Malaysian doctors, particularly houseman officers (HO) will enjoy a new salary revision which will also see automatic grade promotion upon the completion of 2-year housemanship beginning 2010. The new salary scale will effectively convert into the doubling of the present salary scale. From The Star news:
PUTRAJAYA: At least 2,000 graduate house officers in government hospitals will get an automatic promotion to grade UD44 upon completion of their two-year housemanship in 2010. They will be getting at least RM6,000 including allowances every month, which is almost double what the present graduate house officers are getting on grade UD41.
Health director-general Tan Sri Dr Ismail Merican said the promotion exercise would cost RM1.7mil annually. He added that at least 7,000 doctors on grades UD41 and UD44, who were appointed before 2008, would also get their long overdue promotions. This would cost another RM9.8mil. He said many doctors had been stuck at UD41 for six to seven years and that they would be moved to the higher scale of UD44.
“Hopefully, this promotion exercise will indirectly encourage many doctors to remain in the civil service,” he said.
Dr Ismail denied allegations by certain parties that there were not enough opportunities for other races compared to Malays in the medical sector. He said that from 2000 to February this year, there were 2,085 specialists of whom 56% were Malays, Chinese (23.7%) and Indians (19.3% ). He said 55% of the specialists on grade UD48 were Malays, 23% Chinese and 18.2% Indians. As for UD54, it was 58% Malay, 21% Chinese and 16% Indian.
Of the specialists under special grade C, he said 51.1% were Malays and Chinese and Indians made up 24% each. As for those under special grade B, he said that 42% were Malays with the Chinese and Indians making up 24% and 34% respectively. – The Star.
While most doctors and the wannabe-doctors will welcome this news with open arms and tearful joy, few others are still reeling from the adverse psychological effect of being a health practitioner. I guess it is probably true that a doctor’s job (particularly housemanship officers) is the one of the most stressful jobs around. Yesterday, a suicidal doctor tried to take her own life by threatening to jump from the 6th floor of Alor Star Hospital.
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Story up there is a real story telling about a strees doctor in Malaysia and also about the payment. So, is there any relatioship between money and stress?? or stress vs workload vs payment.
Appropriate provider payments is needed optimize the utilization of scarce health care resources, transform clinical practice, and improve the quality of care. Most public hospitals in developing countries are financed through budget allocations that are not directly related to the amount and quality of health care services they provide.
Serving in remote areas in deve loping countries constitutes a personal hardship for physicians, who must forego income from private practices they could establish in urban areas as well as educational and other opportunities for their children. As a result, premiums for enticing physicians to serve in those areas must be high.
There is a study showed that in Indonesia, bonuses of as much as 100% of salary would be necessary to attract graduates from Jakarta to the outer islands, but that bonuses is little as 30% were required to attract physicians originally from remote regions to return there to practice after finishing medical school.
So, Indonesia have compulsory a service requirements in outlying areas for new physicians. This system helps staff the outer clinics at low cost, but does so usually at the expensive of a quid pro quo from the government, such as free tuition in public medical school, guaranteed placement in the civil service, or specialist training, that carries larger efficiency costs than direct cash subsidies to physicians.
Those down here are method of Provider payment but which one is better, still can't be answered
Appropriate provider payments is needed optimize the utilization of scarce health care resources, transform clinical practice, and improve the quality of care. Most public hospitals in developing countries are financed through budget allocations that are not directly related to the amount and quality of health care services they provide.
Serving in remote areas in deve loping countries constitutes a personal hardship for physicians, who must forego income from private practices they could establish in urban areas as well as educational and other opportunities for their children. As a result, premiums for enticing physicians to serve in those areas must be high.
There is a study showed that in Indonesia, bonuses of as much as 100% of salary would be necessary to attract graduates from Jakarta to the outer islands, but that bonuses is little as 30% were required to attract physicians originally from remote regions to return there to practice after finishing medical school.
So, Indonesia have compulsory a service requirements in outlying areas for new physicians. This system helps staff the outer clinics at low cost, but does so usually at the expensive of a quid pro quo from the government, such as free tuition in public medical school, guaranteed placement in the civil service, or specialist training, that carries larger efficiency costs than direct cash subsidies to physicians.
Those down here are method of Provider payment but which one is better, still can't be answered
Methods of Provider Payment
1. Salary
- Monthly payment for a medical doctor without considering amount of members
- Medical treatment not influenced by economic incentives
- Easy to plan and budget
- doctor are paid based on service provided
- market forces mechanism
- difficult in making standard of fee
- doctors happy because of the income depends on productivity
- increase patient satisfaction
- result - over treatment / inappropriate treatment, health risks to patient may be increased
- Payment by insurance company to health providers for services they deliver whether the amount is not based on type and or amount of health services provided but based on the number of members
- e.g : In Puskesmas A, it is assign to provide health services for 5 00 populations, and is is estimated that for each person to have treatment in Puskesmas A, they will be charged Rp 10k per month, so the doctor will get 5 00 x 10 000 = Rp 5 000 000 per month
- there is risk selection (avoid the old abd the sick)
- under-provide services
- Increased refferals
- Diagnosis Related Group DRG - Hospitals charge FFS. Governement pays hospitals based on subvention piece-rate formula. It tend to increase number of cases, decrease services per case, cream skimming( select less severe cases to treat or avoid handling resource-intensive cases). Prospective payment system. e.g : Jamkesmas only pay Rp 300 000 for case typhoid, but if that doctor in hospital A over diagnosed using inappropriate diagnostic tool and it cost around Rp 500 000, so that hospital need to bear Rp 200 000 by itsel
- Casemix - directly proportional to intensity of resources use
- Per Diem - specific amount of money that an organization allows an individual to spend per day, to cover living and traveling expenses in connection with work. It is the allowance given to the doctor for completing a task or going on tour away from home. Increase length of stay (LOS)
- Global budget - fixed maximum budgets or expenditure targets for health care spending. Specific definitions vary depending on the types of services covered and the systems to which the budgets are applied. Typically set by government, for a defined set of health-care services. The size of the budget may be set by an assessment of projected health needs or determined relative to an objective metric (such as a proportion of gross domestic product). Institutional providers such as hospitals may be given individual budgets each year and be required to work within them. If other individual providers like physicians are paid fee-for-service, additional means may be needed to limit spending for those services.
Who bears the risk?
Conclusion
Basically there are two types of
1. patients
- healthy - Non-altruist doctors happy to get healthy patient but altruist doc will be more satisfied to have frail patient.
- frail - Altruistic physicians under-serve frail patients under both fee-for-service because they can ask that non healthy patient to do a lot of unnecessary diagnostic test and prescribe excessive treatment. While non-altruists doctor try to avoid this patient
- altruists - choose to be paid under FFS,derive non-pecuniary benefits from treating frail patients
- non-altruists - choose to be paid under capitation scheme, indifferent about the types of patients whom they treat
Refferences
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