8/3/2019 Regulating Malaysia's Healthcare

1/6

A s h e alth ca re in du stries co ntin u e to gro w , co u ntrie s re q uirep ro pe r reg u la to ry fra m ew o rks in o rd er to co m pe te fo r a size -a ble p iece o f th e p ie a n d M a laysia is n o d iffe re n t. S e cre ta ry o fthe A sia n S ocie ty for Q uality in H ealth care . C A S Q U A ) a ndm e m b e r of th e P a tie nt S afety C ou n cil o f M a laysia, D a to ' D r.R avind ra n Jeg a sothy g uid es u s th rou g h w hat reg u la te sM rllr: lvc;; ;i ;) ', hP,A Ithr~ " '0 C\lC+OVYI Dh""V'I f"'J,.,: u .........A- .L_

8/3/2019 Regulating Malaysia's Healthcare

2/6

M alaysia has built a complex butcomprehensive healthcare regu-latory system that keeps a tab onevery tier of healthcare-related services inthe country, from medical institutions tothe primary end-user - the patient. AsMalaysia's stature inthe global healthcaretravel industry continues to grow, moreeyes are on the country's standards ofpractice and the framework that regulatesits practices.

Of course, such a framework has beenin place for a long time - way beforehealth care travel became a thriving indus-try. Over the years, there's been a naturalprogression to improve the local health-care scene with the introduction of govern-mental bodies, non-governmental bodiesand private establishments to steer it tothe right path. The result is a healthcareframework that can never be more com-plete than it is today.

'''A rose by any other name still smellsas sweet'. Shakespeare's words ring truefor all the various bodies involved," says

dran Jegosothy. "They all have theirspheres of influence and work well withone another. I think as far as patient safetyis concerned, the more the merrier asmuch work needs to be done."G O O D G O V E R N A N C EInMalaysia, the Ministry of Health (MOH) isdirectly responsible for the healthcare regu-latory system, with some help from severalgovernment bodies such as the MalaysianMedical Council (MMC), Malaysia MedicalAssociation (MMA) and Association of Pri-vate Hospitals of Malaysia (APHM). In2003and 2009, the system saw the establish-ment ofthe Patient Safety Council OfMalaysia (PSCOM) and the MalaysianHealthcare Travel Council (MHTC) respec-tively. These bodies engendered fromMalaysia's burgeoning private healthcarefacilities. Today, Malaysia has a comprehen-sive two-tiered healthcare system that con-sists of government-run entities and aprivate healthcare system.The Malaysian Medical Council puts theMedical Act 1971 into action by ensuringthe highest standards of medical ethics,education and practice, in the interests ofpatients, the public and the profession."The MMC possesses the regulatory au-thority over healthcare providers. On a re-lated note, the Council has developed anumber of guidelines to cover areas of rap-idly evolving practice such as stem celltherapy, assisted reproduction and doctors'relationships with commercial enterprises.This is commendable," says Dato' Ravin-dran.The Malaysian Medical Association servesas the voice and arbiter for medicine andfor medical professionals. This governmen-

Data' Dr. Ravindran Jegasothy, Secretaryof the Asian Society for Quality in Health-caretal body organizes educational events, pro-motes social, cultural and charitable initia-tions in the industry as well as encouragesbusiness, trade, joint venture and othercommercial openings for the association."Both the MMC and the MMA have beenactive in advocating ethical practice inMalaysia. The MMAwields considerable in-fluence on the public and the profession ineducating them about the requirements ofethical medical practice," explains Dato'Ravindran.The Association of Private Hospitals ofMalaysia's role includes guidance, promo-tions and representinq private institutionson the formation, operation and manage-ment of healthcare-related staff, patients,institutions, pharmacies, and facil ities. It isalso responsible for ensuring that patients'

8/3/2019 Regulating Malaysia's Healthcare

3/6

in terests are served and are able to con-tin ue to re ce iv e e ffe ctiv e, sa fe a nd a pp ro -priate treatm ent at all tim es. O ne ofA PHM 's p rio ritie s is to e nc ou ra ge in te r-h os pita l c oo pe ra tio n a s w ell a s c oo pe ra -tion be tw een priv ate ho sp itals and o therh e al th ca re p ro v id e rs .

