Cancel the FPP scheme in public hospitals

In an appeal to the Prime Minister, the Coalition Against Health Care
Privatisation expresses astonishment and disappointment over his announcement that specialists in government hospitals would be encouraged to get
involved in private treatment to raise their incomes under the
Full-Paying Patients (FPP) scheme. It warns that the scheme will add to the specialists’ workload and reduce their involvement in treating ordinary (poorer) patients. The training of housemen and doctors would also be weakened.

We, the Coalition Against Health Care Privatisation, are astonished and disappointed to hear your announcement during the tabling of the 2008 Budget on 7 September 2007 that specialists in government hospitals would be encouraged to get involved in private treatment to raise their incomes under the Full-Paying Patients (FPP) scheme.

We agree with the government’s intention of raising the incomes of specialists because this will reduce the exodus of doctors to the private sector. But, based on our analysis and those of many other civil society groups and government specialists, the Full-Paying Patients scheme, which will encourage specialists to treat private patients in government hospitals after working hours, will have adverse implications. Among them are:

•    Treating private patients will add to the workload of the specialists who are involved in this scheme.
•    Specialists who are involved in the FPP scheme will be forced to reduce their involvement in treating ordinary patients in the general hospitals because of a lack of time or energy.
•    Efforts in training and guiding housemen and doctors undergoing training to become specialists under the tutelage of specialists would be weakened because some of these specialists would be focusing their attention on the treatment of private patients.
•     the FPP scheme will erode the incentive for government specialists to raise the performance of the units they lead because the “market” or “demand” for private treatment will only exist if the treatment in the regular clinics is always slow and unsatisfactory, thus prompting patients to seek treatment under the FPP scheme.

Because of all these facts, the involvement of specialists in taking care of ordinary patients (those who cannot afford private charges) will be reduced because of the FPP scheme. Instead, the treatment of ordinary patients will be carried out by young and inexperienced doctors. It cannot be denied that the FPP scheme will jeopardise the treatment of ordinary patients.

The Coalition has tried repeatedly to organise a dialogue with the Health Minister. We have also requested an appointment with you to tell you why we are unable to accept the FPP proposal. Unfortunately, until now, we have not been given an appointment to meet you or the Minister.

With respect, we would like to know:

•    Why was the FPP scheme announced so hastily? In July 2007, the Health Minister made an announcement that the FPP scheme would commence in August at the Putrajaya and Selayang Hospitals as a pilot project, which would be evaluated after six months. But after only one month, a decision was made to launch the scheme in all government hospitals from January 2008. Why?
•    A similar scheme, that is the Private Wings scheme, has been practised at university hospitals for four years. The Coalition understands that this scheme has given rise to difficulties and has undermined the treatment of ordinary patients. Until now, the pros and cons of the Private Wings scheme at the university hospitals have not been analysed or discussed. Why? Why is the government willing to take certain steps that could lead to a variety of adverse implications without acting cautiously?
•    Why haven’t other ideas proposed by civil society groups to stem the exodus of doctors from public hospitals been discussed? Why avoid holding a dialogue with the 82 organisations that have set up the Coalition Against Health Care Privatisation?

Malaysian people’s demands

•    Provide high quality government services for all levels of society. This objective should be regarded by the government as a noble responsibility. Government services should not be seen as just another sector that can be traded for profit.
•    Acknowledge that policies to encourage private hospitals have weakened the public hospital system and given rise to a lack of confidence among the people in the safety and quality of treatment at government hospitals.
•    Give priority to revamping the performance of government hospitals. Only 30 per cent of specialists in Malaysia still work in government hospitals whereas more than 70 per cent of patients who require hospitalisation are admitted to government hospitals. 
•    Create a Special Commission for health personnel so that they can receive better salaries. A salary scheme similar to that found in the National Heart Institute should be the basis of the new salary scheme. Other benefits should be introduced such as three months’ sabbatical leave every five years to allow government specialists the opportunity to improve their knowledge and expertise.
•    Immediately cancel the FPP scheme because the scheme will jeopardise the quality care that can be obtained by various levels of society and the lower- and average-income group.(70 per cent of Malaysian families fall within this category as they receive monthly household incomes of less than RM3,500 per month!)
•    The government should always be mindful of the fact that programmes based on free trade or free market principles will marginalise the 70 per cent of Malaysians who are not wealthy!
•    Freeze the setting up of new private hospitals because they will pinch many more specialists and experienced nurses from the public hospitals.

The Coalition would like to request an appointment for a dialogue with you on the issues raised in this memorandum. We hope the government will dialogue with civil society so that our objective of creating a just and caring society is not undermined.