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MEDICAL PROFESSIONALS
March 2015
ISSUES PAPER
The Medical Professional Issues Paper
MPC is releasing this issues paper to assist individuals and organisations to prepare
and participate in the review. It contains and outlines:
the scope of the review
matters about which the MPC is seeking comment and information
information about how you can get involved in the review.
Participants may add any comment which they consider relevant to the review.
Submissions can be made by email or fax to:
Email : [email protected] and [email protected]
Fax: 03-79600 211
Contacts:
Mr. Mohammed Alamin Rehan
Tel: 03-7960 0173
Ms Ilyana Norsaidah Bt Ab Rahman
Tel: 03-7960 0173
Table Of Contents
1.0 TERMS OF REFERENCE 1
1.1 What The MPC Has Been Asked To Do? 1
1.2 Conduct Of The Review 1
1.3 Timing 2
1.4 Contacts 3
2.0 SCOPE OF THE REVIEW 4
2.1 What Is This Study About? 4
2.2 Professionals Serving In The Health Industry 5
2.3 What Is Regulation? 8
2.2.1 Regulations 8
2.2.2 Regulatory burdens 8
2.2.3 Unnecessary regulatory burdens 8
2.2.4 Restrictions on competition 9
2.2.5 Unnecessary restrictions on competition 9
2.4 Market Challenges: Information Asymmetry 9
2.5 Barriers to Entry 10
3.0 RECENT DEVELOPMENTS AFFECTING PROFESSIONAL SERVICES 13
3.1 Expectation And Demand In Professional Services 13
3.2 Expectation In Professional Services Serving Healthcare Industry 14
3.3 Investment In Technology 14
3.4 Demand In Medical Professionals Services 15
4.0 REGULATION PROCEDURES IN PROFESSIONAL SERVICES VALUE CHAIN 16
4.1 Defining Regulations Within The Medical Professionals Services 16
5.0 YOUR OPINION ON UNNECESSARY REGULATORY BURDENS 22
5.1 The General Questionnaire 22
5.2 Some Of The Issues That Were Raised By Professionals 23
5.2.1 Controls on professional administration 23
5.2.2 Professional services regulators 24
5.2.3 Regulations pertaining to practicing certificates 25
5.2.4 Intervention by government and agencies 26
5.2.5 Entry requirement of professional registration 27
5.2.6 Setting up of clinics / business 29
5.2.7 Registration with government 30
5.2.8 Limitation of roles 30
5.2.9 Completion / termination of practice 32
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
1
MEDICAL PROFESSIONALS SERVICE SECTOR
1.0 TERMS OF REFERENCE
1.1 What The MPC Has Been Asked To Do?
The 10th Malaysia Plan has mandated Malaysia Productivity Corporation (MPC) to
carry out regulatory reviews in view of making it easy to do business in Malaysia. In
relation to this, the Malaysia Service Development Council (MSDC) has asked the MPC
to review the Professional Services to the health sector. This review process will draw
on the expertise and perspectives of public and private sector leaders, who will help
identify key issues and the appropriate solutions. It is part of one of the 12 National Key
Economic Areas (NKEAs) identified, namely healthcare.
1.2 Conduct Of The Review
The study will emulate the approach used by the Australian Government Productivity
Commission (AGPC) and the team will be guided by a regulatory expert Ms. Sue
Holmes. The team will select a sample of medical professionals practising within the
health sector and conduct interviews with the management personnel to identify the
regulatory issues of concern.
Based on the principles of good regulatory practices, the team will formulate feasible
options for further deliberation. These issues and options will be subject to further
consultation with relevant stakeholders in order to develop concrete recommendations
that will reduce unnecessary regulatory burdens.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
2
Figure 1.1: Study Process of the review
1.3 Timing
This review commenced in August 2014 and has started with canvasing interested
parties about concerns with written regulation and its administration.
LIT
ER
AT
UR
E R
EV
IEW
IN
PU
TS
(R
eport
s,
We
b-s
ites,
Art
icle
s &
Sta
tistics)
CO
NS
ULT
AT
ION
AN
D E
XP
ER
T’S
AD
VIC
E (
Fro
m A
GP
C)
Conceptualize the Logistics Value Chain
List all Acts and map them onto the
Value Chain
Scoping & Target Selection
Develop Issues Paper with list of
questions
Conduct interviews
Analyse information gathered
Draft report (proposed options)
Public consultation
Final Report and submission
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
3
1.4 Contacts
Interested parties are welcomed to participate in this review. You can contact the
persons below on matters relating to this review.
Mr. Mohammed Alamin Rehan
Tel: 03-7960 0173
Email: [email protected]
Ms. Ilyana Norsaidah Bt Ab Rahman
Tel: 03-7960 0173
Email: [email protected]
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
4
2.0 SCOPE OF THE REVIEW
The regulations and agencies which govern the professional servicing the healthcare
industry will be assessed and analysed with the focus on modernising business
regulations. Any redundant, unnecessarily burdensome and outdated regulations will be
identified and options will be proposed to reduce the unnecessary burdens in order to
achieve a dynamic, modernised business ecosystem.
