Health Care: Its Protectionism

by Thomas Sim, 28 Dec, 2000

A report taken from The Star, Dec 20th 2000 reads 'Health Ministry parliamentary secretary S. Sothinathan said last Sunday that the ministry was discussing with the Sarawak Government the possibility of relaxing laws that disallow peninsula doctors from setting up clinics in the state'. Apparently, the reason for lower health care standard is that few West Malaysian doctors are willing to take up posting to Sarawak because of the prohibition of future private practice in the state.

The questions that I ask myself are:

1. Is Health Care a public service or a business enterprise?
2. Would protectionism of professionals make them better professionals?
3. Would by lifting protectionism, there will be more doctors in rural areas and district hospitals so that the standard of care can be improved?

Health care is a basic need and therefore in most instances, funded by government via tax collection from the public. Health care standard should be measured by public's view because the receivers are the public. If the definition of health care is decided as such, then the decision to open or maintain the system should depend on the people. Protectionism disguises greed to control and stay in power from objectivity.

Professionals are usually market-protected by the law (e.g. doctors) because no ordinary man is allowed to carry out their job. On the other hand, it is for example, prevention of fee competition or favouritism that they should be given reasonable market dominance in order to maintain a high
standard of service. If everyone on the street is an auditor, you can imagine how desperate s/he is to compete for client to earn a living that at the end, standard of service may be compromised.

In the first place, professional practice does not solely exist as a form of business. It is not in a form of commodity trading but a service that guarantees a certain standard and ethics of practice, not just what dollars and cents can buy. In many instances, they are vested with the power by Act of Parliament. In return, they are being regulated and liable for actions done onto the public. These are liabilities and penalties they face for their wrongs. In simple words, right gains marks, wrong minus marks.

If there is need of 'right and wrong' ways of doing things, by giving the professionals the power to self-regulate is a reasonable solution to set some standard of practice. In the US, state legislation defines their professionals. Some professionals cannot practice in certain states due to this protectionism. In the UK, Chartered Professional Bodies regulate their members and they are well sought after by world class employers and government bodies as reference.

So, is protection of professional necessary? There is no answer to the debate. With protection or without, market regulation is still the key to success or failure of any system. A good health care system is never practical without a set of effective control measures. Whether open or close the system is, unless regulatory system is effective, there is no need to talk about having world class medicine or having 'best buy' clinics everywhere in town.

Like the saying goes: 'Go to where the honey is', I doubt that any genius doctor would want to go all the way to poor African village to set up private clinic for the sack of serving mankind. Lifting protectionism will not make more rural clinics because why would a bright doctor come all the way from home to lower himself here. It is not likely to do any difference, because doctors will not leave the government to practice in the villages. And if they see no advantage, they still won't come. If that is the case, it is back to status quo.

Similarly, whether there is dispensing rights for the pharmacists, or the doctors should also dispense medicine is immaterial. It is the regulatory body that monitors the errant businessmen that makes the difference. Again, this is the role of regulator that I mentioned in my earlier article - Future of a simple man.

I come to the conclusion that no matter how good an idea is, it is the indispensable implementation and control mechanisms that make any difference in its ultimate success.