Waste of Funds

9:39 AM

If you expected a write up on the Tabung Haji - 1MDB issue; you have come to the wrong place. If you want to read about how SOME Malaysian public are wasting your precious tax payer's money, do read on.



I encountered two very different patients this week with the same chronic disease: Diabetes Mellitus.

CASE 1

Mrs A is a foreign immigrant registered under UNHCR. She has Diabetes Mellitus since 2013. She was previously under follow up at a different clinic. However, due to the enforcement of our healthcare policies for foreigners, she can't afford proper healthcare and defaulted treatment for 1 month. Naturally, her sugar level was poorly controlled. Looking at the fee schedule (attached), in order for her to get proper treatment she would have to fork out:

1. RM 15 per clinic visit
2. Metformin 500 mg, twice a day (oral hypoglycemic agent);
    13 sen per tablet x 2 for 30 days = RM 7.80
3. Diamicron 80 mg, twice a day
    RM 1.83 per tablet x 2 for 30 days = RM 109.80

Fee schedule from MOH


Consumer price guide from Pharmaceutical Services Division

Consumer price guide from Pharmaceutical Services Division

Please note that government clinic DOES NOT provide the medications for foreigners. Medications are only given for short duration (max. 5 days). They will need to get the remaining doses from the pharmacy (with proper prescriptions).

Assuming that she only has appointments every 6 months, her annual healthcare cost is:

[RM 15 x 2 (2 visits per year)] + [RM 117.60 (cost of medications) x 12]
= RM 30 + RM 1411.20 = RM 1441.20

Mind you, this does NOT include the cost of blood investigations such as HbA1C, renal profile, fasting blood sugar and lipid profile.

CASE 2

Auntie X came to the clinic with her daughter. She has Diabetes Mellitus for almost TEN years. Yet, she ALWAYS defaults on follow up. She NEVER adheres to the appointment schedule and comes as she pleases. As she comes to see me recently, she came to show me some new medicine she got from the hospital (somewhere along the way, she was being seen at the specialist clinic). Not just a few papan, but a whole BOX!

1. Vildagliptin
2. Diamicron MR

Consumer price guide from Pharmaceutical Services Division

These are good, new drugs. We have limited supply of Diamicron MR in my clinic but no Vildagliptin. Knowing how good these drugs are, I was surprised that her capillary blood sugar (CBS) was 23 mmol/l.

Me:                   Auntie, how come your sugar so high? Did you take your medicine today?

Auntie X:         No la. I take whenever I please. Sometimes I take, sometimes I don't take. Ikut suka                              la!

I was boiling inside....but I cannot be too blunt with an old lady. Need to be a bit polite.

Me:                 I'll have to observe you for a while and hydrate you a bit. I'll take you to the                                          emergency room and assess you further (TRO DKA).

Suddenly the daughter just shouts:

Lagi mau tunggu ka?! Sudah lama la tunggu. Mau kasi mati ka?

....and the Auntie back up her daughter some more!

That was the last straw. I am not a person who shouts at people. My reaction was:

Takpa. I'll give you this slip outlying my plans for my staff to execute at the emergency room. If you want to leave, it is all up to you. It is your mother's health, not mine. I have done my duty. 

They slammed the door and left. 

Getting verbal abuses and insults from patients and their family members is a norm. But what got my gears really grinding was the complete ignorance to the cost of her treatment.


Diamicron MR is RM 3 per tablet. And she is supposed to take 3 tablets a day. While Vildagliptin is RM 3.68 per tablet. How much should it have cost her?

RM 5 per specialist clinic visit 
Diamicron MR; RM 3 x 3 for 30 days = RM 270
Vildagliptin; RM 3.68 for 30 days = RM 110.40

How much is her annual healthcare cost?

[RM 5 x 2] + [(RM 270 + RM 110.40) x 12]
= RM 10 + RM 4564.80 
= RM 4574.80

And how much is she paying now?......NOTHING! Her husband is a pensioner.
How much tax did YOU pay last year?

TAKE HOME MESSAGE

I am not here to be berkira with all the costs. It IS tax payers money, and everyone is entitled to use it. But please, please, PLEASE DON'T ABUSE IT. When medications are given, use them accordingly. Don't waste. Foreigners are dying to get a hold of this ALMOST free healthcare service. But Malaysians just take it for granted. As the saying goes;

NO ONE APPRECIATES THINGS THAT ARE FREE

.....until they lose it one day. And by the look of things that ONE DAY is not that far off.






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10 comments

  1. ..... wonder what will the auntie will say if she came back septic and both legs are just too far gone to be saved?

    ReplyDelete
    Replies
    1. I guess the most common reaction will be blaming the doctors incompetent, and might be on the headline of newspaper. You might get sued If you are lucky

      Delete
  2. Excellent and insightful post.
    Share in the Doctors only FB group Dobbs and this has generated many comments from doctors

    ReplyDelete
  3. how irritating! The ignorance of the elderly lady is one thing but that kind of attitude from the daughter is uncalled for..

    ReplyDelete
  4. how irritating! The ignorance of the elderly lady is one thing but that kind of attitude from the daughter is uncalled for..

    ReplyDelete
  5. i honestly think u shud try to educate them more about their blood sugar control. ur the one whos educated and they prob dont know anythg about significance of 23mmol sugar in blood, which is the reason they dont think its important to be in hosp and so on.

    and his husband is a pensioner. which means he had worked for the government for very long time when he was young,which explain the reason why they deserve to get the free meds. common sense. it is government responsibility to give to their rakyat free healthcare.

    ReplyDelete
    Replies
    1. A diabetic for 10 years and still needs education. Damn, that's no common sense, that's basically a lady not giving a shit am I right? But yes, healthcare professionals do try, and when we see ignorant people like this particular aunty oh goodness heavens we do try to be nice and educate but something made us snap (probably ignorance) and damn its pretty often when it comes to diabetics, it's hard on us too. Ah maybe that's just me, I can't speak for other people.

      Delete
    2. A diabetic for 10 years and still needs education. Damn, that's no common sense, that's basically a lady not giving a shit am I right? But yes, healthcare professionals do try, and when we see ignorant people like this particular aunty oh goodness heavens we do try to be nice and educate but something made us snap (probably ignorance) and damn its pretty often when it comes to diabetics, it's hard on us too. Ah maybe that's just me, I can't speak for other people.

      Delete
  6. every citizens have a right to access the healthcare service regardless if it is free or not.

    Being a public servant does not give a person above right against a non-public servant. That like saying a paddy rice farmer who spend his whole life producing one of the essential source of economy in our country does not deserve to get the free med as he/she hasnt work for the government. Or a hardworking father who opened a shop that successful enough to support his family does not deserve the free medications. That mentality need to change.

    In regards to your comment about the author responsibility to educate the patient, as a medical professional myself, i gave the author the benefit of the doubt that he/she choose not to include that particular part of the conversation in the article.

    As a diabetic patient of 10 YEARS, the patient should have an insight about her own disease and recognise the importance of taking her medications regularly, knowing that BSL 23 is NOT GOOD, and attend follow-up regularly. I'll be surprise that in a space of 10 years, none of the possible at least 10 doctors that she might have seen, fail to educate the patient this tiny bit of fact.

    In the end of the day, regardless if healthcare is free or not, the patient themselves have to take the responsibility of looking after their own health with the assistance of medical professionals and healthcare services

    ReplyDelete
  7. Sorry Dr. Diamicron MR supposedly to be taken only once daily. Not TDS.

    ReplyDelete

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