Over-regulating can occur either when it is not needed to address social, economic or
environmental concerns, or when legitimate issues, are addressed in overly costly
ways. Governments need to carefully balance the costs and the benefits to the public to
ensure the cost burdens do not outweigh the anticipated benefits
2.1 What Is This Study About?
The issues paper is intended to assist interested people either to contribute to a
meeting with MPC or to prepare a submission to the MPC on Medical Professionals
Services to the Healthcare Industry in Malaysia. It provides some general background
information and raises questions that can assist in preparing a submission. The issues
addressed in this paper and the guiding questions cover only a portion of the possible
issues. Hence, participants are encouraged to comment on any issues they believe are
relevant to the review whether or not they have been raised in this issues paper.
For the purpose of this review, the scope is focussed on four medical professions within
the healthcare industry and they include Doctors (general practitioners and specialists);
Dentists; Nurses (covering all areas of specialisation including midwifery) and
Pharmacists. These professions also contribute to other sectors such as education and
tourism.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
5
2.2 Professionals Serving In The Health Industry
A Medical Professional is someone who provides preventive, curative, promotional or
rehabilitative healthcare services in a systematic way to individuals, families or
communities. A health professional covered under this study may be within medicine,
midwifery, dentistry, nursing or pharmaceutical professions. These professionals are
persons formally certified by a professional body as belonging to a specific profession
within healthcare by virtue of having completed a required course of study and/or
practice, and whose competence can usually be measured against an established set of
standards.
For the purpose of this review, the scope will be narrowed down into four main medical
professionals servicing the health industry, which are Doctors, Dentists, Nurses and
Pharmacists. Nurses shall also cover specialised nursing areas including dental nurses
and midwives. These professionals are selected from a list of eight professions as they
represent the majority of the professionals within the industry. They do not only provide
services to the health industry but also other sectors such as education and tourism
while also contributing to the health of all citizens and thus the supply of healthy labour.
Hence, any improvements in the regulation of these professionals may add value to all
sectors and to social wellbeing.
The roles and description of medical professionals under this study are both legally and
functionally defined, as follows:
Doctors : Doctors are persons who are entitled to be provisionally registered as a
medical practitioner (MEDICAL ACT 1971, SEC 29). Functionally,
medical doctors examine, diagnose and treat patients. They can
specialise in a number of areas such as paediatrics, anaesthesiology or
cardiology, or they can work as general practice physicians, source:
CPC Medical Doctors Board of Malaysia.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
6
Dentists : Dental practitioners registered in Division II of the Register; (DENTAL
ACT 1971). Functionally, dentists are health care practitioners who
specialize in the diagnosis, prevention, and treatment of diseases and
conditions of the oral cavity, source: CPC Dentist Board of Malaysia.
Pharmacists : Licensed to carry out a business, so far as such business relates to the
keeping, retailing, dispensing, and compounding of poisons, dangerous
drugs or therapeutic substances, in compliance with a few conditions;
(PHARMACISTS ACT 1951 (REVISED - 1989). Functionally,
pharmacists are drugs experts, responsible in dispensing medications,
educating consumers on the use of over the counter medicines and
advising other health professionals on drug decisions, source: CPC
Pharmacist Board of Malaysia.
Nurses : Person registered as a nurse in accordance with any written law
relating to the registration of nurses for the sick (MIDWIVES ACT 1966
(REVISED - 1990)) Functionally, nurses contribute to the health and
welfare of society through protection, promotion and restoration of
health; the prevention of illness and the alleviation of suffering in the
care of individuals, families and communities, source: CPC Nursing
Board of Malaysia.
Medical professionals being a party within the professional services industry covers the
activities of various Acts governing the professional codes of conduct. Generally, there
are about 150 Acts governing the practice of Medical Professionals. The main Acts
include:
i. Medical Act 1971 (Act 50)
ii. Dental Act 1971 (Act 51)
iii. Nurses Act 1950 (Act 14) & Nurses Registration Regulations 1985
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
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iv. Registration of Pharmacists Act 1951 (Act 371) & Registration of
Pharmacists Regulations 2004
(Collectively referred as ‘the Acts’)
The main objective of the professional Acts is to govern the practise of professionals in
the interest of the public and the nation. However, there are instances where over-
regulating of these professions may lead to unnecessary burdens on the practitioners
and result in higher costs or poorer service to the public. Unnecessarily demanding
Acts, rules and regulations need to be reviewed to make accreditation, career growth
and practice easier and to boost the effectiveness of medical services.
Table 2.1: Medical professional and their professional boards
MEDICAL PROFESSIONAL PROFESSIONAL BOARDS
Doctors Malaysian Medical Council
Dentist Malaysian Dental Council
Nurses Malaysian Nursing Board
Pharmacists Malaysia Pharmacy Board
These bodies are governed by the Ministry of Health Malaysia (MOH) and operate
under specific Codes of Professional Conduct (CPC) as specified in the Medical Act
1971 and related Acts and Licensing requirements as listed below. For this review,
please refer to Table 2.2 for the professionals listed in line no 1,2,3 and 5.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
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Table 2.2: List of Medical Professionals under MOH, Acts, Regulators and APC.
Source : MPC
2.3 What Is Regulation?
2.2.1 Regulations
Regulations are Acts, laws, by-laws, rules or directives prescribed and
maintained by an authority, especially to regulate behaviour. They can also
include quasi regulation such as guidelines and administrative circulars. A good
regulatory system should have a set of regulations which are clear to
practitioners, administratively efficient, enforceable and legitimate.
