Part I: Increasing frustration over FOMEMA’s new contract
FOMEMA Sdn Bhd manages a nationwide mandatory health screening programme for all legal foreign workers in Malaysia. Recently, an open letter in a news portal brought up a few points of discontent with the contract between FOMEMA and their panel doctors. MIMS Doctor spoke to Dr. Raj Kumar Maharajah, the deputy president of the Medical Practitioners Coalition Association of Malaysia (MPCAM), on his views regarding the subject.
Q: Could you briefly describe the agreement between FOMEMA and their panel clinics or healthcare practitioners.
A: FOMEMA was awarded a concession in 1997 by the government to implement, manage and supervise a nationwide mandatory health screening programme for all legal foreign workers in Malaysia. The agreement has been that employers register and pay for medical examinations to FOMEMA; doctors conduct medical examinations, collect blood and urine samples; and for clinics with X-rays, perform the imaging test; and labs conduct blood and urine tests, and relay the results online to FOMEMA. Clinics and laboratories are reimbursed by FOMEMA once the results are available; for each person examined, doctors are paid RM60 and labs are said to be paid RM65.
Q: What are your thoughts on FOMEMA’s contract?
A: FOMEMA’s newest contract dated 18th Jan 2017 received stiff resistance from GPs because it was perceived to give excessive powers to FOMEMA. First, it seemingly provided FOMEMA direct authority to meddle in the day-to-day running of a clinic and to penalize doctors found breaching the contract. It was mentioned that their enforcement teams have the right and authority to visit clinics at any time without prior notification and that they must be allowed in. Even the Ministry of Health (MOH) and Pharmacy Enforcement teams who want to visit our clinics call us to make an appointment first. They only come unannounced when it is a raid due to suspicion of malpractice. If FOMEMA believes a doctor was unethical, they should report the matter to relevant authorities and the Malaysian Medical Council instead. We are afraid this will lead to an unhealthy precedent where other third party administrators (TPAs) or managed care organizations (MCOs) will start sending enforcement teams and punishing doctors on their own. This will affect the practice of medicine. TPAs or MCOs should not be given the liberty to be judge, jury and executioner.
It is also written in the contract that if an investigation team was sent by FOMEMA, any expenses for the first visit will be borne by the company. However, any expenses incurred by consequent visits will be borne by the doctors. Our members feel all these new inclusions are very high handed, and are vulnerable to abuse and bully.
Last but not least, in 1997, the format for a medical examination was brief. In the following years, more examinations were included. However, the doctors’ fees have remained stagnant at RM60 since 1997. For a less detailed examination, an insurance company pays the GP RM90 and the governments’ health screening programme pays us RM85. We have been asking FOMEMA for a fee increase to match the reimbursements by insurance companies but to no avail.
Q: What would be a win-win situation for all parties involved?
A: We have short- and long-term problems. In the short-term, FOMEMA’s newest agreement and standard operating procedure (SOP) should be revoked. An agreement and SOP that is in line with the guidelines and regulations set by the Medical Practice Division of the MOH—which took into consideration feedback from stakeholders—should be introduced to replace the current one. In FOMEMA’s18th January contract, doctors are required to submit many documents to remain as panel doctors. We would like to suggest reducing the documents to only the annual practicing certificate and MOH’s Form B for Clinic Registration. Additionally, the mandatory annual continuing professional development (CPD) organised by FOMEMA that requires a fee of RM215 should be made optional instead because doctors have the right to attend any CPD of their choice to update their knowledge.
The many long-term problems should be addressed accordingly.
1. As mentioned earlier, the medical examination and X-ray fees should be reviewed.
2. MOH should include a clause in the new contract that no employee of FOMEMA or their families should be allowed to have a business relationship with FOMEMA. This is to prevent unnecessary expenses.
3. Getting feedback from employers, foreign workers and doctors should be established as one of FOMEMA’s Key Performance Indicator (KPI).
4. Distribution of foreign workers to clinics needs to be addressed, plus touts and agents need to be removed.
5. Strict measures to prevent private laboratories and private hospitals from conducting medical examinations for foreign workers. First, screening requires the expertise of a primary care practitioner. Second, private hospitals are classified as tertiary care centres. Thus, they are not allowed to perform the screenings required by FOMEMA, even if they have a medical officer in their emergency or outpatient departments.
Q: Do you have any advice for GPs who are considering or already working with FOMEMA?
A: My advice is to continue screening the workers as we have a duty to our country and the citizens to prevent foreigners with communicable diseases from spreading their diseases. Moreover, I would advise them to withhold from signing the new contract until we have discussed this matter with the MOH on 22nd Feb 2017.
MPCAM is a registered medical association with the Registrar of Societies. For more information on the association, refer to their Facebook page, Malaysian Primary Care Network.
Ed: Doctors have always been held in high regard in Malaysia. The clause enabling TPAs and MCOs to dictate and meddle with medical practice is sure to raise some hackles amongst the medical fraternity. We hope an amenable solution will arise from the meeting in late February.
FOMEMA has already been contacted for comments and is slated to respond after the meeting.