Posted on by Kit

Businessmen using docs as proxies to open clinics

BUSINESSMEN USING DOCS AS PROXIES TO OPEN CLINICS
by FDI
Shah Alam

I read with amusement the above article which was headlined in the mainstream media stating that only doctors are allowed to open clinics. Doesn’t the MOH have better things to do? Clearly this does not bear logic.

Large private hospitals in this country with all their various specialist clinics are owned by such corporations as KPJ which are public-listed, Sime Darby, Tabung Haji, Pantai Hospitals, Sunway, Gleneagles, are all owned by businessmen. They employ or contract out services to a large number of doctors. The Raffles Medical Group in Singapore is also owned by businessmen and runs a chain of 60 medical clinics in various parts of the island.

In fact it is to the advantage of doctors that businessmen are partners/owners in these ventures as it would bring in much needed investment capital and management expertise to upgrade services and also frees the doctor to focus on what he knows best — doctoring, and leave matters pertaining to customer service, marketing, accounts, IT, billing, credit control and banking to people who are well-versed and trained in these areas, unless of course the MOH would like to see our doctors become ruthless businessmen attending share market reviews instead of medical conferences.

If this rationale was applied to other industries, then buses must be owned by bus drivers or conductors, engineering companies be owned only by engineers or Genting should not own a power plant as they are only experts in gambling and Manchester United must necessarily be owned by Bobby Charlton or Ryan Giggs and not the Glazer brothers. We might as well dismantle the KLSE.

The statement by the MOH official further states that these arrangements contravene the Private Healthcare Facilities and Services Act 1998 (PHFSA). This would mean then that the Act would directly contradict established Malaysian business rules and company regulations lending further credence that the PHFSA was a cut and paste legislation engineered by a few incompetent MOH officials and passed through an ignorant parliament oblivious to the existing laws of this country.

The official further states “..unscrupulous businessmen might get off scot-free as the law is silent on their participation in the business”. Silent? Whatever happened to collective responsibility and how is it possible that the law is silent on such important matters. Is the Medical Practices division implying that the AG’s chambers who supposedly vetted this Act were sleeping on the job?

However what was clearly inappropriate was the reporter asking the doctor for his original APC? It appears the Star’s reporters have now become quasi health ministry enforcement officers. This report appears to have been designed, with the help of a possibly bored Medical Practices division, to go on another round of GP bashing to gain some cheap publicity.

If the Medical Practices division is serious about proper pharmaceutical efficacies based on evidence-based medicine, they should immediately send in their enforcement officers to seal all the traditional sinseh shops which sell roots and herbs of questionable medicinal value which carry the risk of causing severe peptic ulcers, liver and kidney failure to the unsuspecting.

While Singapore is dismantling many of its anti-business regulations causing the Singapore Medical Association to withdraw guidelines on medical fees for fear of contravening the Competition Act, our MOH officials are on the reverse gear and seem completely unaware that the world is hurtling inexonerably towards globalization. Cooking up regulations so that you can hide under the shell of protectionism will only mean we will be left behind and may suffer a fate worse then Proton.

There are far greater issues this country’s healthcare system is facing and they are serious. The absence of discussion in the mainstream media is so glaring that one has to assume that it probably has more to do with protecting its political owners and masters rather then sticking to the thin narrow line of professional journalism.

Ambulances that don’t have petrol, the high number of dengue deaths especially in Selangor, the ministry’s uncompleted and crumbling hospitals and last week, the question of patient’s having delayed access to heart treatment causing many of them to die on the waiting list are issues that require focused attention.

Unless the MOH is rudderless, which it currently appears to be so, this is clearly no time to be petty unless of course the MOH is using issues of this nature to deflect recent criticisms of its poor services in which case it should perhaps put its house in order before trying to clean up others.

23 Replies to “Businessmen using docs as proxies to open clinics”

  1. I think it relates to clinics being run by non medical professionals. How would any of us like to be treated by someone whom you thought was a qualified registered medical Professional but is actually his wife or girlfriend or a nurse or MA/HA who is not a qualified medical practitioner?

    And sadly this is happening in Malaysia. You have unqualified persons passing off as Dentists and Doctors and actually doing harm to the patients.

    Anyway I am sure the current PHFSA will have enough bite to go after the Doctor whose practising licence was used to open the clinic.