2.2.2 Regulatory burdens
Regulatory Burdens are the extra requirements, activities and costs that
practitioners must deliver or bear in order to comply with regulations. The extra
requirements usually demand extra efforts, time and cost from the practitioners,
thus impose costs on and often decrease the productivity of the practitioners.
2.2.3 Unnecessary regulatory burdens
Unnecessary regulatory burdens arise when regulation is more burdensome than
necessary in serving its objectives. They arise from inefficient and redundant
rules or directives or from poor administration by the regulatory authority. These
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
9
unnecessary encumbrances impose a higher cost on business than necessary to
achieve the benefit.
2.2.4 Restrictions on competition
Restriction on competition are those that either prevent, or have the potential to
prevent anyone, or a number of market participants from competing on various
aspects such as price, quality, service delivery or even regulations imposed at
the point of entry. For Professional services, examples of these restrictions are
the limit to entry for foreign professionals and graduates into the local market.
2.2.5 Unnecessary restrictions on competition
Unnecessary restriction on competition are regulations that may be restricting
competition more than is needed to achieve its legitimate public policy objectives.
Examples include restrictions on starting a new business, regulations that affect
the ability to compete and regulations that affect business behaviour. Medical
Professionals are highly restricted from advertising their specialisations and
testimony. Such regulation on advertisement could form a restriction to
competition and deny the public access to relevant information about the service
providers.
2.4 Market Challenges: Information Asymmetry
One of the challenges faced by medical professionals is the dilemma of information
asymmetry or the Principal-agent theory which normally occurs when the "agent" is able
to make decisions that impact on another person or entity - the "principal". It exists
because sometimes the agent is motivated to act in his own best interests rather than
those of the principal. For example, a dental patient (the principal) may wonder whether
his dentist (the agent) is recommending expensive treatment because it is truly
necessary for the patient's dental health, or because it will generate income for the
dentist.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
10
The problem arises where the two parties have different interests and asymmetric
information (the agent having more information), such that the principal cannot directly
ensure that the agent is always acting in its (the principal's) best interests – this being a
conflict of interest .
In order to manage this situation and minimise losses on the service recipient, a good
regulatory practice is imposed such as regulating healthcare professionals through
occupational licensing.
An example of regulation addressing the Information asymmetry issue could be those
under the Medical Act 1971 which restricts doctors to two official treatments/ patients’
visit in a day, during a hospital stay as discussed in this Issues paper. This will bring us
to investigate the issue of public-private dichotomy in greater length, throughout the
report.
2.5 Barriers to Entry
Self-regulation by professional boards allows discretion to restrict entry and imposes
additional requirements in terms of training programmes and other qualifications in
selection of prospective candidates. The rules and regulations are frequently set up by
the professional bodies, reflecting the better capacity of the bodies to know what is
required to establish competency.
While professional bodies have a significant role to judge competency, they can face
two types of adverse incentives: one is to be too lenient on its members when
assessing poor performance; and the other is to apply entry requirements which are too
stringent in order to reduce competition, although some may see that the stringent
control is necessary to insure the quality and prestige of their professions.
Therefore, the regulators and Professional associations have to be cautious in
prescribing selecting criteria for entry to these professions and in regulating the delivery
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
11
of professional services, thus to get the balance right between protecting clients and
others from their incapacity to assess the competency of Professionals while not making
the barriers to entry overly stringent and thus reducing competition more than is
necessary.
In some self-regulatory systems, the rules are established by government or developed
by regulators with approval from government. Nevertheless, the governing body should
give priority to the public interest and not the interest of the profession alone, although it
is frequent that the public interest and profession interest can be the same. Due to the
intermittently conflicting interest between the public and the profession such as those
discussed in the information asymmetry where the medical professionals normally has
more or better information than the patient (the Principle Agent Theory), the government
usually requires a separation between profession governing body and professional
association.
While stringent requirements imposed upon the graduate to qualify for registration can
be seen as a way to safeguard the quality of medical service delivery if overly stringent,
they may exclude practioners who could do a competent job from providing services in
the market. An example is that a graduate from India who has completed the
‘Compulsory Rotating Internship’ or houseman ship, cannot be granted full registration
with the Malaysian Medical Council (MMC), even if they are fully registered with the
Indian Medical Council. Such a restriction may be unfavourable to these graduates or
hinder them from returning to Malaysia, causing the country millions of RM in experts
migration and and loss of potential contributor to the local healthcare system.
Another issue that is hindering competition is the regulation of the advertisement of
medical practices under the Medicines (Advertisement and Sale) Act 1956 (Revised
1983) and the Medicine Advertisements Board Regulations 1976. The regulation
restricts medical professionals from mentioning their skills, knowledge and experience
in any promotional material or advertisement. Testimonials from patients and
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
12
endorsements are also impermissible. However, weak enforcement has caused some
practitioners to disobey the regulation, giving them an advantage over competitors who
comply with the regulation.
