Association of Third Party Medical Claims Administrators Malaysia (TPA) vice-president Paul Cheok said the Malaysian Medical Association (MMA), in asking for a 30% increase in consultation charges last month, had also proposed staggering increases in charges for specialist procedures.
TPA members, who form part of the country’s managed care organisations, provide administrative and medical claim processing services for insurance companies and more than 1,000 employers, mostly corporations.
“We are not against the approved 14.5% hike in consultation fees agreed on by the Health Ministry, but the MMA’s proposal for an increase in surgical procedures and anaesthetist fees must not be allowed. Patient volume has increased over the years, so based on the current rates, specialists are already fairly compensated,” he said.
“Specialists think private hospitals make a lot of money, but the reverse is true.”
TPA estimates that there are about 800 to 1,000 procedures listed in the 5th Edition of the MMA Fee Schedule.
Cheok said the MMA must also justify why certain procedures have been upgraded to a higher surgical fee category.
“Some procedures which were previously categorised as minor, have been pushed into the ‘major category’.
“Coupled with the new rates, this will lead to patients paying more than 200% of current charges.
“Patients should be more concerned over the proposed cost of surgical procedures instead of worrying about a rise in consultation fees,” he said, adding that often, one operation consists of multiple surgical procedures which could lead to multiple charges.
MMA president Datuk Dr NKS Tharmaseelan however said specialist procedure fees in Malaysia were still the lowest in the region.
He said doctors should not be blamed for high hospital bills as their fees only amounted to 20% of the bills.
“If hospital bills have risen, it is due to the hospitals charging higher fees for their services and other items,” he claimed.
“Many specialists in private practice can hardly make ends meet. And, they have to pay exorbitant indemnity insurance. For example, obstetricians and gynaecologist and plastic surgeons pay almost RM80,000 per annum in premiums.”
On TPA’s claim that MMA’s proposal to increase the fees for surgical procedures would lead to patients paying more than 200% than current charges, he said their calculations for the new fee rates for specialist procedures were “mere conjecture”.
“I don’t know where they are plucking the numbers from,” he said.
Medical Practitioners Coalition Association of Malaysia (MPCAM) and Malaysian Primary Care Network (MPCN) president Dr Jim Loi said the proposed rate for procedures are justified if “100% goes to the specialists”.
“The cost of items and materials have risen in tandem with the current economic state and the total cost of procedures. Specialists need to invest a lot of money,” he said.