PETALING JAYA: There have been no changes in the practices of Third-Party Administrators (TPAs) or Managed Care Organisations (MCOs) since 2015, says the Malaysian Medical Association (MMA).
MCOs and TPAs are companies appointed by corporate bodies to manage the health benefits of their employees.
Its president Dr Muruga Raj Rajathurai said despite matters being highlighted to the Health Ministry (MOH) since 2015 coupled with a series of engagements on TPAs, no remedial action has been taken.
Currently, he said there are more than 30 TPAs under the ministry’s Registry.
“For years, the practices of TPAs have gone unchecked, and there is now commercialisation of healthcare taking place right under our noses.
“The unchecked problematic TPA revenue structures and outsourcing practices can potentially undermine the quality of patient care.
“MMA's early warnings on the potential issues and malpractices since 1998 have gone unheard,” he said in a statement on Saturday (Aug 5).
Dr Muruga Raj said a number of the TPAs charge private general practitioners (GPs) clinics substantial registration fees of up to RM5,000 just to be appointed as panel clinics.
They (TPAs) also obtain revenue through the practice of fee-splitting, either by reducing GP consultation fees or claiming a portion of these fees through deduction of the final settlement. In medical practice, fee-splitting is illegal.
“Some TPAs even take a 10 to 15% deduction from the total bill, which can potentially compromise patient care.
“Some notorious TPAs delay payments to panel clinics that leave many struggling financially,” he said.
This is because private clinics rely on the payments to sustain their practice as a substantial number come under the managed care model while only a small percentage are walk-in paying patients, he added.
Dr Muruga Raj also pointed out that the absence of monitoring TPA's practice of outsourcing long-term medications (LTM) prescription to pharmacists via e-prescriptions was another grave concern.
He said this practice poses health risks to patients on long-term medication, which is not in line with the holistic care approach in the management of chronic cases especially non-communicable diseases (NCDs).
There can be potential abuse of medications and risk of complications such as end-stage renal failure from such disregard for proper health care monitoring and protocols, he pointed out.
“These malpractices have also been highlighted to the Malaysian Medical Council (MMC), calling for action to be taken against doctors in questionable contracts with TPAs.
“The MMC has assured action will be taken upon receiving valid written complaints about practitioners,” Dr Muruga Raj said.
As such, the MMA is urging the ministry, MMC and relevant bodies to urgently step in and put a stop to the unethical practices of the TPAs and strictly regulate their activities.
He added that it was vital to preserve the sanctity of the medical profession and safeguard the quality of care for the people but the ministry has so far refused to intervene in these matters.
“In a recent meeting organised by the Private Healthcare Productivity Nexus under the Malaysian Productivity Corporation, the MMA had again raised these issues.
“It is disappointing to see Bank Negara Malaysia’s (BNM) reluctance in engagement while echoing concerns over the rising costs of healthcare,” he said.
