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MEDICAL PROFESSIONALS

March 2015

ISSUES PAPER

The Medical Professional Issues Paper

MPC is releasing this issues paper to assist individuals and organisations to prepare

and participate in the review. It contains and outlines:

the scope of the review

matters about which the MPC is seeking comment and information

information about how you can get involved in the review.

Participants may add any comment which they consider relevant to the review.

Submissions can be made by email or fax to:

Email : [email protected] and [email protected]

Fax: 03-79600 211

Contacts:

Mr. Mohammed Alamin Rehan

Tel: 03-7960 0173

Ms Ilyana Norsaidah Bt Ab Rahman

Tel: 03-7960 0173

mailto:[email protected]%20and%[email protected]

Table Of Contents

1.0 TERMS OF REFERENCE 1

1.1 What The MPC Has Been Asked To Do? 1

1.2 Conduct Of The Review 1

1.3 Timing 2

1.4 Contacts 3

2.0 SCOPE OF THE REVIEW 4

2.1 What Is This Study About? 4

2.2 Professionals Serving In The Health Industry 5

2.3 What Is Regulation? 8

2.2.1 Regulations 8

2.2.2 Regulatory burdens 8

2.2.3 Unnecessary regulatory burdens 8

2.2.4 Restrictions on competition 9

2.2.5 Unnecessary restrictions on competition 9

2.4 Market Challenges: Information Asymmetry 9

2.5 Barriers to Entry 10

3.0 RECENT DEVELOPMENTS AFFECTING PROFESSIONAL SERVICES 13

3.1 Expectation And Demand In Professional Services 13

3.2 Expectation In Professional Services Serving Healthcare Industry 14

3.3 Investment In Technology 14

3.4 Demand In Medical Professionals Services 15

4.0 REGULATION PROCEDURES IN PROFESSIONAL SERVICES VALUE CHAIN 16

4.1 Defining Regulations Within The Medical Professionals Services 16

5.0 YOUR OPINION ON UNNECESSARY REGULATORY BURDENS 22

5.1 The General Questionnaire 22

5.2 Some Of The Issues That Were Raised By Professionals 23

5.2.1 Controls on professional administration 23

5.2.2 Professional services regulators 24

5.2.3 Regulations pertaining to practicing certificates 25

5.2.4 Intervention by government and agencies 26

5.2.5 Entry requirement of professional registration 27

5.2.6 Setting up of clinics / business 29

5.2.7 Registration with government 30

5.2.8 Limitation of roles 30

5.2.9 Completion / termination of practice 32

ISSUES PAPER: RURB ON MEDICAL PROFESSIONALS

MEDICAL PROFESSIONALS IN MALAYSIA page

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MEDICAL PROFESSIONALS SERVICE SECTOR

1.0 TERMS OF REFERENCE

1.1 What The MPC Has Been Asked To Do?

The 10th Malaysia Plan has mandated Malaysia Productivity Corporation (MPC) to

carry out regulatory reviews in view of making it easy to do business in Malaysia. In

relation to this, the Malaysia Service Development Council (MSDC) has asked the MPC

to review the Professional Services to the health sector. This review process will draw

on the expertise and perspectives of public and private sector leaders, who will help

identify key issues and the appropriate solutions. It is part of one of the 12 National Key

Economic Areas (NKEAs) identified, namely healthcare.

1.2 Conduct Of The Review

The study will emulate the approach used by the Australian Government Productivity

Commission (AGPC) and the team will be guided by a regulatory expert Ms. Sue

Holmes. The team will select a sample of medical professionals practising within the

health sector and conduct interviews with the management personnel to identify the

regulatory issues of concern.

Based on the principles of good regulatory practices, the team will formulate feasible

options for further deliberation. These issues and options will be subject to further

consultation with relevant stakeholders in order to develop concrete recommendations

that will reduce unnecessary regulatory burdens.