When professional boards become too protective of their members and exclude
competent practitioners, it may be appropriate for government to intervene in order to
give priority to the public interest. It is important to be careful in differentiating useful
from unnecessary barriers to entry.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
13
3.0 RECENT DEVELOPMENTS AFFECTING PROFESSIONAL SERVICES
The services sector, in particular medical professional services, plays an important role
in supporting the growth of Health Tourism in the country, generating over RM688
million in 2013. The growth of Health Tourism and Malaysia My Second Home which is
supported by the Annual Global Retirement Index for 2014 which voted Malaysia among
the top five best places to retire, also poses a potential increase in the demand for
medical professionals which spawns employment opportunities, source: International
Living, NST online 11/01/2015.
The number of medical professionals in the country is also growing with 5,000 medical
graduates entering the medical workforce each year. In addition to that, Malaysia also
gets 1,000 specialised medical experts a year, being part of the nation’s aim to provide
1 doctor for every 400 population. There are around 142,000 health professionals in
Malaysia as shown in Table 3.1.
Table 3.1: The distribution for Medical Professional in public and private sector.
Source : Health Facts 2013, Ministry of Health Planning Division
Table 3.1 indicates that the most favourable ratio appears in the number of nurses to
population which is 1: 345. The ratio between doctors to population has improved
significantly from 1: 1000 in 2008 to 1: 758 in 2013.
3.1 Expectation And Demand In Professional Services
Demand for and supply of health professionals and the nature of the services they
provide are heavily influenced by government. Collectively, the Malaysian Government
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
14
spent over RM16 billion on healthcare (4.96 Per cent of GDP), source Estimated
Federal Budget 2012, MOF. Expenditure on the medical workforce currently accounts
for about two-thirds of total health care spending.
Governments also regulate, and are the major employers of health workers, including
health professionals listed in this study. Malaysia health industry generally faces issues
on globalisation and the increasing trend of private healthcare spending, which poses a
great challenge in maintaining the strength of the current healthcare system.
3.2 Expectation In Professional Services Serving Healthcare Industry
Medical Professionals serving the healthcare industry are expected to be competent to
work across a complex set of inter-professional relationships and services. This
requires skilful management and vigilant mind-set that involves continual improvement
processes. A study titled “ A nationwide survey on the expectation of public healthcare
providers on family medicine specialists in Malaysia, 2014” shows that the public are
expecting a more coordinated service delivery form medical professionals. Examples of
the inputs include the expectation for more experienced specialist doctors compared to
junior Medical Officers (MO) in hospitals, ability to communicate effectively with other
discipline specialists for seamless patients referral and more time spent on clinical
duties than administrative or courses.
The significant collaboration between public healthcare and private practices shows the
growing expectation for cross coordination between medical professionals. Hence
investment in technology and communication becomes apparently important in
supporting these expectations.
3.3 Investment In Technology
Malaysia was voted third best in the world for healthcare services in 2014, Source:
International Living, Global Retirement Index. That is mostly attributable to the sound
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
15
deployment of technology by the medical professionals. These investments include
computer hardware and software. Online patients’ reporting systems enable
radiologists to transmit patients’ MRI or X-ray results to doctors anywhere in the world,
thus enabling more flexible medical professional services. However, such facilities
provide higher competitive advantage to more established practitioners, especially
those operating in remote areas. Like other software, there are also compatibility issues
faced by Medical Professionals. Therefore, there often include additional investment to
upgrade existing systems and training on the usage of the new technology.
Technology has also made drugs prescription easier. However, it could pose danger to
patients who could purchase freely from the internet and have the drugs consumed
without prescription from any doctors or certified medical professionals.
3.4 Demand In Medical Professionals Services
The expected demand in the Professional services can be estimated by comparing the
professional to population ratio. There is clear evidence of a global skills shortage that is
particularly acute in the developing world. In 2011, Manpower Group’s annual Talent
Shortage Survey found that 45% of Asia-Pacific employers had difficulty filling job
vacancies due to a lack of available talent. About three-quarters of employers globally
cited a lack of experience, skills or knowledge as the primary reason for this struggle to
hire appropriate workers.
In Malaysia, there are about 15,000 unemployed nurses in the recent year. Hospitals
have blamed the low quality of training and attitudes for them being unemployable. The
recent plan to separate drugs dispensing and prescription may also alter the demand for
medical professionals and may result in shortages, especially in remote areas where
the number of pharmacists are already limited.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
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4.0 REGULATION PROCEDURES IN PROFESSIONAL SERVICES VALUE CHAIN
4.1 Defining Regulations Within The Medical Professionals Services
The value chain covered within the study starts from the stage of acquiring education
until the departure from professional medical practice:
Figure 4.1 : The Value Chain of Medical Professional
In this context, the scope of this review shall cover the following:
Tertiary education required to obtain the first certificate to be certified and
practise within the field of medicine (minimum requirements, supply vs. demand,
quality).
Placement as junior practitioners (e.g. houseman ship, trainee nurse).
Delivering services (in MOH hospitals or private practices) - Annual Practicing
Certificate (APC) and other requirements;
Qualifying for specialisation (e.g. requirements based on the number of years of
service, demand for specialist and the areas of specialisation);
The completion or termination of practice.
To understand the current regulations that are governing each step within the Value
Chain, herewith is the list of regulations, Acts and relevant requirements with the
Ministries and Regulators responsible. Each process is mapped against related
regulations, acts and requirements to enable respondents to examine the regulatory
issues that are encumbering each process within the chain.
