The recent raging debate over medical consultation fees, dispensing separation (of drugs), national healthcare scheme, and third party insurance (TPA/MCO) has caused great distress to general practitioners (GPs) and now Fomema Sdn Bhd is making things worse.

Fomema was awarded a concession in 1997 by the government to implement, manage and supervise a nationwide mandatory health screening programme for all legal foreign workers in Malaysia.

The objectives of the concession was to ensure that foreign workers in the country were free of an identified list of communicable diseases and to ensure that Malaysia’s public health facilities were not burdened with unhealthy foreign workers with medical conditions or diseases that required prolonged and extensive treatment. GPs have therefore been the front liners in screening these foreign workers.

A GP under the Fomema panel is responsible for the following:

• consultation, examination;
• blood taking (blood tubes, syringes, disposables, sharp bins, gloves);
• urine collection;
• review of results;
• data entry into the Fomema website;
• certification of suitability of foreign worker;
• dealing with employers;
• notification of disease;
• dealing with inspection from Fomema personnel (printing copies of forms, filing, documentation);
• dealing with unsuitable foreign workers (appeals, more forms);
• payment of designated staff to handle Fomema matters;
• taking chest x-rays (review, reporting, accountability of accuracy).

Why is all this significant at this time?

Since Fomema’s inception in 1997, there has been no revision of fees to GPs. Recently GPs received a new and revised agreement from Fomema, subject to a registration fee of RM255 (excluding 6% GST).

With this new agreement, doctors are required to diligently examine and perform a comprehensive physical examination within a suggested period of 20 minutes per foreign worker. In this suggested timeframe, doctors are required to do the following:

• take a detailed history (most foreign workers do not speak a word of English);
• carry out a thorough examination which now includes a systemic review;
• carry out a cardiovascular review which entails heart size and murmur;
• review respiratory system;
• carry out rectal examination;
• carry out full psychiatric evaluation;
• review of anaesthetic skin patch;
• assess if limb deformity is present;
• assess hearing;
• conduct vision test;
• carry out abdominal examination;
• measure peripheral nerve size;
• assess nervous system such as power, reflexes and speech.

All this excludes taking the foreign worker’s blood and collecting a urine sample. I beg to differ that such an extensive examination will only take 20 minutes of a doctor’s time.

Furthermore, the doctor is even required to confirm if a foreign worker has cancer or epilepsy. How can one reach such a diagnosis based on the foreign worker’s history and a 20-minute examination? Making such a diagnosis which then renders the foreign worker unsuitable for employment, may expose the doctor to medical litigation.

I have not even touched on the issue of chest x-rays. Doctors have recently been forced to go digital with their x-ray machines, a directive that has incurred more expenditure on the GPs. While this move may be beneficial in the long run, it does increase a doctor’s overheads.

What also comes as a shock is that the doctor is only paid RM25 per x-ray, of which RM4 is deducted as transmission fees by a certain company. So if we have 1.2 million foreign workers being screened per year, doctors with x-ray facilities end up collectively paying RM4.8 million a year to that certain company in the form of the transmission fees of x-rays alone. This does not include the software that must be installed and which comes at the hefty price of RM5,000.

Doctors with x-ray facilities are also forced to attend a compulsory Seminar on Foreign Workers’ Medical and Chest X-ray Examination, conducted by Fomema, and for which they are charged RM215 each time. Failure to attend this seminar may cause a doctor from being removed as a Fomema panel doctor.

In a nutshell, all aspects of overheads are increased for the general practitioner in the name of ensuring quality foreign worker screening without actually increasing the stipulated doctor’s fees.

I call this the blatant bullying of GPs. It is very unfair to disregard old contracts with GPs, and push new contracts with additional SOPs and charge administration fees without any degree of transparency. The new SOPs even allow Fomema and the/or relevant authorities to visit and inspect the clinic from time to time without prior notice to conduct inspections.

Fomema claims to reserve the right to take punitive action against doctors, and may also withhold the whole or part of the payment if terms and conditions of the agreement and/or SOP are found to be have been breached.

GPs in the private healthcare sector are already regulated by the Private Healthcare Facilities and Services Act 1998 and I therefore cannot see how Fomema has the authority to regulate a medical clinic. If there is any wrongdoing by the assigned doctor, then a proper channel should be sought which is through the regulatory medical board.

I would like to express my concerns about the method of practice and the liberty by which Fomema has extended their authority on medical clinics given that they are a TPA/MCO.

If this kind of practice is not regulated, the objective would soon be lost which would then inevitably pave the way for massive greed and monopoly. We doctors are here to serve the country and protect the people from communicable diseases, but the bullying of GPs by Fomema is appalling, and we demand for transparency and fairness.

“I will prevent disease whenever I can, for prevention is preferable to cure.” Hippocratic Oath.

Dr Amutha Subramaniam is an FMT reader.

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