The Malaysian Medical Association (MMA) has urged the Health Ministry and the Malaysian Medical Council (MMC) to address ethical issues raised regarding the involvement of third-party administrators (TPA) in the healthcare industry.

Dr Ravindran R. Naidu, MMA president, stressed that the growth of TPAs could potentially worsen the pressing issue of patient confidentiality that has affected the healthcare industry for 22 years. The TPAs discussed are organisations allotted to manage medical bill payments by corporations.

The subject of restrictions imposed on doctors by TPAs was also discussed – as there is currently a lack of regulations detailing the extent of hold TPAs have on doctors.

Monopolistic conditions could follow

Dr Ravindran said in a statement recently, “Huge amount of patient data is captured by TPAs on a daily basis. Does this comply with the Personal Data Protection Act?” He also noted that some government-linked companies (GLCs) have invested in TPAs, and the market share of TPAs have gone up from 1.5% in 1997 to 10% in 2014.

He warned that this collaboration could eventually lead to monopolistic conditions if unchecked, as pharmaceutical distribution companies own some TPAs.

“The Harvard group engaged by the Health Ministry mooted the idea of Voluntary Health Insurance to the Health Ministry, and if it takes off, it may become the ‘Mother of all TPAs’,” he added.

“The MMC and the Health Ministry cannot dismiss these grievances as a private contract or trade issue between GPs and TPAs as it involves ethical issues for the registered medical practitioners while providing the services to the patients.”

TPAs restricting doctors’ prescriptions

Other issues pertaining to the TPAs which were highlighted by the MMA are such as delayed payments to clinics, minimal consultation fees paid to medical professionals, denial of patients’ right to choose their clinics and medication, charging various fees to general practitioners and even taking a certain cut from invoices issued by clinicians.

Dr Ravindran said, “There are 7,000 GP clinics in the country and the time has come for the Health Ministry and the MMC not only to listen to their grouses but to take action. If the issues raised by GPs in the past 22 years are not addressed promptly, the end losers will be the patients.”

Some TPAs even imposed rules regarding which medications doctors could and could not prescribe. “Without regulations, the law cannot touch them. So if they come and tell me that I cannot give this medication, what happens then? I’m restricted in my treatment for the patient. I’m not free to prescribe medicine which I believe should be given to the patient,” Dr Ravindran was quoted when speaking to Free Malaysia Today.

He added, “At the end of the day, the doctor must be given the right to decide what medication should be prescribed because doctors should know best. That is the biggest problem here.”

Most TPAs were only concerned about the business aspect of healthcare, unlike doctors. This, in turn, would frequently lead to a compromise in patients’ care, he explained.

Dr Ravindran stated, “For us, the patient is the most important. You must think of the patient. For example, if I’m treating a patient who requires medicine A, and they say: ‘No you can’t give this medication, you have to give some other choices’, then I’m not doing what is best for the patient. It’s a massive compromise.”

With TPAs asserting fixed prices on patients’ fees, he said that there was no fair market due to increased costs for either doctors or patients. For example, he said that for consultation fees, the fees are fixed whether you see a patient for 30 minutes or an hour. MIMS

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