Pre-Qualification
Medical Prof. Trainee
General Practices &
Specialisation
Exit / Termination
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
17
Table 4.1: Value Chain mapped against Relevant Acts / Regulations
STAGE ACTIVITIES /
PROCESSES
ACTS /
REGULATIONS
REGULATORS /
GOVERNMENT
BODIES
Pre-
Qualification
1. Tertiary
Education pre-
requisite.
2. Entry into certified
medical schools.
3. Qualifying
Examinations.
Education Act 1996
(ammd. 2006).
Medical Act (1971)
Private Higher
Education Act 555
(1996 amend 2006)
Ministry of Education
(MOE)
Ministry of Health
(MOH)
Boards of Each
Medical Professional
Service Entry 1. Comply with
Placement /
Houseman ship
requirement in
MOH Hospitals.
2. Restrictions to
overseas
graduates and
foreigners.
3. Additional
Requirements for
overseas
graduates from
certain countries
and private
institutions.
Education Act 1996
(ammd. 2006).
Medical Act (1971)
– Amend 2012
Private Higher
Education Act 555
(1996 amend 2006)
Medical
Regulations 1974
Medical (Setting for
Provisional
Registration)
Regulations 2012
Nurses Act 1950
(Amend 1980)
Medical Qualifying
Exams.
Registration of
Pharmacist Act
Ministry of Education
(MOE)
Ministry of Health
(MOH)
Ministry of Human
Resource
Malaysian Medical
Council (MMC)
Malaysia Nursing
Board.
Pharmacy Board
Malaysia Dental
Association (MDA)
Midwives Board
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
18
STAGE ACTIVITIES /
PROCESSES
ACTS /
REGULATIONS
REGULATORS /
GOVERNMENT
BODIES
1951
Midwives Act 1966
(Rev 1990)
Malaysia
employment Act
1955.
General
Practitioner
and
Advancement
-
Specialisation
MOH Hospitals:
1. Requirements for
entry into
practice.
2. Career
advancement-
availability of
patients and
cases to improve
competencies /
Continuing
Professional
Development
(CPD)
3. Requirements to
qualify for
Specialisation.
4. Obtaining
specialisation -
field of study :
Fitting supply with
Medical Act (1971)
– Amend 2012
Medical
Regulations 1974
Medical (Setting for
Provisional
Registration)
Regulations 2012
Nurses Act 1950
(Amend 1980)
Registration of
Pharmacist Act
1951
Midwives Act 1966
(Rev 1990)
Private Healthcare
Facilities &
Services Act 1998.
PDPA 2013
Malaysian Health
Promotion Board
Ministry of Education
(MOE)
Ministry of Health
(MOH)
Ministry of Human
Resource.
Ministry of Domestic
Trade, Co-operatives
and Consumerism.
Ministry of Trade and
Industry (Tourist
Development
Corporation-TDC)
Malaysian Medical
Council (MMC)
Malaysia Nursing
Board.
Pharmacy Board
Malaysia Dental
Association (MDA)
Midwives Board
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
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STAGE ACTIVITIES /
PROCESSES
ACTS /
REGULATIONS
REGULATORS /
GOVERNMENT
BODIES
demand.
5. Code of Conduct
6. Registration and
Licenses to
practice
Private Practices:
1. Qualification to
practice in private
practices.
2. Statutory
Registration.
3. Professional
Registration/
Licenses.
4. Sales of Drugs.
5. Codes of Conduct
: Private
Healthcare
Regulations
6. Maintenance and
Administration of
practice location /
professional
license/
registration/
medical
Act 2006.
Fees Act 1951 –
Fees Medical Rev
1994)
Registration of
Pharmacists Act
1951 (Rev- 1989)
Medicines
(Advertisement &
Sales) Act 1956
(Rev-1983)
Dental Act 1971
Dangerous Drugs
Act 1952 (Rev
1980)
Malaysia Tourism
Board Act 1992
Malaysia
Employment Act
1955.
Medical Devices
Act.
Malaysia Healthcare
Travel Council
(MHTC)
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MEDICAL PROFESSIONALS IN MALAYSIA page
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STAGE ACTIVITIES /
PROCESSES
ACTS /
REGULATIONS
REGULATORS /
GOVERNMENT
BODIES
employees.
7. Provide support
for Health
Tourism
Termination/
Exit
Exit process
1. While under
contract
2. After contract
expiry
3. Natural attrition
(retirement).
4. Disciplinary –
Force to exit
Medical
Regulations 1974
Medical (Setting for
Provisional
Registration)
Regulations 2012
Nurses Act 1950
(Amend 1980)
Medical Qualifying
Exams.
Registration of
Pharmacist Act
1951
Midwives Act 1966
(Rev 1990)
Malaysia
employment Act
1955.
Occupational
Licensing of
Healthcare
Ministry of Education
(MOE)
Ministry of Health
(MOH)
Ministry of Human
Resource
Malaysian Medical
Council (MMC)
Malaysia Nursing
Board.
