MSN Press Statement on Dialysis Centre standards

In response to St John’s Ambulance concern about their existing dialysis centres (see Dialysis Outrage), the Malaysian Society of Nephrology has come up with an official Press Statement

THE Malaysian Society of Nephrology has been following the issues highlighted by the media regarding the licensing of dialysis centres and the lowering standards of certain NGO centres.

As a professional body whose main objective is to develop the field of kidney medicine in the country, the Malaysian Society of Nephrology would like to reiterate its support for the Health Ministry’s stand to insist that all haemodialysis centres should have the minimal standards before being licensed.

The minimal standards that were used by the ministry in licensing haemodialysis centres are not new as they were developed in 1994. Higher standards are now being used in developed countries.

The society had recently assisted the ministry in updating the new standards for haemodialysis treatment while the Malaysian Society of Quality in Health (MSQH), a national accreditation organisation, is developing standards for the credentialing of haemodialysis centres. This clearly shows that we should not be talking about lowering the old and existing standards but to strive for higher standards.

It is important that minimal standards are maintained to ensure that safe and effective haemodialysis treatment is provided to all patients. Failure to do so may result in a higher risk of death, high risk of healthcare associated infections (especially HIV, hepatitis C and hepatitis B) and higher dialysis associated complications.

It is essential that the standards and quality of medical care, including haemodialysis, should progress along with the country. We cannot have a first class nation with third class medical care.

Malaysians would not board a bus driven by an untrained driver and yet are we prepared to undergo complex medical procedures that are performed by untrained personnel? This is even more critical in haemodialysis as patients are now more elderly, more complex and have more medical conditions.

Since the ministry started licensing haemodialysis centres, the standards of care in these centres have gradually improved and are becoming increasingly safer. Quality haemodialysis centres are being licensed including NGO centres. It is vital that we continue to ensure that all haemodialysis centres achieve minimal standards with safe and effective treatment.

There should be no difference between the standards of care in government, private and NGO centres, as every Malaysian deserves safe and quality haemodialysis treatment.

The standards and criteria that are required to be fulfilled when applying for a licence are available in the public domain. Hence it is rather difficult to comprehend the centres that are still being planned or constructed without fulfilling the minimal standards. This would be understandable 20-30 years ago where the majority of Malaysians had no access to dialysis therapy.

Fortunately, with the help from all quarters especially the NGOs, the number of patients initiating dialysis has increased from three per million population in 1980 to 160 per million population in 2010 with 22,932 patients on maintenance dialysis at the end of 2010. 28% of these patients (6,492 patients) received haemodialysis in NGO centres.

If one is to assume that each haemodialysis machine can provide treatment to five patients, then based on the National Renal Registry Report 2010, on average, existing NGO centres were operating at only 60% of their capacity and a total of 4,228 new patients can theoretically start treatment in these centres.

The success and growth of dialysis in this country would not be possible without the support of Malaysians and the ministry, which introduced the RM50 subsidy for every haemodialysis treatment performed in NGO centres.

Patients who would otherwise be paying RM110 per treatment in NGO centres are now paying only RM60 (except NKF centres which charge RM50). Malaysia has also successfully brought down the cost of haemodialysis treatment to one of the lowest in the region and private stand-alone haemodialysis centres charge only RM120-150 per treatment while haemodialysis units in private hospitals normally charge around RM200.

I hope and appeal to all quarters and all Malaysians to work together with a single aim to improve the standard and quality of medical care in this country as we move towards 2020.

President
Malaysian Society of Nephrology

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10 comments on “MSN Press Statement on Dialysis Centre standards
  1. lazyman says:

    whats the moral of the story?
    loads of irrelevant information not addressing the real issue!!!
    MOH says st john ambulance dialysis centre fail to comply or fell foul of the requirements of the PHFSA law
    st johns ambulance spokesman said they may need to close those centres becos of PHFSA.
    simple question-has the society inspected the premises or does the society thinks that PHFSA is harsh on those voluntary organisation?

  2. Poor doctor says:

    It boils down to money or profit margin factor. One of the significant cost is payment to a doctor or nephrologist who cover the particular centre. Money has to come from some where!

  3. huajern says:

    If money is an issue, then concentrate on improving existing centres rather than opening up new non-compliant ones.

  4. Poor doctor says:

    Demand is so big that existing centers are not enough to Cater the needs. So it is either less centers with good quality but expensive fee or more centers with moderate quality with moderate fee. Either ways, poor patients are the one going to be affected.

  5. huajern says:

    As per the MSN statement, only 60% of NGO HD capacities are utilized. In other words, there are more dialysis slots than patients.
    I know there are certain places which are still badly underserved due to maldistribution of centres, with patients suffering from a lack of options. But I can assure you Selangor is well serviced in terms of dialysis slots – NGO & private.
    It makes one wonder why certain parties are still hellbent in opening centres there.
    Oh by the way, the standards prescribed are the MINIMUM requirements from 1994. If a centre can’t comply, it is not “moderate” in quality, it is poor.

  6. huajern says:

    I may look at certain NGO centres with more compassion if they only took in those who can’t pay or can only pay minimally. But if one is taking in JPA, BaitulMal, SOCSO sponsored patients who are paying the full fee, are you really a charity organization?

  7. lazyman says:

    charitable organisations are also allowed to treat full fee paying patients.money earned may be use to subsidise less fortunate customers.we may be sceptical or wary about organisations masquerading as charitable body making obscene profits etc.-thats a subject for another day!!
    the dialysis centres still provide a service to the community.why do we have to make insinuating/condescending remarks about a private organisation charitable or otherwise running a profitable business and yet unreservedly accept the profit motivated private hospitals?
    i m never against hospitals or any medical enterprises making money -let market forces decide the quantum of profit and and the number of private centres etc.competition will benefit consumers and the more medical and dialysis centres the better for consumers.

  8. huajern says:

    Lazyman: a charity centre wants full-paying patients, requests for grants, receives donated dialysis machines & cash donations, accepts govt subsidies for NGOs. Don’t you think it should follow the standards and requirements of HD centers then?

  9. lazyman says:

    huajern
    pardon my ignorance
    1 you reckon that all dialysis centre not complying with the PHFSA should cease operation?
    2 charitable organisations receiving subsidies from the state or public donations should turn away full fee paying patients?these neighbourhood institutions are design exclusively for the less fortunate segment of the community and anyone with the means to pay must be treated in private hospitals?
    i agree with you completely that charitable organisations should not be profit driven or motivated however that does not preclude them from providing service to those self paying customers.the monies earned is also a source of income for the operation of those centres

  10. huajern says:

    Lazyman, I apologise for not making myself understood. I will try to answer your questions.
    1) Functioning dialysis centres which do not comply with PHFSA despite years of advice AND who put their patients at risk should be closed down. This however can only be done when there are alternative dialysis services available to take over the patients.
    – Centres must be given time to comply with the PHFSA requirements. Do you think 2 years is enough?
    – PHFSA regulations which impact on patient safety directly must be followed. Eg isolation of hepatitis B & C patients, proper preparation of dialysate, proper maintenance of water supply, trained staff.
    – new centres should not be opened until PHFSA regulations are met.

    2) A charity centre can take in full-paying patients. Though I have reservations, there is no law against it, and some good reasons too.
    Charity dialysis centres cannot be exempted from PHFSA as these are minimum standards required for patient safety. These centres are given special dispensations due to their non-profit nature. Eg tax exemption, grants, donated funds and equipment, subsidies etc. Therefore lack of financial ability cannot be used as an excuse not to comply with PHFSA.