P art o f A PHM 's p ortfo lio is t o e du ca tethe p ub lic on th e av ailable h ealthcare serv -i ce s, p ro du ce h ea lt hc ar e- re la te d p ub li ca -tion s as w ell as to org an ize m edica ltre atm en ts w ith in a nd o utsid e M ala ysia ." Pro fe ss io na l b od ie s lik e t h e MMA a ndA PHM pla ya m ajor ro le in ed ucatin g d oc-tors an d th e p ub lic th rou gh th eir an nu alc on fe re nc es a nd semin ar s," sa ys D ato 'Ravindran.T he M ala ys ia H ea lt hc ar eT ra ve l C o un cil,one of the new est governm ental bodies, isthe p rim ary a gen cy in ch arg e of prom otinga nd d ev elo pin g th e lo ca l h ea lth ca re tra ve lin du stry . A ll e ye s w ill b e o n its C hie f E xe cu -tive O fficer, D ato ' O oi Sa y C huan , an d h isteam to w ork w ith ind ustry p laye rs to fo r-m ulate strateg ic plan s for p ro mo ting andc oo rd in at in g h ea lt hc ar e t ra ve l s er vi ce s f orh ea lth ca re p ro vid er s a nd r ela te d s ta ke -h old ers. M H TC is also tasked to b ind thes yn erg is tic e ffo rts o f p ro min en t p la ye rs inthe lo cal health care travel ind ustry , b oth inthe go vernm ent a nd in t he private sector,to galvanize and to drive grow th in the in-dustry.

"T he g ov ern men t is comm itted toh ealthcare travel. It sh ou ld no t on ly belooked upon as only a revenue earner but am eans o f im prov in g m ed ical sta nd ards inthis co un try . O nly w hen th e stand ard s areassured w ould a tourist com e in f or m ed-ic al tre atm en t," D ato ' R av in dr an s ta te s.

P A T IE N T P R IO R I T YT he P atie nt S afe ty C ou nc il o f M ala ys ia(P SCOM ) w as bo rn un der the directive ofthe M alay sian C ab inet and , as the nam es ug ge sts , it is re sp on sib le fo r le ad in g th ena tio na l effo rt to im pro ve patien t safety b yraisin g th e aw aren ess of p atient safety is-sue s w hile en ab lin g, em pow ering and m o-tiv atin g th e s ta ke ho ld er s a bo ut th eirrig hts. H elm ed by Tan S ri D ato ' Se ri D r.H aji M oh am ad Isma il M eric an , th e D ire c-to r-G en era l o f t he M in is try o f H ea lthM a la ys ia , th e C ou nc il a ls o a dv ise s th eMOH on the situ ation o f p rev entab le ad -verse events as w ell as m easures taken toov erco me the m, in an effo rt to p ro mo tesystem ic im pro vem ents in the safety an dq ua li ty o f h ea lth ca re i n Ma la ys ia .

In 2009, w ith p atient sa fety in m in d, th eMa la ys ia n Me di ca ti on E rr or R ep or ti ng S ys -tem w as in tro du ced by the M edic ationS a fe ty Te chn ic al Adv is or y Commi tt ee

L IST O FTHE W OR LD HEA LTHO RG AN ISA TIO N'S W O R LD A LLIA N CE O N13 PA TIEN T SA FE TY PR O G R A M A R E A SAc ti on Area 1: (G lo ba l P at ie nt S af et y Ch al le ng e) 2005 -2006: C lean C are Is Safer C are 2007-2008: Safe Surgery Saves Lives 20 09 -2 01 0: T ack lin g A ntim icrob ial R esistan ceA ction A rea 2: Patients For Patient SafetyA ction A rea 3: R esearch For Patient SafetyA ctio n A rea 4: T axo no my - In terna tio na l P atien t S afety C lassificationA ction A rea 5: R eporting A nd L earningA ction A rea 6: Solutions For Patient SafetyAction Area 7: H igh 5sA ction A rea 8: T echnology For Patient SafetyA ctio n A rea 9: K no wled ge M an age men tA ctio n A re a 1 0: E lim in atin g C en tr al L in e-a ss oc ia te d B lo od str ea m In fe ctio nsAc ti on Area ll: E du cation F or Sa fer C areA ctio n A rea 12 : S afety P rizeA ctio n A re a 1 3: M ed ic al C he ck lis t

