 is the year to empower the voice of the doctor and his patient. We need not remain silent.” MIMS

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