2

Figure 1.1: Study Process of the review

1.3 Timing

This review commenced in August 2014 and has started with canvasing interested

parties about concerns with written regulation and its administration.

LIT

ER

AT

UR

E R

EV

IEW

IN

PU

TS

(R

eport

s,

We

b-s

ites,

Art

icle

s &

Sta

tistics)

CO

NS

ULT

AT

ION

AN

D E

XP

ER

T’S

AD

VIC

E (

Fro

m A

GP

C)

Conceptualize the Logistics Value Chain

List all Acts and map them onto the

Value Chain

Scoping & Target Selection

Develop Issues Paper with list of

questions

Conduct interviews

Analyse information gathered

Draft report (proposed options)

Public consultation

Final Report and submission



3

1.4 Contacts

Interested parties are welcomed to participate in this review. You can contact the

persons below on matters relating to this review.

Mr. Mohammed Alamin Rehan

Tel: 03-7960 0173

Email: [email protected]

Ms. Ilyana Norsaidah Bt Ab Rahman

Tel: 03-7960 0173

Email: [email protected]

mailto:[email protected]



4

2.0 SCOPE OF THE REVIEW

The regulations and agencies which govern the professional servicing the healthcare

industry will be assessed and analysed with the focus on modernising business

regulations. Any redundant, unnecessarily burdensome and outdated regulations will be

identified and options will be proposed to reduce the unnecessary burdens in order to

achieve a dynamic, modernised business ecosystem.

Over-regulating can occur either when it is not needed to address social, economic or

environmental concerns, or when legitimate issues, are addressed in overly costly

ways. Governments need to carefully balance the costs and the benefits to the public to

ensure the cost burdens do not outweigh the anticipated benefits

2.1 What Is This Study About?

The issues paper is intended to assist interested people either to contribute to a

meeting with MPC or to prepare a submission to the MPC on Medical Professionals

Services to the Healthcare Industry in Malaysia. It provides some general background

information and raises questions that can assist in preparing a submission. The issues

addressed in this paper and the guiding questions cover only a portion of the possible

issues. Hence, participants are encouraged to comment on any issues they believe are

relevant to the review whether or not they have been raised in this issues paper.

For the purpose of this review, the scope is focussed on four medical professions within

the healthcare industry and they include Doctors (general practitioners and specialists);

Dentists; Nurses (covering all areas of specialisation including midwifery) and

Pharmacists. These professions also contribute to other sectors such as education and

tourism.



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2.2 Professionals Serving In The Health Industry

A Medical Professional is someone who provides preventive, curative, promotional or

rehabilitative healthcare services in a systematic way to individuals, families or

communities. A health professional covered under this study may be within medicine,

midwifery, dentistry, nursing or pharmaceutical professions. These professionals are

persons formally certified by a professional body as belonging to a specific profession

within healthcare by virtue of having completed a required course of study and/or

practice, and whose competence can usually be measured against an established set of

standards.

For the purpose of this review, the scope will be narrowed down into four main medical

professionals servicing the health industry, which are Doctors, Dentists, Nurses and

Pharmacists. Nurses shall also cover specialised nursing areas including dental nurses

and midwives. These professionals are selected from a list of eight professions as they

represent the majority of the professionals within the industry. They do not only provide

services to the health industry but also other sectors such as education and tourism

while also contributing to the health of all citizens and thus the supply of healthy labour.

Hence, any improvements in the regulation of these professionals may add value to all

sectors and to social wellbeing.