"Hospitals have beenrefused accreditatlonb ecause their cante_-",_:7;:'are not u p tosays D~tol

c alle d u po n th e p artic ip atio n o f a ll h ea lth -c are p ro vid er s, w he th er p ub lic o r p riv ate .T his year, th e C oun cil h as m ade p atientsafety a perm an ent ag end a in all he alth-c are -re la te d s em in ars , c on fe re nc es a ndm ee tin gs , in clu din g m an ag em en t m ee t-ings, and has m ade the use of hand disin-

v isito rs. A s p art o f th e co mm itm en t to-w ar ds p atie nt s afe ty , M ala ys ia is a s tro ngs up po rte r o f t he W o rld H ea lth O rg an iz a-t io n's (WHO}Wor ld A lli an ce f or P at ie ntS afety and w as also o ne of its e arliest sig-natories."PSC OM has m em bers from the public

I ...

8/3/2019 Regulating Malaysia's Healthcare

4/6

.. t ted byPSCOMand there hasbeen.n1la ..b l'I'increasingfocus on patientalso ee . di tt: .... th:ehospital accre Ita Ion pro-Sill,ety ItI

'IsharesDato' Ravindran.gramme, ,.

A G C ~ E D I T I N GE X C E L L E N C E .O n e maJot"aspectthat draws potential. kehQldersto selected healthcare~ta No rnatter if i .proviclet5isaccreditation. ~ m~tter I It ISloca1or,jf,lternational, accreditation servesnot enlY.asa . standard setting mechanismut alsoallows healthcare providers to irn-pf,OJI,eam:!cElntinueo be assessedon serv-icesaswell as'good practices' byindependent agencies, according to pre-establlishedstandards. In Malaysia, manyhospitalsare accredited by two major,agencies.-Joint Commission International(Jell onthe international front andMalaysianSociety for Quality in HealthMS@H),10(:;ally."Ihoey have a choice, patients should

ly go to accredited hospitals. An accred-ed hospital means that a non-partisanctor has inspected the work processesd patient safety issuesby putting himself

inthe shoesof a patient. If he feels safe,ly then will he recommend the accredita-on. Hospitals have been refused accredita-

The Joint Commission International isan international affiliated accreditationagency established in :1993by the JointCommission (United States of America) inresponse to growing demands for inter-national accreditation standards. Today,JCIstands asthe benchmark and the pri-mary healthcare-related stamp of ap-proval for international hospitals andclinics.The standards are developed andaccreditation titles are meted out by apanel of international healthcare experts.The 300odd Jet-approved facilities, serv-icesand special programmes to publicand private healthcare providers acrossthe globe put it asthe leader and mostrecognized agency in healthcare qualityand patient care.Sofar, Malaysian private facilities,

namely, International Specialist EyeCen-tre, National Heart Institute (Institut Jan-tung Negara), Pantai Hospital KualaLumpur, PenangAdventist Hospital,PrinceCourt Medical Centre and SimeDarby Medical Centre SubangJaya Sdn.Bhd. arepart of that l ist.The Malaysian Society for Quality inHealth isan independent, non-profit or-ganization that promotes safety and con-tinuous quality improvement inMalaysia's healthcare facilities and serv-icesthrough a voluntary accreditationprogramme. It also develops, reviews, ad-vises and consults on healthcare stan-dards to the industry and professionalbodies. Established in :1997through initia-tives of the MOH, APHM and MAA, theagency hasaccredited 8:1hospitals andclinics inthe country asof 2009, withmore facilit ies onthe keep-in-view list ornotfarfrom reaching accredited status."The Jel isaccredited bythe Interna-

tional Society of Quality in Healthcare(ISQUA) and 50 isMSQH. Not many knowthis but Jel and MSQHareon par witheach other," reveals Dato' Ravindran.The regulatory framework in