  5. it is a noble cause that MOH actually is concerned about non-medical professionals opening medical clinics and such … but as long as there are qualified medical professionals manning the doc’s table and giving out proper prescriptions … dun really see what’s the issue with businessmen being partners or owners of such establishments …

    Of course, the problem now is that unscrupulous businessmen are employing non-qualified ppl to do the actual job because they want to make more profit or there is not enough medical doctors …

    I think the point Uncle Kit want to make here is how MOH is handling the whole issue. Instead by being clear abt the criminalities of non-qualified persons masquerading as medical practitioners, they are harping on commercial rules & regulations which totally missed the main points:

    a) Hiring non-qualified ppl as medical professionals is a serious crime. MOH and the gov should be very firm and clear on this. Non-qualified ppl acting as medical practitioners should be punished heavily as what they are doing are extremely irresponsible and dangerous to other’s life.

    b) No clear guidelines on why some medical establishments are allowed to be owned or runned by business ppl rather than medical professionals and why some must require the owners to be medical doctors … Either it’s allowed for businessmen to own or not at all … law & regulations cannot be wishy washy and vague …

    c) MOH seems to be fixated on GPs in small private clinics … what about more serious problems like the conditions of gov hospitals, the sub-standard ambulance service, not enough medical docs in public hospitals etc … where is their priority ?

  6. Talking about a centre of education excellence. Talking about achieving developed country status. You don’t need to look far to see how far are we from achieving it.

    I wonder whether our minister of education has any feeling of embarrassment or shame when he meets his counterparts of other countries.

    It is not that Malaysia universities could not be in the top. We have been there in the past. The policy maker doesn’t want it. They are willing to sacrifice Malaysia competitiveness for a particular group.

    It has been 50 years. Malaysia has suffered for 50 years due to certain policies. With the natural resources we have, we could have achieved more than what our neighbour Singapore achieved.

    It is so sad. Malaysia is a country with vast potential but under achieve. As time travel, this potential is gradually dwindling. When will they wake up?

    60000 unemployed graduates summed up the quality of the universities: low quality staffs, low quality students. Smarter undergraduates are all local-overseas universities graduates or overseas graduates.

    Since the 1980s, Singapore has been stealing all the good ones and that is why Singapore is well ahead than Malaysia in human resources. And they are now even stealing from Europe, Japan and US.

    What is the result of our investment in Biovalley or Cyberjaya? Bolehland is good only for ideas but can’t walk the talk. Vision 2020 is only a dream.

    Politicians and rich peoples here rarely send their children to local universities. They know why.

    Universities are seen as an opportunity for Umno to consolidate its political power base. As long as malays are given degrees even if they do not qualify for them, Umno rightly feels this will buy them loyalty. It is in fact Umno interest that malays remain insular insecure, narrow minded and uneducated. This makes it easier for them to control the noose.

    Paradoxically, when you have uneducated malays, political Islam too flourishes. PAS and Umno are reverse sides of the same coin. They both flourish when there is ignorance, insecurity, racism and religious bigotry.

    Malaysia public universities are not about education in its widest sense. They are political to a lesser extent PAS and breeding grounds for Umno.

    Non-malays who want quality education so that they can be trained to be intellectual and to the best of their ability have to seek alternative sources. This often means going overseas. Sadly, most talented Malaysians do not return which is a terrible waste. But does Umno care? Like hell they do!

  7. You guys have to realize that this is what happen when ‘unqualified’ people sits on top of the management.

    Just like our local universities, staff are not promoted or recruited based on merit. That’s how they destroyed it. You cry but they won’t listen and they won’t budge.

    The only way out is to let it rot while we build a new one elsewhere and keep it away from the UMOs.

    See, the sub-standard comment by the MOH is proof to what I said.

  8. Malaysia is a corrupt and racist country and that is the reason we have this malay dilemma.

    This malay dilemma exists because of one person, that is, the leader of that race. If the leader is corrupt and racist, we will have all sort of dilemmas – the Barisan dilemma, the Chinese dilemma, the Indian dilemma, the Malay dilemma, the NEP dilemma, the Proton dilemma, the Scenic Bridge dilemma, etc. The list is dilemmatic and is endless……….

    Yes, this corrupt racist is dilemmatic but yet was at the helm steering Malaysia into dilemmatic waters, that is why Bolehland is having all sorts of dilemmas in Malaysia, not only the malay dilemma!

    The definition of a system is defined as several components linked together so that when an input is applied to the system, the desired output is attained! It is up to individual to choose any one of such systems and applying it to the day to day lifestyle living.

    There are efficient systems and inefficient systems. And every system is operated by different components in the systems. If a system is to work efficiently and systematically, each of the components is to function the tasks assigned to that individual component accordingly.

    A system can work efficiently with a favorable environment, abundant natural resources and most of all intelligent human resources. The most important component of an efficient system is the human component!