The roles and description of medical professionals under this study are both legally and

functionally defined, as follows:

Doctors : Doctors are persons who are entitled to be provisionally registered as a

medical practitioner (MEDICAL ACT 1971, SEC 29). Functionally,

medical doctors examine, diagnose and treat patients. They can

specialise in a number of areas such as paediatrics, anaesthesiology or

cardiology, or they can work as general practice physicians, source:

CPC Medical Doctors Board of Malaysia.

http://en.wikipedia.org/wiki/Health_care

http://en.wikipedia.org/wiki/Medicine

http://en.wikipedia.org/wiki/Midwifery

http://en.wikipedia.org/wiki/Dentistry

http://en.wikipedia.org/wiki/Nursing

http://www.businessdictionary.com/definition/person.html

http://www.businessdictionary.com/definition/certified.html

http://www.businessdictionary.com/definition/professional-body.html

http://www.businessdictionary.com/definition/profession.html

http://www.businessdictionary.com/definition/completed.html

http://www.businessdictionary.com/definition/required.html

http://www.businessdictionary.com/definition/study.html

http://www.businessdictionary.com/definition/practice.html

http://www.businessdictionary.com/definition/competence.html

http://www.businessdictionary.com/definition/establish.html



6

Dentists : Dental practitioners registered in Division II of the Register; (DENTAL

ACT 1971). Functionally, dentists are health care practitioners who

specialize in the diagnosis, prevention, and treatment of diseases and

conditions of the oral cavity, source: CPC Dentist Board of Malaysia.

Pharmacists : Licensed to carry out a business, so far as such business relates to the

keeping, retailing, dispensing, and compounding of poisons, dangerous

drugs or therapeutic substances, in compliance with a few conditions;

(PHARMACISTS ACT 1951 (REVISED - 1989). Functionally,

pharmacists are drugs experts, responsible in dispensing medications,

educating consumers on the use of over the counter medicines and

advising other health professionals on drug decisions, source: CPC

Pharmacist Board of Malaysia.

Nurses : Person registered as a nurse in accordance with any written law

relating to the registration of nurses for the sick (MIDWIVES ACT 1966

(REVISED - 1990)) Functionally, nurses contribute to the health and

welfare of society through protection, promotion and restoration of

health; the prevention of illness and the alleviation of suffering in the

care of individuals, families and communities, source: CPC Nursing

Board of Malaysia.

Medical professionals being a party within the professional services industry covers the

activities of various Acts governing the professional codes of conduct. Generally, there

are about 150 Acts governing the practice of Medical Professionals. The main Acts

include:

i. Medical Act 1971 (Act 50)

ii. Dental Act 1971 (Act 51)

iii. Nurses Act 1950 (Act 14) & Nurses Registration Regulations 1985

http://en.wikipedia.org/wiki/Mouth



7

iv. Registration of Pharmacists Act 1951 (Act 371) & Registration of

Pharmacists Regulations 2004

(Collectively referred as ‘the Acts’)

The main objective of the professional Acts is to govern the practise of professionals in

the interest of the public and the nation. However, there are instances where over-

regulating of these professions may lead to unnecessary burdens on the practitioners

and result in higher costs or poorer service to the public. Unnecessarily demanding

Acts, rules and regulations need to be reviewed to make accreditation, career growth

and practice easier and to boost the effectiveness of medical services.

Table 2.1: Medical professional and their professional boards

MEDICAL PROFESSIONAL PROFESSIONAL BOARDS

Doctors Malaysian Medical Council

Dentist Malaysian Dental Council

Nurses Malaysian Nursing Board

Pharmacists Malaysia Pharmacy Board

These bodies are governed by the Ministry of Health Malaysia (MOH) and operate

under specific Codes of Professional Conduct (CPC) as specified in the Medical Act

1971 and related Acts and Licensing requirements as listed below. For this review,

please refer to Table 2.2 for the professionals listed in line no 1,2,3 and 5.



8

Table 2.2: List of Medical Professionals under MOH, Acts, Regulators and APC.

Source : MPC

2.3 What Is Regulation?

2.2.1 Regulations

Regulations are Acts, laws, by-laws, rules or directives prescribed and

maintained by an authority, especially to regulate behaviour. They can also

include quasi regulation such as guidelines and administrative circulars. A good

regulatory system should have a set of regulations which are clear to

practitioners, administratively efficient, enforceable and legitimate.

