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.
Malaysian Society of Nephrology