Pharmacy Board
Malaysia Dental
Association (MDA)
Midwives Board
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
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Table 4.1 may not show the full process in delivering the professional services, but it is
intended to assist respondents to gauge the scope of regulatory burden imposed on
these Professionals at every stage of the profession. Professionals may encounter
numerous regulations other than those stated above such as regulations pertaining to
professional fees charges, rules in delivering services, contract administration,
professional risk and indemnity, etc. may also be raised. Therefore, additional
information that may be relevant from the respondents’ experience and perspective are
welcomed including suggesting any additional regulations which should be added to this
list.
ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS
MEDICAL PROFESSIONALS IN MALAYSIA page
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5.0 YOUR OPINION ON UNNECESSARY REGULATORY BURDENS
The MPC has developed a standard set of questions for its reviews and these are listed
directly below. In addition, some specific issues are nominated followed by some
questions. The MPC would like to hear what you consider are regulatory costs which
require modernisation, irrespective of whether they are listed here.
5.1 The General Questionnaire
1. Which regulations, including those written and/or administered by Professional
associations, concern you the most? Why?
2. Which regulations are the hardest to comply with?
3. Which regulations do you think are too burdensome given what they are trying to
achieve?
4. Do you think any regulations are not justified at all?
5. Are some regulatory requirements inconsistent? Are all requirements publicly
accessible?
6. Do you consider the Professional associations and other regulatory
administrators do a good or a poor job? In what ways?
7. Do you find the Professional associations and administrators are consistent in
their decisions?
8. Do you find they are helpful or unhelpful in advising you how to comply? Are
there any publicly available guidelines?
9. How long do the Professional associations and other regulators take to respond
to applications to register, etc.?
10. Do you have any suggestions for reducing the burden of compliance of
regulations whether administered by the Professional associations or
Government administrators?
11. Some practice guidelines, technical instructions, circular letters and other forms
of administrative controls implemented by the regulators are not gazetted, do you
have trouble in knowing when they have been issued and in accessing them?
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12. Is there any administrative controls implemented by the regulators and
Professional associations which you believe are unnecessary?
5.2 Some Of The Issues That Were Raised By Professionals
5.2.1 Controls on professional administration
The regulation and administration of professional practice by the professional boards
are made with the authority provided under an Act of Parliament. Through the
professional Acts, the relevant boards regulate the practice of its professional members
and makes rules and regulations to be adhered by its members. Amendments to the
Acts must be formalised by a gazette in Parliament. Rules and regulations made by the
Boards can be gazetted under the minister and are not required to be tabled in
Parliament, though they must be formalised through the Ministry’s approval.
Although the Federal Government holds the highest authority in the legislative structure,
state and local governments are also empowered to issue gazetted state and
municipality regulations, rules and by-laws as long as they do not contradict the Act of
Federal Parliament.
Besides the Acts of Parliament, gazetted regulations and rules, it is also common for
regulators to issue other forms of controls such as technical and non-technical
statements of policies, practice guidelines, circular letters, letters of instructions, desk
instruction and technical instructions. While these controls do not constitute a law under
the legislation they form the administrative procedure required to be fulfilled by
practitioners and as such will be treated as regulation. The administrative controls may
be introduced by the regulators from time to time to facilitate the administration of the
practice of its members.
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Que 13: What is your view over statutory non-professional task to the professional
practitioners such as government service tax collection/ Goods & Services Tax?
Que 14: Do you think it is easy or not easy to access all regulations relating to the
medical professions? Are circulars, etc easy to understand?
5.2.2 Professional services regulators
Through the provisions of the respective Acts, there are various regulators that are
administering some Acts that are affecting the practice of medicines in the country. An
example of this is the Clinical Waste Management regulations that are administered by
the Department of Environment (DOE) and the Private Healthcare Facilities & Services
Act 1998 that is regulated by the Ministry of Health (MOH). Within the regulation, a pro-
rated charge for all types of private practices regardless of the amount of waste
produced is being imposed (e.g.: a Psychiatric clinic with minimum or zero clinical
waste must pay the same rate of charges as imposed by the law on Dentists who
produce more wastes in their service delivery). PDPA is also seen by practioners as an
additional burden and redundant as it has been postulated earlier under the Private
Healthcare Act (PHCA).
Another example is the renovation requirements for clinics and private hospitals.
Although the regulations are governed by MOH under the Private Hospital Act 1998, its
practice is also administered by the Local Council who determines the annual business
license renewal. There are issues regarding the differences in regulations interpretation
and also the enforcement approach. In addition to that, issues also arise when the
inspections by various regulators are done at isolated time leading to encumbrances to
medical professionals operating private practices.
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Que 15: Do you think there are too many regulations and regulators? If so which ones
are not required or could be improved or merged? Do medical practioners find they
have to provide the same information to more than one regulator?
Que 16: Do you find any regulations and/or regulators to be inconsistent? For example,
some ….LG vs the Act – MoH, DoE, LGs
Que 17: Have you experienced difficulty with waste material management this regards
and how do you think the situation could be improved?
5.2.3 Regulations pertaining to practicing certificates
Based on initial discussions with the respective respondents operating within the
healthcare industry, some of the most pertinent regulatory issues faced by Medical
Professionals in the healthcare industry are the burdensome processes in dealing with
service delivery. These processes consist of a wide range of procedures from
application for registration with the Council or relevant professional Boards,
examinations, registration for Annual Practicing Certificates (APCs) and renewal to the
administration of fees involved to comply to these certifications. In many cases, the
process may also include the requirement for private Medical Professionals such as
Doctors and Dentists to obtain separate APCs for each place of practice, hence
subjecting a locum serving 10 clinics to acquire and administer 10 APCs on an annual
basis.