2.2.2 Regulatory burdens

Regulatory Burdens are the extra requirements, activities and costs that

practitioners must deliver or bear in order to comply with regulations. The extra

requirements usually demand extra efforts, time and cost from the practitioners,

thus impose costs on and often decrease the productivity of the practitioners.

2.2.3 Unnecessary regulatory burdens

Unnecessary regulatory burdens arise when regulation is more burdensome than

necessary in serving its objectives. They arise from inefficient and redundant

rules or directives or from poor administration by the regulatory authority. These



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unnecessary encumbrances impose a higher cost on business than necessary to

achieve the benefit.

2.2.4 Restrictions on competition

Restriction on competition are those that either prevent, or have the potential to

prevent anyone, or a number of market participants from competing on various

aspects such as price, quality, service delivery or even regulations imposed at

the point of entry. For Professional services, examples of these restrictions are

the limit to entry for foreign professionals and graduates into the local market.

2.2.5 Unnecessary restrictions on competition

Unnecessary restriction on competition are regulations that may be restricting

competition more than is needed to achieve its legitimate public policy objectives.

Examples include restrictions on starting a new business, regulations that affect

the ability to compete and regulations that affect business behaviour. Medical

Professionals are highly restricted from advertising their specialisations and

testimony. Such regulation on advertisement could form a restriction to

competition and deny the public access to relevant information about the service

providers.

2.4 Market Challenges: Information Asymmetry

One of the challenges faced by medical professionals is the dilemma of information

asymmetry or the Principal-agent theory which normally occurs when the "agent" is able

to make decisions that impact on another person or entity - the "principal". It exists

because sometimes the agent is motivated to act in his own best interests rather than

those of the principal. For example, a dental patient (the principal) may wonder whether

his dentist (the agent) is recommending expensive treatment because it is truly

necessary for the patient's dental health, or because it will generate income for the

dentist.

http://en.wikipedia.org/wiki/Agent_%28economics%29

http://en.wikipedia.org/wiki/Principal_%28commercial_law%29



10

The problem arises where the two parties have different interests and asymmetric

information (the agent having more information), such that the principal cannot directly

ensure that the agent is always acting in its (the principal's) best interests – this being a

conflict of interest .

In order to manage this situation and minimise losses on the service recipient, a good

regulatory practice is imposed such as regulating healthcare professionals through

occupational licensing.

An example of regulation addressing the Information asymmetry issue could be those

under the Medical Act 1971 which restricts doctors to two official treatments/ patients’

visit in a day, during a hospital stay as discussed in this Issues paper. This will bring us

to investigate the issue of public-private dichotomy in greater length, throughout the

report.

2.5 Barriers to Entry

Self-regulation by professional boards allows discretion to restrict entry and imposes

additional requirements in terms of training programmes and other qualifications in

selection of prospective candidates. The rules and regulations are frequently set up by

the professional bodies, reflecting the better capacity of the bodies to know what is

required to establish competency.

While professional bodies have a significant role to judge competency, they can face

two types of adverse incentives: one is to be too lenient on its members when

assessing poor performance; and the other is to apply entry requirements which are too

stringent in order to reduce competition, although some may see that the stringent

control is necessary to insure the quality and prestige of their professions.

Therefore, the regulators and Professional associations have to be cautious in

prescribing selecting criteria for entry to these professions and in regulating the delivery

http://en.wikipedia.org/wiki/Information_asymmetry

http://en.wikipedia.org/wiki/Information_asymmetry

http://en.wikipedia.org/wiki/Conflict_of_interest



11

of professional services, thus to get the balance right between protecting clients and

others from their incapacity to assess the competency of Professionals while not making

the barriers to entry overly stringent and thus reducing competition more than is

necessary.

