Still unclear on Covid-19 centre’s role

Health associations are also in the dark about the management of Covid-19 patients at private hospitals

by NUR HANANI AZMAN / pic by ARIF KARTONO

THE health services fraternity is still uncertain about the mechanism of the Covid-19 assessment centre, a government project that is expected to begin operations soon.

Health associations contacted by The Malaysian Reserve (TMR) are also in the dark about the management of Covid-19 patients at private hospitals, which is also included in the proposal.

Galen Centre for Health and Social Policy CEO Azrul Mohd Khalib said it is not about strictly nationalising private healthcare per se, but it is much about the weight and serious intent of the government to fully utilise the resources of private healthcare in the current public health emergency, which has manifested itself through an Emergency Ordinance.

Azrul said dealing with infectious diseases has been a traditional role shouldered by the public healthcare system, with private hospitals having to refer patients with ailments like tuberculosis to government hospitals.

“As a result, there is arguably a dearth of relevant expertise in the private healthcare space which could treat incoming patients. The healthcare workforce needs immediate and up-to-date training.

“The number of intensive care unit beds in public healthcare is far more than those in private hospitals. The gain in this area would be an additional couple of thousand beds, definitely needed but not as many as are needed,” he told TMR.

Health DG Tan Sri Dr Noor Hisham Abdullah recently announced in his daily Covid-19 briefing that the Health Ministry (MoH) had decided to establish a Covid-19 Assessment Centre that will categorise patients by symptom severity in a bid to take some strain off the country’s public healthcare system.

He said Covid-19 patients will be placed according to their risk of becoming severely or critically ill.

“We are looking into coordinating the public and the private sector through a Covid-19 Assessment Centre. All cases will be assessed in the centre, and as I said, once they have been assessed, whether, for example, low-risk groups and young-patients, (they) can be actually monitored at home,” Dr Noor Hisham added.

Azrul said many doctors in the private healthcare system are of advanced age and are actually in the group of people considered vulnerable and at risk of complications due to Covid-19 infection.

He said if there are incidences of failure in the safety and containment protocols at these facilities, fatigue or human error, it might also increase the risk of mortality among healthcare workers, especially the more senior doctors.

Since the private healthcare providers are also expected to be part of the overall Covid-19 treatment system, Azrul said the billing system and expenses of the treatment should also be made clear.

Azrul said it is possible that the government would impose a standard fee per diagnosed Covid-19 patient which is adjusted according to their stage of disease.

“The issue of medical liability appears to be open regarding the effect or cost of dealing with the outbreak to the hospitals under their existing insurance. The issue of personal insurance at the moment seems to be limited to covering only screening tests.

“There is no indication of treatment yet. Are patients expected to pay out-of-pocket for treatment at a private hospital if the government decides not to pay?” he said.

So far, the stakeholders and health service providers including Galen Centre for Health and Social Policy, Malaysian Medical Association (MMA) and Malaysian Public Health Physicians Association (MPHPA) told TMR that no engagement with the government has been established on the proposal.

However, Azrul said some of the details of the plan have been made known. Among others, private hospitals must manage Covid-19 cases that have been diagnosed in their facilities.

Azrul said based on recent protocols, the treatment would likely also include patients diagnosed as being in Stages 3-5, depending on the private medical centres’ capacity and capability.

“Private hospitals will probably need to prepare for the possibility that their beds, facilities and manpower could be utilised to offload or take on some of the patient load that is currently being shouldered primarily by the public health sector,” he said.

Meanwhile, MMA president Prof Datuk Dr Subramaniam Muniandy said he will wait for more details from the MoH before making further comments.

“Nevertheless, the government must engage stakeholders on this. Views from the rakyat must also be taken into consideration,” he told TMR.

On the other hand MPHPA president Datuk Dr Zainal Ariffin Omar said setting up of the centres is a very good proposal, especially if the plan involves major stakeholders.

“This was one of the elements under the Health System Reforms proposed a few years ago by many players in our health system.

“Hopefully, the government will be serious about it and take advantage of the current situation to make it happen,” he told TMR.