Under the Medical and Dental Acts 1971, both medical Doctors and Dentists must
register with the respective Malaysian Medical Association (MMA) and the Malaysian
Dental Council (MDC) and must acquire the Annual Practicing Certificate (APC) for
each place of practice, in order to legally practise. These licenses must be renewed on
an annual basis as opposed to other countries like Singapore that allows a validity
period for practicing certificate or PC to up to two years.
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Que 18 : What purpose do these demanding and lengthy requirements serve? How do
you think the situation could be improved?
5.2.4 Intervention by government and agencies
The general purpose of the present professional Acts generally is sufficient to govern
the practice of the Professional boards. However in some cases, the boards do not
enforce some aspects of these Act, thus, the Government through various agencies
imposes extra regulations to enforce the practice of the Professionals. For an example,
the Professional Board of Nurses together with the MOE administers the development
of training faculty curricula and facilities for nurse training. However, many private
institutions providing nursing education are not affiliated with any hospitals whilst the
Department of Public Services (JPA) is expecting a nurse to function in a clinical setting,
not just teaching and managing. A local study, “Basic Nursing Competencies for
Recent Diploma Graduates” by MOE revealed that student nurses from such private
institutions had difficulty getting clinical experience. If the regulation in nurses training is
not improved, candidates could be disadvantaged from further career opportunities.
Where the Government senses inefficacy of regulation by the professional boards, it
may introduce additional measures to stiffen the regulation. Frequently, the introduction
of additional regulations are meant to protect the interest of the public and to improve
the administration of the professionals, however, sometimes they may not work as
intended. Under the new Regulatory Impact Assessment (RIA) requirements, the
regulators need to analyse any proposal for new regulations before their implementation
to avoid overlapping regulations by multiple agencies.
Que 19: Respondents are encouraged to give feedback and suggestion on their
experience and concerns in dealing with these regulations.
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Que 20: Can you suggest ways to address this overlap in functions and regulations
which would be less burdensome?
5.2.5 Entry requirement of professional registration
Prior to acceptance of registration as professional member with the professional boards,
a graduate must undergo specialised training consisting of recognised education
programme, practical experience and professional examination or interview to qualify for
the registration. Professional board may prescribe their own entry rules and requirement
to be fulfilled by the prospective professional.
Professional boards through their professional accreditation councils or agencies also
set the criteria for assessment and accreditation of programmes offered by institutions
of higher learning. Subsequently, the institutions are required to apply for renewal of the
accreditation validity before expiring of the terms to ensure continuous validity of the
programme.
Graduates who have completed their study from unrecognised programmes will not be
able to be registered as graduate members of professional boards, unless after going
through additional trainings, courses, examination or interview as determined by the
professional boards. The Board only accepts application from graduates graduating
from recognised institutions as per the Schedule 2 of the Medical Act, although there
were cases where these institutions were approved by the Ministry of Public Services
(JPA).
The Ministry of Health (MOH) regulation states that foreign medical professionals are
prohibited from participating in private practice. Provisional registration is available only
to practitioners with the following nationality, rights and qualifications:
Holding a basic medical degree from a recognised institution (as per the Second
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Schedule ( ) of the Medical Act 1971);
Malaysian citizens;
For non-citizens, exemption is given only to local graduates or those related or
married to Malaysians.
Exemption is only given to non-citizens who are local graduates and those related or
married to Malaysians. To that effect, candidates should submit relevant
documents/testimonials from consultants where the rotations were previously done. The
testimonials should state the date of commencement and completion of each posting
and that the work and conduct was satisfactory. Pursuant to the Medical Act 1971, an
application is accepted only if the graduate has completed internship in a foreign
country to the satisfaction of the Medical Qualifying Board.
As the ‘Compulsory Rotating Internship’ is part of a medical programme, fresh
graduates from training institutions in India are not qualified to apply for exemption or
full registration, even though they are fully registered with the Indian Medical Council.
The Registration of Pharmacist Act has been amended [Act A1207 - The Registration of
Pharmacists [Amendment] Act 2003] to make it mandatory for pharmacists to serve the
government for a period of 4 years. In this compulsory service, Pharmacy graduates are
required to be provisionally registered with the Pharmacy Board of Malaysia and on
being provisionally registered, engaged in employment as a public servant in a listed
premise for a period of not less than one year, before serving the government for
another 3 years. Failure to serve the government on full registration may lead to a fine
not exceeding fifty thousand ringgit. However, it is not clear the MOH hospital can
provide enough training facilities and dental experts to train these graduates?
Like other medical professionals, Nurses are also subject to registration with the Nurses
Board upon satisfying the requirements. That also applies to individuals trained outside
Malaysia as stated in Nurses Act 1950.
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Que 21: What is your opinion on the academic qualifications and practical experience
prescribed by the professional board for graduates to register as professional
members? Are they justifiable or otherwise?
Que 22: What is your opinion of the self-regulation practised by the professional boards
to regulate their members?
