The PHFS Act (1998) and Regulations (2006) – an update
IT has now been about four months since the Private Healthcare Facilities And Services (PHFS) Act 1998 And Regulations (2006) has come into force. The various open dialogues between the Health Ministry, the Federation of Private Medical Practitioners’ Association of Malaysia (FPMPAM) and other relevant stakeholders have culminated in a relatively easy registration process for private medical practitioners (see table).
For existing clinics (before May 1, 2006), registration can be made using Form A or online at http://medpcs.moh.gov.my. Duplicate copies of duly certified documents required include:
i) Annual Practising Certificate,
ii) Professional & or Specialist qualifications
iii) Assessment rate receipt
iv) A sketch plan that includes dimensions of physical structures
v) Contracts with any Managed Care Organisation if available
To facilitate the registration process, the various state private practitioners’ associations have been holding workshops with the co-operation of the relevant state health departments. The PMPASKL will be holding such a session on Sept 24 at the Sime Darby Convention Centre, Bukit Kiara, from 2-6pm. Doctors in the Klang Valley are encouraged to attend and at the same time hand in their registration forms to the State Health Officers who will be there to register them.
It is thus time to move on to facilitating compliance as seamlessly as possible with the specifications of the Regulations without causing undue interference to the delivery of patient care in the private sector. Implementation will have to be done gradually and without causing undue inconvenience and distress to the sick patient, the public and the doctor.
The Clinic Manual and Standard Operating Procedure (CMSOP)
One of the first important milestones in the process of compliance, which takes effect the moment a clinic is registered, is administrative compliance. The PHFS Act (1998) and Regulations (2006) requires that all private clinics shall have specific written policies and standard operating procedures to ensure that quality of care is maintained.
As part of our service to members in the private sector and to bridge the needs of the regulators, doctors and patients for better healthcare, the FPMPAM, in conjunction with the Health Ministry, has produced the Clinic Manual and Standard Operating Procedures (CMSOP), which was officially launched by the Health Minister on Sept 11 at the Marriot Hotel, PutraJaya.
The CMSOP will help private clinics streamline its administration almost immediately and to enable it to deliver better service to the patient while complying with the Act.
It is hoped that the CMSOP will set the bar for responsible and ethical clinic governance, and enable doctors to continue their good work in healing those in need while meeting the new provisions of PHFSA.
Among the many items in the CMSOP is a set format for Patient Grievance Mechanism and also a format for provision of Emergency Medical Care as required by law. The CMSOP can also be adapted for private dental clinics as well.
Four thousand copies will initially be distributed at cost to doctors via the individual state private practitioners associations that are members of the FPMPAM, with additional copies to be printed for distribution to all doctors.
Each book is priced at RM25, which covers the cost of its printing and production.
Safeguarding standards in private medical care
As the national medical body, the FPMPAM represents the interests of private medical practitioners in providing accessible, quality and compassionate patient care.
It is the stated objective of the FPMPAM to safeguard the foundations of ethical and responsible medicine while building on the sanctity of the patient-doctor relationship. Our motto, “Duty before Self”, is a testimony to this objective.
The FPMPAM is supportive of reforms to the nation’s healthcare system when they are aimed at improving the delivery and efficiency of healthcare services, upgrading facilities and treatment options available to patients, and enhancing the integrity of the medical profession.
As members of the medical profession and uncompromising advocates of our patients’ welfare, we acknowledge that there are inherent strengths and weaknesses in our current healthcare system, and that it has a large role to play in improving healthcare in Malaysia.
When the Private Healthcare Facilities Act and Regulations (PHFSA) was announced in May this year, the reaction of doctors all over the country ranged from anxiety to strong disapproval.
The profession is fortunate that the Ministry is sympathetic to the concerns of doctors and has the discretion to distinguish between healthcare policies that will likely succeed and policies that will likely do more harm than good.
Rather than a purist approach, the Health Ministry has welcomed input from parties affected by the new law, and has adopted a flexible and responsive approach in the implementation of the PHFSA.
While the FPMPAM has made significant strides in building consensus with the Ministry on the implementation of the Act, we are aware that there are outstanding issues that are of concern to doctors and patients in the country.
Important points to note for concerned parties are several proposals that are still under consideration by the Health Ministry, which aims to address the implications of emergency care, and the specific physical requirements for complying with the Act.
We look forward to a quick agreement with these proposals so as to provide a truly conducive social and clinical environment for doctors and their patients.
The Good Samaritan Clause
The PHCFS Act and its Regulations require that clinics provide emergency medical services to the occasional patient that is brought to the clinic. It is the position of the FPMPAM that patients in dire straits should not be turned away by the clinics.
However, it must be noted that this provision in its current form in the Regulations has too many grey areas which potentially will open the door to increased medico-legal litigation, an increase in medical indemnity insurance and eventually encourage defensive medicine. At the end of the day, it is the patient and the public that will have to carry this extra burden.
The FPMPAM has proposed a “Good Samaritan Clause”, which essentially states that, short of gross negligence or professional incompetence, doctors providing free and voluntary emergency care for such patients that are brought to the clinics should be protected from liability. This is only fair as the law is needed to protect those who need help, but also those who provide help.
General Provision (Regulations Part IX)
The Regulations also require many clinics to renovate extensively to comply with the general provisions of the Regulations.
Some of these provisions, like providing doors and passages to be 1.2m, is not possible in many clinics in view of the existing physical limitations of these buildings. Clinics that are located on the first floor of shop houses, including many dental clinics, will find this a major undertaking.
Furthermore, to renovate, many clinics will have to close for periods of time ranging from two to more than six weeks depending on the type of renovation that needs to be done. There will be considerable inconvenience to the patients and the public.
From the survey of clinics by the FPMPAM in Kuala Lumpur, Selangor, Perak, Perlis, Kedah and Penang, the estimated cost of renovation to the private sector will be in excess of RM250 million, not to mention a whole host of other intangible costs.
The FPMPAM is happy to note that the Health Minister, in his speech during the launching of the CSMOP, had mentioned that the Ministry will consider appeals on a case-by-case basis.
Conclusion
The medical profession is as old as age itself. Medicine, with its noble legacy of healing, is rich and momentous beyond comparison. The doctor’s duty is always first and foremost to his patients and the advancement of the patient’s health and welfare.
As a regulator, the Government can build safeguards, incentives and disincentives into our health care system, but the good and honest professional never needs to fear the regulator.
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Note: Dr Chang Keng Wee is honorary secretary of the Federation Of Private Medical Practitioners’ Association Of Malaysia (FPMPAM).
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