A prelude to 1Care?
There has recently been a spate of publicity about Separation of Dispensing and a letter to the NST suggests all this may be a prelude to a “Healthcare Transformation” or what was previously termed 1Care.
AMONG the medical fraternity there has been some anxiety regarding the medicine dispensing separation, a long debated topic, now said to be parked at the Attorney General’s office in Putrajaya pending being passed in Parliament sometime this year.
The pharmacists have long been fighting that the dispensing be solely their prerogative as they “know more about medicines” than doctors.
Everyone wants to be a doctor these days. Look at your neighbourhood barber, he dons a doctors’ apron. We have a car clinic, shoe clinic, Math clinic, Dr Cardin (shoe specialist), and Dr Cermin (windscreen specialist). All are doctors and specialists in their own field.
Malaysia has a unique primary healthcare service. For over a century now, the general practitioner, has been the gate keeper, seeing people with complaints before diagnosing and medicating them or sending them off to a secondary or tertiary centre for further treatment.
The public has been very comfortable with this arrangement where they can visit their family doctor anytime, without an appointment for a consultation and collect their medicines at the same centre without the hassle of looking for a pharmacy.
This system is unique to Malaysia and Malaysian culture and hardly practised in other parts of the world. It has made Malaysia one of the top 3 countries, with the most affordable and accessible primary healthcare service in the world.
However, all this is said to change in the future with the introduction of the Pharmacy Bill and Health Transformation Bill which are expected to be tabled soon.
The doctors and pharmacists will benefit from this new bill. The pharmacists will now concentrate on dispensing and selling medicines instead of toothpastes , toothbrushes and other toiletries and doctors will concentrate on consultation, treatment and prescribing medicines.
From the doctors’ perspective, our over heads will reduce. We will just need one assistant or clerk at any one time. We will work from 9am to 5pm like other office workers. Patients see us by appointments. We get our holidays and family time. We will be rewarded handsomely, from RM50 to RM150 for each consultation unlike the meagre RM10 now.
We don’t need to stock medicines in our clinics and watch for their expiry dates and losses due to this. Enforcement will stop coming and harassing us to see if our medicines are stored in accordance with the rules, and whether we are keeping our records up to date.
We will be paid a capitation fee, (fees or payment of a uniformed amount charged per person) from which dues will be subtracted each time the client visits us. The more you visit your doctor, the more will be subtracted from the capitation. This is to discourage you from visiting your doctor and for your doctor to keep the population he is in charge of, healthy at all time.
The rakyat will also see some changes. Some say short changed. Each family will have to contribute to an insurance scheme called the National Health Financing Scheme. Each time you visit your clinic, you just flash your insurance card.
You will have to choose 2 clinics to register yourself, one at your work place and the other at your place of residence. You will be with the same doctor the whole year until you re-register the following year.
For example, in a populace of 10,000 in an area with 10 clinics. Each clinic will get 1,000 patients. The 1,001th patient will have to register at the next clinic. Your insurance card will only be accepted in the clinic where you and your family have registered. You have to make an appointment to see your doctor. You will have to collect your medicines from the nearest pharmacy after seeing your doctor. If you wish to see another doctor during the course of your treatment, you will have to pay for it.
In countries like the United Kingdom, United States of America, Australia and others where the Health Transformation has taken place, the cost of primary health care has escalated. In India and Indonesia, the general practitioner, also known as the family doctor is almost extinct. The understanding is simple. More middle men, more money involved. Will the change be good or bad for Malaysia?
Executive Council Member
Malaysian Practitioners Coaliation Association of Malaysia (MPCAM)