    Malaysia can create the best system in the universe but if we have a corrupt and racist operator managing the Malaysia dilemmatic system, what do you expect the outputs of this corrupt and racist dilemmatic system?

    Hence the axiom, garbage in and garbage out (GIGO) as illustrated in a computer system.

    If the Malaysia quality system is to work efficiently, harmoniously, peacefully and prosperously, all the components got to link together and work diligently and efficiently. Then the Malaysia system will produce quality production!

    Now if the malay component is practicing corruption, cronyism, deviant religion, misuse of funds, judiciary, powers, and NEP, nepotism, racial discrimination, and etc etc, can anybody expect such Malaysia system to work efficiently? Can MAS, Perwaja, Proton, the government systems work efficiently?

    The mockery of the corrupt and racist Malaysia dilemmatic system is that when an input is fed into this system, there is no output from this corrupt and racist dilemmatic system, it is all devoured by the various corrupt components in the corrupt and racist system!

    As long as Malaysia is having this corrupt and racist dilemmatic system, we will have the Bolehland dilemma, the Chinese, Iban, Indian, Jakun, Kadazan, Malay, Sakai etc dilemmas, the Malaysian dilemma, and etc.

    We can see the obvious problems to the Malaysia dilemma and the solution to this dilemma is to overhaul the corrupt, inefficient, problematic and racist dilemmatic system and replace it with a clean, effective and efficient quality system.

    This implies all components in the system got to work effectively, efficiently and impartially according to nature laws – not the deviant religious laws, fancy laws, jungle laws and whim laws.

    And what are nature laws? Nature laws are the efficient application of natural resources for human benefits and needs. Not the prodigal and raping use of natural resources for personal luxuries!

    Yes, Malaysia wants qualitative production, not quantitative production!

    So, for an efficient, harmonious, peaceful and prosperous Bolehland, Malaysia must adopt the best component, the best operator and the best system.

    That is why Malaysia needs a corrupt and racist free, quality system with quality district, parliament, state councils, quality judiciary, quality leaders and quality Malaysians in order to achieve quality production!

  11. “..I read with amusement the above article which was headlined in the mainstream media stating that only doctors are allowed to open clinics. Doesn’t the MOH have better things to do? Clearly this does not bear logic. ..”

    doctors partnership with businessman can ar?

    why limit the businessman opportunity? sometime it have to be co-exist.

    ..”If this rationale was applied to other industries, then buses must be owned by bus drivers or conductors, engineering companies be owned only by engineers or Genting should not own a power plant as they are only experts in gambling and Manchester United must necessarily be owned by Bobby Charlton or Ryan Giggs and not the Glazer brothers. We might as well dismantle the KLSE…”

    doctors have no money so cannot open clinics lar? sometime doctors can be the best attending to patient but business could be something they are strong in. often i see clinics are run down, everything still manual, difficulty managing cashflow and subsequently closed down because of debt. Eventually they are back to hospitals.

    by theway, is there any racist motive behind this comment by the MOH? or some udang disebalik batu thingy? maybe i m 2 sensitive. hope i m wrong.

  12. I personally am for businessmen managing hospitals etc. Doctors are just that – doctors; often they lack the expertise to manage a hospital efficiently, causing rising costs etc. True, encouraging businessmen to participate would inevitably increase the marketisation of the medicine sector, but marketisation is not always a bad thing. The liberal market approach taken in the US and some EU countries towards education has proven successful and private hospitals often function better than public ones. The only concern would be increase in prices and quality drops (e.g. hiring unqualified staff) – but that is the point of the MoH is it not? They should be regulating business ethics in the medical sector, not preventing it.

  14. I think you are wrong here. The private healthcare and services regulations 1980 has no provisions for businessmen who are not on the medical register to open a clinic or clinics, not within the operations of a hospital. If you doubt my words, get a copy of the regulations. If you are not a doctor you can own hospitals and the otupatients clinics but you cannot open a stand alone clinic e.g a shophouse based clinic.
    As to the analogy of bus drivers, please bear in mind bus drivers are not professionals. Can you open a law firm if you are not a lawyer? Can you open an engineering counsultancy if you do not have a PE? Can you open an audit firm if you are not a registered accountant? Of course not. You cannot open such outfits and hire lawyers, architects, dentists, auditors, vets etc.

  16. I don’t buy FDI’s arguments.

    Doctors take the Hippocratic oath and abide by its ethic “Primum non nocere” (Do no harm) – businessmen’s main ethic is to make money!