Malaysia's healthcare system hastakenmany years to build and eventhough thestructures work like clockwork, there isroom for improvement asa recent intro-duction of new programmes and govern-mental bodies haveshown. As it is,theregulatory system hasdone wonders toput Malaysia onthe map of the globalhealthcare industry. "We may be brandedasa third-world country by some but theWHO acknowledges that we are first-world in many aspects of healthcare. Lastyear, ISQUA organized its first ever Re-gional Conference outside Europe andNorth America here in Malaysia togetherwith the Asian Society for Quality inHealthcare (ASQUA) and APHM. This was

Oneof the key goals of the MOH ismaking. the Malaysian healthcaresystem safer and part of thisinitia-five isthe Quality Assurance Pro-gramme (QAP). Launched in 1985,QAP evaluates the quality of serv-icesprovided in a planned and sys-tematic manner and consists of twocomponents: Quality Managementfor the overall management functionthat develops and executes the poli-cies for quality, and Quality Control,the technical arm that deals withtechniques and activities to maintainperformance quality. Under the QAPbanner, the MOH intends to internal-ize and institutionalize quality in thehealthcare system, first, by strenqth-ening structure and mechanism forquality improvement, followed by theintegration of quality Improvementeffort, building quality culture aswell as p ro rn e t i n q strong leadershipand commitment.Efforts to ensure quality and

safety among healthcare providersinclude occupational safety andhealth, enhancing incidence report-ing and learning systems,heighten-ing control on infections and lastly,to shift towards people-centred care,which involves improving manage-ment of complaints, customer satis-faction surveys, soft skills andcorporate culture ..Such efforts aremonitored by external auditing agen-cies suchasthe International Stan-dardization Organization and arerecognized by the World Health Or-ganization (WHO) as Malaysia hasbeen the WHO Collaboration Centrefor Quality Improvement for the

8/3/2019 Regulating Malaysia's Healthcare

5/6

Surpassing Standards in Accred itationIn m an y w ay s , h e a lth c a re is a b o u t g o in g b e y o n d e n s u rin gth a t h o s p ita ls h a v e th e n e c e s s a ry a c c re d ita tio n s . C ha n Li J inta lk s to D a to ' D r. 1 < . K u la v c e ra s in q a m , P re s id e n t o f th e A sia nS o c ie ty o f Q u a lity In H e a lth c a re (A S Q U A ) a n d C h a irm a n o fH ea lth T o u ris m in th e A ss o c ia tio n o f P riv a te H os p ita lsM ala y s ia (A P H M ), a n d fin d s o u t th a t it is s till th e h e a lth -c a re p ro fe s s io n a ls w ho u ltim a te ly m ak e th e d iffe re n c e .Inan exclusive interview with HealthcareMalaysia, Dato' Dr. K.Kulaveerasingamexplains how excellence in health carestandards does not just mean acquiring thelatest medical devices, gaining local and in-ternational hospital accreditations or offer-ing the widest range of treatments.

Equally important are skills, certificationand attitudes of healthcare professionals in-cluding doctors, nurses and the hospitalmanagement. The team's responsibility ex-tends beyond caring for the patient while atthe hospital and after discharge, to provid-ing public education programmes for pre-ventive health, making availablepsycho-social support services and ensuringethical practices.

Inevery aspect, the key considerationsare always quality and safety, not only forthe patient, and his/her caregivers but alsothe healthcare providers themselves.HM: Apart from a medical degree, whatother criteria do doctors in Malaysia needto fulfi ll before they can practice? 1 5 thissimilar with global standards or do wehave further criteria specific to Malaysia?Dr. Kulaveerasingam: Medical doctorsmust have a medical degree that is recog-nized by the Malaysian Medical Council(MMC), which governs medical practice na-tionwide. Alldoctors must serve at govern-ment hospitals for at least three years inorderto get the necessary practical skil ls.Doctors who profess to be specialists mustbe recognized and registered with the Acad-emy of Medicine under the auspices of theMalaysian Ministry of Health and the Na-tional Specialists Register.

