From Dr S Mahendra Raj
The public perception of private hospitals, at least by those who have access to them, is often that of a necessary evil when ill health strikes. Yet, the Malaysian national health service is hailed as exemplary for providing universal health coverage.
Why, then, have private hospitals flourished in Malaysia? It’s because patients get to choose their doctors and don’t have to wait as long for operations, procedures or drug treatment compared with overburdened public hospitals.
The altruistic argument often used to justify the existence of private hospitals is that it frees up public hospitals for those of lesser means.
On the other hand, entrepreneurs argue that private hospitals generate revenue for the nation by serving the large numbers of medical tourists who flood private hospitals.
Clearly there is merit in sustaining the private hospital sector. The greater question is whether this sector can evolve into one that provides quality care that is accessible to a larger segment of the population or whether it will deteriorate into one that only services a small affluent elite.
The health ministry recently made a tentative suggestion for a value-based approach which essentially rewards providers based on patient outcomes, in contrast to the existing system that remunerates providers for services irrespective of outcomes.
A value-based remuneration model requires the existence of a sophisticated information system; the infrastructure for this in Malaysia is at best on the distant horizon and has not quite reached prime time status.
A compromise of sorts is remuneration based on diagnostic related groups, a system that pays private hospitals fixed amounts based on the diagnosis of the condition and one that has not surprisingly been embraced by insurers.
No sooner had the government signalled its intention to introduce this system than there was an outcry from private hospitals and specialists denouncing this.
The counter argument was that introduction of the DRG-based payment model would effectively result in private hospitals cherry picking less complex, lower-risk cases that would result in these patients migrating to and further straining already overburdened public hospitals.
The argument also runs that it could threaten the financial viability of private hospitals and reduce investment in the private healthcare sector. However, there are non-regulatory tools to help healthcare providers improve efficiency, including the value driven outcome concept.
The advantage of this concept is its pragmatic applicability on a modular basis in individual units, departments, hospitals and hospital groups. It empowers clinicians with the ability to change clinical management practices to optimise the value of healthcare based on data that is continuously fed to them.
So, can private hospitals in Malaysia be efficient, compassionate and profitable all at the same time? It must be so, as the nation can ill afford to allow the private hospital sector to collapse.
The transformation to the utopian system is unlikely to lie in broad brush regulatory measures but in tweaking several knobs in a complex grid. VDO practices should be universally implemented as should effective quality assurance measures in general.
To avoid lawsuits, victims of negligence must be reasonably compensated without instilling fear among doctors that inevitably result in the escalating practice of cost guzzling defensive medicine.
Unscrupulous healthcare providers should be weeded out by an efficient monitoring system. Naïve and idealistic as it may sound, this requires constructive, transparent and sincere engagement between all stakeholders including doctors, private hospitals, insurers and the government.
Sadly, much of the conversation so far has been confrontational with stakeholders taking polarised positions and focusing on deflecting blame. The opportunity to engage must be seized.
Dr S Mahendra Raj is a consultant gastroenterologist and an FMT reader.
The views expressed are those of the writer and do not necessarily reflect those of FMT.