    To partner a doctor and A businessman and say one complements the other (“a doctor can do what he knows best – doctoring whilst business partner takes care of “marketing, accounts, IT, billing, credit control and banking”) ignores the difficulty of drawing a line between medical ethics and business profit, and assumes that the doctor will not in his practice be influenced by his partner and his business considerations. It ignores the fact that the doctor may be beholden to defer to the business imperatives of his business partner who finances the whole set up and infrastructure of the clinic. It ignores the fact that the business partner may have more say, leverage and power in that partnership. It mentions complementarity without factoring the inherent conflict of interest. It ignores that billing, collection and credit control can be outsourced by physicians to outside accountants and other consultants. To me, (I must confess a layman and non doctor), there’s certainly all the appearances as well as potential reality of conflict of interest. For examples :-

    (a) Patients may be persuaded to undergo more expensive technical procedures that rake in the profits in borderline situations in which more conservative, less expensive options might be just as acceptable;

    (b) Worse still, take the case of (say) an “eye doctor” (opthalomogist) who knows there are certain risks in refractive surgery/laser as a remedy to cataracts and who feel that the risks of the procedure did not justify the benefits and would normally not recommend it unless with the risks and pros and cons fully explained but his business partner now tells him, “don’t tell the patients too many things, they can’t weigh the options rationally, do your best, it is a recognized procedure that you can’t be faulted, do it, it pays well RM4,000 per surgery that takes only an hour (see how many you do a day?), don’t forget I and we have obligations to service interest to banks for their loans, pay premiums to cover our liability, and most important our money – profit sharing – don’t you want more? Isn’t that the reason we partnered in the first instance?”

    (c) Many tests, procedures, and operations, which may have not yet been fully evaluated or scientifically compared with other available measures for cost effectiveness may be recommended by a physician influenced by his business partner if these are well paying!

    (d) Also pharmaceutical prescriptions marginally useful if at all may be recommended because there is a profit margin in sale. It is so much easier to prescribe antibiotics (to which bacteria rather than virus responds to treatment) for a common flu from virus if the ancillary profit motive is existing, the Hippocratic ethical reservation being assuaged by the rationalization that whilst antibiotics does not good, it does not, at the same time, inflict harm on a patient with no known allergies!

    In comparing “other industries” and arguing whether “buses must be owned by bus drivers or conductors, engineering companies be owned only by engineers or Genting should not own a power plant as they are only experts in gambling”, FDI neglects to differentiate that doctors like lawyers, engineers and accountants etc are professions that have their respective traditions, ethics and objectives – which, I must add, are very distant from the commercial objectives of profit!

    Then FDI refers to “large private hospitals in this country with all their various specialist clinics are owned by such corporations as KPJ which are public-listed, Sime Darby, Tabung Haji, Pantai Hospitals, Sunway, Gleneagles, are all owned by businessmen”.

    Here, he entirely ignores the scale of operations involved and their different roles in holistic scheme of healthcare; he ignores that physicians run their own clinics within the hospitals; obviously the costs of equipment in a hospital and costs of running it are of different scale that require participation of investors and businessmen but that does not necessarily mean that the doctors having their clinics within such a set up cannot negotiate more independence at least in whatever that happens inside the clinic.

    Even then commercial considerations would admittedly intrude – the hospital’s board of directors and shareholders – will expect the medical practitioner to make enough to pay for contributions to leasing costs of expensive equipment of the hospital and pay rental for his clinic but still the situation is not on all fours with a clinic as distinct from a hospital. Being smaller, both medical and non medical partners, run the clinic in an inextricably interdependent and indivisible manner with stark blurring of lines when it comes to medical decision of a physician being influenced by business decision.

    I won’t argue with the fact that ultimately it depends on the character and ethics of a doctor as a person. But who are we to know which doctor is good and which is not so and who will when tempted by money turn from good to bad? It is the frailty of human nature that one cannot depend on it alone to ensure that all good results will happen. Human nature needs to be buttressed by institutional checks and balance – not just in medical practice but as we all know here the practice of politics as well! Why subject a doctor to temptation or pressure from a business partner of a clinic?

    What I am saying is that conflict of interest – conflict between Hippocratic Ethics and Money – is softened and better guarded against (as distinct from entirely eliminated) by not subjecting private practitioners in clinics to additional pressures of business partners and their commercial objectives.

    It is agreed that the winds of change blow over the past few decades affecting the economic dimensions of medicine as technology and organization of medical practice have become increasingly specialized, complex, and expensive, with diagnostic and therapeutic technology now expanded at great costs, which is why hospitals require business men to invest and medical insurance becomes necessary.