In some self-regulatory systems, the rules are established by government or developed

by regulators with approval from government. Nevertheless, the governing body should

give priority to the public interest and not the interest of the profession alone, although it

is frequent that the public interest and profession interest can be the same. Due to the

intermittently conflicting interest between the public and the profession such as those

discussed in the information asymmetry where the medical professionals normally has

more or better information than the patient (the Principle Agent Theory), the government

usually requires a separation between profession governing body and professional

association.

While stringent requirements imposed upon the graduate to qualify for registration can

be seen as a way to safeguard the quality of medical service delivery if overly stringent,

they may exclude practioners who could do a competent job from providing services in

the market. An example is that a graduate from India who has completed the

‘Compulsory Rotating Internship’ or houseman ship, cannot be granted full registration

with the Malaysian Medical Council (MMC), even if they are fully registered with the

Indian Medical Council. Such a restriction may be unfavourable to these graduates or

hinder them from returning to Malaysia, causing the country millions of RM in experts

migration and and loss of potential contributor to the local healthcare system.

Another issue that is hindering competition is the regulation of the advertisement of

medical practices under the Medicines (Advertisement and Sale) Act 1956 (Revised

1983) and the Medicine Advertisements Board Regulations 1976. The regulation

restricts medical professionals from mentioning their skills, knowledge and experience

in any promotional material or advertisement. Testimonials from patients and



12

endorsements are also impermissible. However, weak enforcement has caused some

practitioners to disobey the regulation, giving them an advantage over competitors who

comply with the regulation.

When professional boards become too protective of their members and exclude

competent practitioners, it may be appropriate for government to intervene in order to

give priority to the public interest. It is important to be careful in differentiating useful

from unnecessary barriers to entry.



13

3.0 RECENT DEVELOPMENTS AFFECTING PROFESSIONAL SERVICES

The services sector, in particular medical professional services, plays an important role

in supporting the growth of Health Tourism in the country, generating over RM688

million in 2013. The growth of Health Tourism and Malaysia My Second Home which is

supported by the Annual Global Retirement Index for 2014 which voted Malaysia among

the top five best places to retire, also poses a potential increase in the demand for

medical professionals which spawns employment opportunities, source: International

Living, NST online 11/01/2015.

The number of medical professionals in the country is also growing with 5,000 medical

graduates entering the medical workforce each year. In addition to that, Malaysia also

gets 1,000 specialised medical experts a year, being part of the nation’s aim to provide

1 doctor for every 400 population. There are around 142,000 health professionals in

Malaysia as shown in Table 3.1.

Table 3.1: The distribution for Medical Professional in public and private sector.

Source : Health Facts 2013, Ministry of Health Planning Division

Table 3.1 indicates that the most favourable ratio appears in the number of nurses to

population which is 1: 345. The ratio between doctors to population has improved

significantly from 1: 1000 in 2008 to 1: 758 in 2013.

3.1 Expectation And Demand In Professional Services

Demand for and supply of health professionals and the nature of the services they

provide are heavily influenced by government. Collectively, the Malaysian Government



14

spent over RM16 billion on healthcare (4.96 Per cent of GDP), source Estimated

Federal Budget 2012, MOF. Expenditure on the medical workforce currently accounts

for about two-thirds of total health care spending.

Governments also regulate, and are the major employers of health workers, including

health professionals listed in this study. Malaysia health industry generally faces issues

on globalisation and the increasing trend of private healthcare spending, which poses a

great challenge in maintaining the strength of the current healthcare system.

3.2 Expectation In Professional Services Serving Healthcare Industry

Medical Professionals serving the healthcare industry are expected to be competent to

work across a complex set of inter-professional relationships and services. This

requires skilful management and vigilant mind-set that involves continual improvement

processes. A study titled “ A nationwide survey on the expectation of public healthcare

providers on family medicine specialists in Malaysia, 2014” shows that the public are

expecting a more coordinated service delivery form medical professionals. Examples of

the inputs include the expectation for more experienced specialist doctors compared to

junior Medical Officers (MO) in hospitals, ability to communicate effectively with other

discipline specialists for seamless patients referral and more time spent on clinical

duties than administrative or courses.