In many ways, our regulations for doc-tors and hospitals are more stringent thandeveloped countries because the MalaysianSociety for Quality in Health (MSQH) rnoni-+ ........ ~ 'A/irlar crAno nf h a: :: :. It hr :l rt : o t h: :: li n t h, :: :.

minor details such as whether the hospitalentrances are suitably located and whetherthe wheelchair facilities are sufficient. Thereare also regulations looking into the welfareof doctors and hospital staff to maintainhigh levels of morale and protect their pro-fessional interests.HM:Are medical licences renewable on anannual basis? Ifyes, what are the condi-tions that may cause a medical profes-sional'slicence to be revoked?Dr. Kulaveerasingam: Doctors need to getan Annual Practising Certificate, issued bythe Malavsian Medical Council (MMC), by

workshops, seminars or conferences. Thecertificate ensures ethical practises at alltimes, equivalent to a business licence fordoctor. Ifa doctor is declared a bankrupt ois undergoing a court case for a criminal offence, his/her licence to practise medicinewill be suspended unti l he/she is found notguilty.

Similarly, nurses need to collect Continuous Professional Development (CPO) pointto get their nursing licences renewed everyyear.HM: Are there any differences betweendoctors who treat local patients and pa-tients from overseas? Are there addit ionaqualifications required for doctors wishinto practice health/medical tourism?Dr. Kulaveerasingam: There are no differ-ences inqualifications; both require thesame level of qualifications and experience.Doctors practising health tourism usuallyhave substantial exposure to internationalstandards and are usually based at top-clashospitals offering state-of-the-art equip-ment and facili ties. They are also moreaware ofthe limitations and circumstancesof their foreign patients inorderto offernecessary advice, such as whether certaintourist activit ies should be avoided or en-couraged and how to speed upthe healingprocess.HM:Are there 'unwritten laws' that doc-tors abide to, for instance, they cannotrepresent a direct-selling company or peform a certain procedure without specifictraining?Dr, Kulaveerasingam: Doctors can onlypractise the specialty that they are raqis-tered for under the Malaysian SpecialistsRegistry. Inany case, doctors are expectedto act and recommend the best fortheir p

8/3/2019 Regulating Malaysia's Healthcare

6/6

tive to the need of the patient and accom-panying relatives or friends. For instance,patients from less developed countriesseeking treatment here may be totally clue-less about complicated medical terms, sodoctors will need to explain fully what thetreatments entail and why they need it.Thegood news isthat many of our hospitalshere offer psychosocial support to patientsand caregivers so that they won't feel afraidand alone.HM:What can patients do if they are un-happy with a doctor after a certain treat-ment?Dr. Kulaveerasingam: The correct proce-dure would be to first fi le an official com-plaint with the hospital where thetreatment or surgery was conducted. EveryMalaysian hospital has a Medical Director(a qualified doctor) or Person-In-Charge

These peer reviews are an important moni-toring mechanism to ensure every doctorprovides the best care and treatment forpatients.

Upon receiving a complaint, the hospi-tal's Public Complaints Committee willlaunch a thorough investigation into thematter dependi ng on the gravity of theissue, including meeting the doctor(s) in-volved and the patients to determine theexact point of distress. Inmy experience, Ihave found that patients have alreadyformed an opinion about their doctors dur-ing the first meeting, which willdeterminewhether or not they will sue or make a com-plaint after their treatment. It all bolls downto communication skills; how well the doc-tor and nurses interact with the patients andcaregivers to make them feel cared for,

Ifthe Committee cannot provide a satis-factory reply to the patient or his/her family,they can file a complaint with the Malaysian

HM: In the case of complications, can pa-tients claim forinsurance coverage fromthe doctor's insurance'?Dr. Kulaveerasingam: Insurance coverageis usually not extended to patients seekingtreatment from foreign countries, but it isdetermined on a case-by-case basis, Pa-tients need to check with their doctors,agents and insurance companies beforetheir treatment to have a clearer idea ofwhat they can claim and what they can't,

Of course, prevention isbetter than cure,so all doctors must advise patients aboutstaying healthy and well via exercising and agood diet. This includes taking regularhealth screenings especially for conditionsfor which you are at high risk, managingstress levels and keeping the family environ-ment happy. Preventive healthcare musttake centre stage in current practise andother doctors and patients must play their