    But MOH and the Private Healthcare Facilities and Services Act 1998 (PHFSA) address the private clinics (smaller than hospitals) that are supposed to play a role to help patients not requiring hospitalization and to play the complementary role of referring them to hospitals if the patient’s condition requires so. The clinics are not supposed to be hospitals so that what is applicable for hospitals (investment by businessmen) is automatically applicable for clinics, as what FDI appears to argue! I believe private clinics have separate role to complement hospitals rather than compete with them in health care and making money!

    That is why the PHFSA clearly states that “person in charge of a registered private medical clinic” shall be a registered medical practitioner as spelt out clearly in Third Schedule of the PHFSA.

    It is already law. I am sure FDI would be aware of this. If he wants public opinion to side him to amend this to include non medical businessman to co-operate a private clinic, he must come out with more persuasive arguments than that which he has, so far.

  17. Chua Soi Lek & Ismail Merican both hve nothing better to do than dabbling on such trivial matters. They are bankrupt of ideas to develop the health care system in the country, and cahsing after trivials.

  18. “Now if the malay component is practicing corruption, cronyism, deviant religion, misuse of funds, judiciary, powers, and NEP, nepotism, racial discrimination, and etc etc, can anybody expect such Malaysia system to work efficiently? Can MAS, Perwaja, Proton, the government systems work efficiently?” Fargowin

    Corruption, abuse of power, criminal breach of trust, crimes against property and against persons etc are not the ‘prerogative’ of any one race. Who was the judge who achieved notoriety for his handling of the Anwar case? Who was the person behind the Perwaja’s huge loss, who has not been brought to trial to face allegations made against him? Who was the man behind the BMF scandal not too long ago? Who were the cronies working hand in glove with UMNO? This is to name a few.

    This kind of rhetoric will not garner support nor votes for the DAP – and right now we need votes.

  20. Machap weighs heavily on my heart. Shakespeare would have lamented thus for Machap:

    “The weight of this sad time we must obey,
    Speak what we feel, not what we ought to say.”

    Democracy demands that we accept (’obey’) the verdict of the people; yet nothing can detract our sorrow for the blindness that darkened the sight of Machap-ites, who for a loaf of bread did give away their inheritance and for a fish did give away the entire seas!

    BN’s victory is hollow; for what glory is there in victory purchased with deceit and bribery. The loser laments not; the battle’s outcome was decided by a dice, not by virgin Machap’s hearts.

  21. Kementerian Kesihatan Malaysia is cooperating with the private sector not just in the country but also overseas. Financial profits as expected by the business people does not enjoy a good relationship with ethical issues faced by the medical personnel. I believe that there are hidden talents of a doctor like for example knowing how to do a great business. Not all the doctors are doctors for the right reasons. Whatever that happens in the ministry level affects their staff and this in turn affects the public. The many Ketuas inside the ministry hate to confront problems. They would rather believe in a lie and think that nothing is wrong. Or to blame everyone except the one who deserves the blame. They are very quick to dismiss or to silent those trying to tell the truth. Problems cannot be solved in a day. But they have been going on the the past 50 odd years. What have all the officers been doing ? Sitting around and gossip during office hours ?
    If everyone’s been busy rushing around and doing her work faster than fast, you can be sure there is not much quality. Quality takes time. The Ministry of Health introduces some new working ideas. However if everybody rush to do their job, they can be sure there is no quality at all. Who is the Superman who will revamp the whole Ministry and the whole system ?

  22. Although I am saddened by the Machap election resulots, it is good that DAP lost. Now is the time for DAP/PKR/PAS to work on a plan for the coming GE. Its better that BN wins easily now and rests comfortably thinking they can easily win the next GE.

    But the opposition must work on a comprehensive plan. And that includes all those present here who can help spread the message to as many friends as possible for the coming elections. It’s obvious that due to poor media coverage, DAP/PKR/PAS do not have the means to reach everyone. But we do, if we care enough about this country. And its not enough to say that you did your democratic duty by voting for opposition, but if you feel strongly enough, you need to air your views and convice as many of your friends and relatives as possible. Then if your candidate loses, you can say, you have done your duty.

    It also means convincing the older generation to vote for change, for the ultimate good of the nation and not just vote for BN out of fear.

  23. I love this phrase “If this rationale was applied to other industries, then buses must be owned by bus drivers or conductors, engineering companies be owned only by engineers….”

    Well, care to ask MOH if they hav e balls to ask e PM if he can quit his post as Finance minister because he failed his statistics paper, quit as home minster because he has no policing background n also quit being a PM because he has no management background. For someone who grad from islamic studies, he is only qualified to b an imam.

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