5.2.6 Setting up of clinics / business
The usual type of registration of private clinics with CCM is via either partnership or
body corporate, whereby the registration of sole-proprietor practice with CCM is
optional. Conventionally, the registration of body corporate (private limited company) is
governed under the Companies Act 1965, and the registration of partnership practice is
under the Registrations of Business Act 1956. The conventional partnership setup has
no limitation of risk of liability, however, a recently enacted Limited Liability Partnerships
Act 2012 shall give options for practitioners to setup their partnership practice with
limited liability under the Limited Liability Partnerships Act.
One example of an arduous regulation with regards to starting a practice is a
requirement stated under the Private Healthcare Act that requires a maternity
centre/hospital to have a resident anaesthetist and a paediatrician. The regulation may
cause serious cost implication to small hospitals as they need to maintain the cost of
resident specialists when the number of delivery cases especially caesarean is low.
Que 23: Is this regulation too onerous for most maternity centres or are they justified by
health and safety concerns?
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5.2.7 Registration with government
Besides registration with the professional board for the professional practice and CCM,
firms also need to be registered with the Ministry of Finance (MOF) as a prerequisite for
delivering panel professional services to the government and its agencies. The
encumbrance of being a panel clinic is the presence of a 3rd party administrator.
These practices, if not governed effectively may impose serious financial burdens on
Medical Professionals. An example was cited that a third party administrator currently
owes 35 doctors in Malaysia an amount of RM500,000 for the medical services
rendered to patients registered under their medical panel.
Another hurdle in the registration system with the Government is the single registration
entitlement for every individual person. Any person or business owner who is registered
with MOF under any company name, is prevented from registering with another
company, hence, the second company must appoint new directors, source :
http://home.eperolehan.gov.my.
Que 24: What objectives are served by having a third party administrator and the single
registration entitlement? Do the requirements impose unnecessary burdens? Are there
better ways to achieve the Government’s objectives so that any burdens on business
are lowered?
5.2.8 Limitation of roles
Regulations under the Medical Act 1971 also restrict doctors to two official
treatments/visits during a patient’s hospital stay to protect them from doctors
overcharging (principle-agent theory). On the other hand, some doctors feel that the
regulation is preventing them from charging for services rendered to patients with critical
medical needs. This issue also arises with a patient in labour, who requires a visit by a
doctor every four hours. Although the restrictions were designed to mitigate the
dilemma of information asymmetry within the medical professionals’ services industry,
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such restriction may deny patients’ rights to treatment and doctors’ rights to charge,
where genuine needs arise.
Under the CODE OF PROFESSIONAL CONDUCT (Medical Act Section 19(2)),
Responsibility for Standards of Medical Care to Patients, doctors, In pursuance of their
primary duty to protect the public, are expected to provides the following:
1. conscientious assessment of the history, symptoms and signs of a patient's
condition;
2. sufficiently thorough professional attention, examination and where necessary,
diagnostic investigation;
3. competent and considerate professional management;
4. appropriate and prompt action upon evidence suggesting the existence of
condition requiring urgent medical intervention; and
5. readiness, where the circumstances so warrant, to consult appropriate
professional colleagues.
The Council may institute disciplinary proceedings when a practitioner appears
seriously to have disregarded or neglected his professional duties to his patients whilst
the public is entitled to expect that a registered medical practitioner will provide and
maintain a good standard of medical care. Such limitation of roles may subject doctors
to negligence and additional burden in procuring their services.
Que 25: Do you think these restrictions are justified or unjustified? Are there other ways
that could protect patients without such restrictions on services received? Do you know
of other restrictions which might not be justified or which limit the flexibility with which
medical services are provided?
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5.2.9 Completion / termination of practice
Upon retirement or termination of a professional practice, the practitioner may opt to
terminate their practice licence with consent from the respective professional boards.
Termination of the licence may be voluntary by the professional or by regulatory
enforcement by the professional boards. Professional boards may exercise its power to
cancel the professional registration through provisions of the Acts.
Voluntarily termination by a Professional can be done by informing the relevant
professional board the intent to retire, cancel registration or close the practice.
Supporting documents such as a Letter of Release is required to be presented together
with the application. Voluntarily cancellation of registration may also be achieved by a
Professional by not renewing the annual subscription, thus resulting in the cancellation
of registration by professional boards through enforcement of regulations.
Upon the acceptance of application to terminate the professional registration, a
Professional must cease practice and cease providing professional services. However,
it is often tedious for a Medical Professional to transfer the ownership of the practice to
another professional. That is due to the regulations stated in the Private Healthcare Act.
Que 26: Are there ways to make closing a clinic less burdensome?
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______Medical
______Dental
______Nursing (Please indicate areas of specialisation if any)
______Pharmacy
______Others (please indicate)
APPENDIX 1
Expression of interest
Malaysia Productivity Corporation
RURB ON MEDICAL PROFESSIONALS
Please complete and submit this form with your submission:
By email: [email protected] OR by fax: (03) 7960 0206
Or by post: Malaysia Productivity Corporation
A-06-01, Tingkat 6, Blok A, PJ8
No.23, Jalan Barat, Seksyen 8
46050 Petaling Jaya, Selangor
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Please indicate your interest in this review:
Be informed of developments including receiving the draft report
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