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Saturday, April 18, 2015

UMMC’s RM120 million budget cut threatens patient care, training

University Malaya Medical Centre’s 2015 budget has been slashed from RM510 million last year to RM387 million, which is forcing the teaching hospital to compromise on patient care and training for medical students. – The Malaysian Insider file pic, April 18, 2015.University Malaya Medical Centre’s 2015 budget has been slashed from RM510 million last year to RM387 million, which is forcing the teaching hospital to compromise on patient care and training for medical students. – The Malaysian Insider file pic, April 18, 2015.
A budget cut of RM120 million for University Malaya Medical Centre (UMMC) this year is causing concern among several doctors over the hospital's ability to give adequate treatment to patients.
They worry that patient care would be compromised after the teaching hospital's budget for 2015 was reduced to RM387 million against an expenditure of RM510 million last year.
And as a teaching hospital, cut would also affect the quality of education provided to medical students.
The 21-year-old former waitress, who did not want to give her real name, said UMMC had been treating her for a life-threatening disease in 2013 and had waived the RM6,000 medical bill then after she lost her job as a result of falling ill.
But in February this year, she received a "red letter" instructing her to pay up RM3,000 within 14 days or face legal action, the former waitress told The Malaysian Insider.
"When I asked why I had to pay, the hospital said that they had no money and so they were claiming back what they were owed.
"So I stopped going to the hospital to get my medication for fear of being charged.”
But she returned to UMMC last week when the pain from the illness became too much to bear.
"I was in so much pain and decided I would go to the hospital and plead with them to let me pay RM100 a month because I badly needed treatment and my medication," she said, bursting into tears. 
Higher costs as teaching hospital
Universiti Malaya's Dean of Medicine, Professor Dr Adeeba Kamarulzaman (pic), told The Malaysian Insider that UMMC was verbally informed of the budget cut earlier this year by the Education Ministry (MoE) which the hospital falls under as it is a teaching hospital.
She said the budget cut was expected to put a further strain on UMMC's ability to provide patient care given that it was expecting a rise in the number of patients switching over from private hospitals following the implementation of the goods and services tax (GST) at 6%.
In addition, UMMC would be paying an estimated RM4 million in GST every month to suppliers.
Already operating under tight constraints, this is expected to exacerbate the chronic funding problem the hospital is facing.
Dr Adeeba said UMMC had to make do with a comparably smaller budget for its size, compared with hospitals under the Ministry of Health (MOH). This was despite the fact that it had to serve the public just like any other government hospital.
With this, Dr Adeeba said that ‎even purchasing costly antibiotics was going to be a problem, let alone more expensive types of medicines such as chemotherapy for adults and children with cancer.
She added that patient numbers at UMMC had doubled from 2007 to 2013, reaching 1.03 million last year.
"We have not yet seen the full impact of the recent cutback as there are still enough internal funds to buy medicines.
"But once the money runs out towards the third quarter of the budget year or sooner, we would face problems caring for patients.”
She said UMMC, as a tertiary care hospital, with multiple intensive care units, provided a full range of services, including costly ones such as cardiac and neurosurgeries, solid organ and bone marrow transplantations.
"Plus we are a teaching hospital which naturally results in increased costs, for example, in the operation theatre. Instead of three people requiring sterile gowns for a particular procedure, it's going to be five to accommodate medical students and trainee surgeons, so the cost is going to double."
Consultant gynaecologist oncologist Professor Dr Woo Yin Ling said UMMC patients were paying more than those at other government hospitals as the hospital could not afford to absorb the costs of certain drugs and equipment.
She gave the example of standard chemotherapy for ovarian cancer, which was free in an MOH hospital but chargeable at RM500 per cycle at UMMC.
Dr Woo said the hospital has had to also deal with price hikes, especially for items imported from the United States and United Kingdom, and as such, has been actively taking steps to counter these increases by raising prices.
She cited examples where the cost per radiotherapy session, which is already subsidised, has doubled while admission rates have also been increased.
"So even without a budget cut, it's an odd situation where patients come in and have to buy a lot of medications and services, at what is essentially a government hospital.
"For example, if you come in for surgery, you have to buy the special anti-clot stockings and also the injections to prevent clots," she said, adding that even government servants had to pay first and claim back later.
Medical training at risk
The funding cut may also cause UMMC to turn away certain patients unable to afford treatment and drugs. This will result in fewer cases, in turn, affecting the hospital's quality of teaching.
UMMC consultant paediatric oncologist Professor Dr Hany Ariffin gave the example of thalassemia patients who needed regular blood transfusions, where the cost of blood at UMMC was now RM120 per pack.
Dr Hany said the price hike was because the hospital was unable to subsidise any longer the cost of the screening process involved to ensure that the blood was safe for use, and as such, had to pass it on to patients.
"But even with this hike, the hospital cannot afford it now and we have had to send out patients to MOH hospitals like Ampang and Sungai Buloh where they can get the blood for free," she added. 
Her concern is that if they keep sending patients away, the quality of teaching at UMMC would be compromised.
"If we continue to send 'expensive' and complicated patients out, we are only going to be seeing 'routine' cases, such as coughs and colds in time to come.
"And although 1 in 10 Malaysians is a thalassemia carrier for instance, our students may end up never seeing a single case of thalassemia major one day if we keep sending them away."
According to Dr Woo, thalassemia patients were not the only ones the hospital was turning away – UMMC has also had to shut its door to pregnant women despite having empty beds in the wards.
This was because of the lack of nursing staff employed despite the opening of a new wing for women and children three years ago.
As the dean of medicine, Dr Adeeba said she was concerned about maintaining high standards for medical students, adding that as a teaching hospital, UMMC was expected to practise cutting-edge medicine.
She added that the chronic shortage of funds has led to many doctors, who were highly trained specialists and experts in their field, feeling frustrated and demoralised.
This was another factor pushing doctors to leave UMMC for better equipped private hospitals, she said.
"We are the custodian for training the next generation of doctors and specialists, so to maintain standards and to ensure that we practise evidence-based medicine, we need to have to the right tools, the right mix of patients, the right drugs.
"But we are losing out as the teaching hospital for undergraduates and postgraduates because we have to make do all the time from a lack of funds," she said, adding that the recent budget cut announced earlier this year exacerbated an existing problem.
Waiting for a solution
Dr Adeeba said the Education Ministry was aware of UMMC's problems and both parties were finding ways to improve the situation.
But, in the meantime, she said the government needed to look at the immediate need for more funding for the hospital.
It was a known fact that all over the world, she said, a teaching hospital was going to be more expensive to run compared with a service hospital.
"For now, in real terms, there needs to be more money to commensurate with our role as a teaching hospital and the fact that UMMC serves as a public hospital to more than one million patients.
"And so our budget has to reflect the type and volume of patients, given our role as a teaching, tertiary and government hospital.”
Dr Hany agreed, saying that they were only asking for a more realistic budget, given that they were taking a lot of patients out of the MOH hospital system.
She added that while it was not practical to expect healthcare in Malaysia to be completely free, she hoped that in the future, Malaysia could implement a system where every citizen had an equal allocation on their medical bills, taking into account the government's allocation for healthcare at 3.8% of GDP.
Dr Woo said all Malaysians, whether they walked into a teaching or a MOH hospital, should have similar access to medicine and equipment, and should not be discriminated against when they seek medical attention in any public hospital.
- TMI

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