Published by CodeBlue

MCA deputy president Dr Mah Hang Soon questions the sustainability of MOH continuing to pay for pensioners’ treatment at IJN. The cardiologist by training also notes high drug prices charged by IJN to MOH, up to about 4,300% higher than MOH’s procurement.

KUALA LUMPUR, Oct 23 — MCA deputy president Dr Mah Hang Soon says it may be unsustainable for the Ministry of Health (MOH) to continue paying for pensioners’ treatment at the National Heart Institute (IJN).

The former deputy education minister said the government should not simply “react” to complaints from pensioners who were discharged from IJN and referred to public hospitals, after Prime Minister Anwar Ibrahim announced last Friday that government patients, particularly those aged 65 years and older, would be allowed to continue their care at IJN.

“I’m worried about whether MOH is able to bear the subsidy and whether it is going to be sustainable in the long run,” Dr Mah told CodeBlue.

CodeBlue reported Monday that the MOH – which is the payer for government-dependent patients at IJN – paid IJN Sdn Bhd (IJNSB) RM606.5 million last year. Pensioners comprised nearly six of 10 government-dependent patients in 2023; the remaining are federal civil servants and underprivileged patients.

IJNSB’s bill to MOH may rise to RM660 million to RM840 million next year if the Minister of Finance Incorporated (MOF Inc.) approves IJN’s request to raise its fees for government patients by 10 per cent to 40 per cent.

Over the past decade, MOH’s payments to IJNSB jumped 68 per cent from RM361.8 million in 2013 to RM606.5 million in 2023, higher than the 37 per cent increase in patient visits by government-dependent patients to IJN.

MOH’s payments to IJNSB also continued rising every year since 2013, except for a 2 per cent dip in 2022, despite an overall trend of declining patient numbers since a peak of 54,691 government-dependent patients at IJN in 2017. Last year, 48,144 patients were recorded.

Dr Mah highlighted extremely high drug prices that IJNSB charges to MOH – as cited in CodeBlue’s report – up to 4,323 per cent higher than prices paid by MOH’s procurement, including statins like atorvastatin and other medications like pantoprazole, which lowers stomach acid, and empagliflozin that treats type 2 diabetes.

CodeBlue pointed out that the MOH enjoys economies of scale in drug procurement, compared to much smaller buyers like individual hospitals.

“With an advantage of economies of scale, this is more reason for us to procure those medicines at a cheaper price. Essentially, this still eats into MOH’s allocation,” Dr Mah said.

He also stressed that generics are effective, while patients with specific conditions can be prescribed originator medicines.

The former Perak state executive councillor for health defended IJN’s discharge exercise of pensioners to government cardiac centres under the MOH. The ministry claimed last February that patients are only discharged from IJN when they are in “stable” condition.

“I’m confident that MOH would have looked at this over the years. They have to manage their funding. Some patients, despite whatever they do, are still not stable, that’s true. But most patients, after treatment, are stable,” said Dr Mah.

At a recent media briefing, IJN Holdings group chief executive officer Prof Dr Mohamed Ezani Md Taib said the “control mechanism” over referrals of government patients to IJN is managed by MOH officers based in the MOF Inc.-owned hospital.

Dr Ezani told the media that pensioners seeking outpatient services must first obtain clearance from MOH officers based in IJN, adding that the MOH’s criteria for discharge are defined as no longer being “cardiology active”.

This means that the patient is perceived as not having heart disease anymore, but only concomitant conditions like diabetes or hypertension. However, the IJN CEO acknowledged the “fine line” between being free and still having heart disease, noting that cardiac conditions may arise again if one’s blood pressure is poorly controlled.

“Whoever is sent by MOH to screen through those patients, I don’t believe it’s just the decision of the MOH officer alone. I’m sure there’s communication between the officer and the IJN specialist,” Dr Mah said. “I don’t think it’s a unilateral decision.”

CodeBlue understands that MOH officers based in IJN are from the income assessment unit who decide whether the government can pay for the treatment of patients who walk in to IJN but have no means of paying, similar to units at other government hospitals that offer financial assistance.

Dr Mah, who is a cardiologist by training, stressed that public policy cannot take into account all assumed situations, citing a future scenario of a heart patient suddenly turning unstable after initial stability following treatment.

“In that case, we should ask the cardiologist for an angioplasty. In any event, with any angioplasty, even with the most updated stent, there’s still risk of recurring [disease]. So are we saying we should keep all the patients [at IJN]? No, I don’t think so.”

He expressed confidence that the MOH has historical data on how many heart patients are stable after treatment.

Dr Mah said only emergency or urgent cases, a “subset” of heart patients, need continued care at IJN, whereas others can be referred to MOH cardiac centres, like Sultan Idris Shah Serdang Hospital in Selangor, Pulau Pinang Hospital in Penang, and Sultanah Aminah Johor Bahru Hospital in Johor.

Raja Permaisuri Bainun Hospital in Ipoh, Perak, also provides angiograms and angioplasty, he noted, even though the general hospital doesn’t have a cardiothoracic department.

“Should there be a need, if patients are unstable at any time, then they can be referred back to IJN if necessary, although most of those cases can be treated in MOH hospitals,” said Dr Mah.

“The other day, I visited a friend in Serdang Hospital; it’s very good, very up to date, and very modern.”

Dr Mah acknowledged that IJN – which he said has never been a “government” hospital as it’s owned by MOF Inc. – needs to survive in the private hospital industry, but expressed concerns about IJN’s proposed fee hike of up to 40 per cent for government patients.

He suggested that the government explore the idea of having the Retirement Fund (Incorporated), or KWAP – which pays retired civil servants’ pensions – replace the MOH as the payer for pensioners’ medical care at IJN instead.

When pointed out that many patients want the originator medications at IJN that they cannot obtain in MOH hospitals, the MCA deputy president reiterated that generics are “almost equally efficacious” to branded drugs.

“In an ideal world, everyone wants the best. But we don’t live in utopia; we know the constraints. I’m not defending MOH, but I’m merely stating the facts,” said Dr Mah.

“Whatever funds that MOH receives and their planning – we have to make sure it’s sustainable.”