THE government’s decision to raise the upper consultation fee cap for private general practitioners (GP) to RM80 while maintaining the outdated lower cap of RM10 is concerning and raises questions about its potential impact on the sustainability of private primary care services in Malaysia.
For over three decades, private GPs have operated under an outdated Schedule 7 fee structure that does not reflect rising inflation, regulatory compliance costs, staff wages or medical indemnity premiums. The newly revised range also remains below the rates in Schedule 13, which has had a ceiling of RM125 since December 2013.
This decision – made despite repeated representations to the Health Ministry, Parliamentary Select Committees and even direct memoranda to the prime minister – shows that economic modelling has overtaken practical healthcare realities.
While the government may have acted on advice from health economists seeking to preserve affordability by maintaining a low floor price, this logic fails completely in a third-party administrator (TPA)-dominated market.
The RM10 “floor” immediately becomes a corporate anchor for reimbursement, handing managed care organisations (MCO) and TPA a ready-made tool to suppress fees and dictate terms – undercutting consultation time, continuity and patient safety.
The Federation of Private Medical Practitioners Associations, Malaysia (FPMPAM) urges the government to immediately revisit and rectify this decision by:
0 Synchronising Schedule 7 fees with Schedule 13, which itself was last reviewed 12 years ago.
0 Prohibiting TPA and MCO from pegging reimbursement rates to the statutory minimum.
0 Aligning community GP fees with Schedule 13 to remove the two- tier disparity between clinics and hospitals.
FPMPAM will take the following steps:
0 Call for deregulation of all consultation fees.
0 Advise GP to unbundle charges in line with transparent costing.
0 Advise medical practitioners to continue rejecting any TPA instructions or guarantee letters (GL) that restrict or compromise patient care.
0 Publish, based on verifiable evidence, a list of TPA with contracts that contravene the Private Healthcare Facilities and Services Act 1998 or Malaysian Medical Council Code of professional conduct.
0 Launch a national campaign for change.
FPMPAM will remain open to working with TPA that respect professional autonomy, transparency and the law. However, any GL that compromises clinical judgement, limits treatment options or endangers patient care will continue to be unacceptable.
There may be political implications if the government continues to prioritise the interests of TPA over the sustainability of primary care. Should this trend persist, the impact will be felt by patients – through clinic closures, longer waiting times and fewer treatment options – and public accountability will inevitably follow.
A government that loses the trust of doctors and patients will also lose the moral legitimacy to speak for healthcare reform.
The government must decide whether it stands with patients and doctors or with corporate intermediaries who profit from their suffering.
Dr Shanmuganathan Ganeson
President
FPMPAM