The significant collaboration between public healthcare and private practices shows the

growing expectation for cross coordination between medical professionals. Hence

investment in technology and communication becomes apparently important in

supporting these expectations.

3.3 Investment In Technology

Malaysia was voted third best in the world for healthcare services in 2014, Source:

International Living, Global Retirement Index. That is mostly attributable to the sound



15

deployment of technology by the medical professionals. These investments include

computer hardware and software. Online patients’ reporting systems enable

radiologists to transmit patients’ MRI or X-ray results to doctors anywhere in the world,

thus enabling more flexible medical professional services. However, such facilities

provide higher competitive advantage to more established practitioners, especially

those operating in remote areas. Like other software, there are also compatibility issues

faced by Medical Professionals. Therefore, there often include additional investment to

upgrade existing systems and training on the usage of the new technology.

Technology has also made drugs prescription easier. However, it could pose danger to

patients who could purchase freely from the internet and have the drugs consumed

without prescription from any doctors or certified medical professionals.

3.4 Demand In Medical Professionals Services

The expected demand in the Professional services can be estimated by comparing the

professional to population ratio. There is clear evidence of a global skills shortage that is

particularly acute in the developing world. In 2011, Manpower Group’s annual Talent

Shortage Survey found that 45% of Asia-Pacific employers had difficulty filling job

vacancies due to a lack of available talent. About three-quarters of employers globally

cited a lack of experience, skills or knowledge as the primary reason for this struggle to

hire appropriate workers.

In Malaysia, there are about 15,000 unemployed nurses in the recent year. Hospitals

have blamed the low quality of training and attitudes for them being unemployable. The

recent plan to separate drugs dispensing and prescription may also alter the demand for

medical professionals and may result in shortages, especially in remote areas where

the number of pharmacists are already limited.



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4.0 REGULATION PROCEDURES IN PROFESSIONAL SERVICES VALUE CHAIN

4.1 Defining Regulations Within The Medical Professionals Services

The value chain covered within the study starts from the stage of acquiring education

until the departure from professional medical practice:

Figure 4.1 : The Value Chain of Medical Professional

In this context, the scope of this review shall cover the following:

Tertiary education required to obtain the first certificate to be certified and

practise within the field of medicine (minimum requirements, supply vs. demand,

quality).

Placement as junior practitioners (e.g. houseman ship, trainee nurse).

Delivering services (in MOH hospitals or private practices) - Annual Practicing

Certificate (APC) and other requirements;

Qualifying for specialisation (e.g. requirements based on the number of years of

service, demand for specialist and the areas of specialisation);

The completion or termination of practice.

To understand the current regulations that are governing each step within the Value

Chain, herewith is the list of regulations, Acts and relevant requirements with the

Ministries and Regulators responsible. Each process is mapped against related

regulations, acts and requirements to enable respondents to examine the regulatory

issues that are encumbering each process within the chain.

Pre-Qualification

Medical Prof. Trainee

General Practices &

Specialisation

Exit / Termination



17

Table 4.1: Value Chain mapped against Relevant Acts / Regulations

STAGE ACTIVITIES /

PROCESSES

ACTS /

REGULATIONS

REGULATORS /

GOVERNMENT

BODIES

Pre-

Qualification

1. Tertiary

Education pre-

requisite.

2. Entry into certified

medical schools.

3. Qualifying

Examinations.

Education Act 1996

(ammd. 2006).

Medical Act (1971)

Private Higher

Education Act 555

(1996 amend 2006)

Ministry of Education

(MOE)

Ministry of Health

(MOH)

Boards of Each

Medical Professional

Service Entry 1. Comply with

Placement /

Houseman ship

requirement in

MOH Hospitals.

2. Restrictions to

overseas

graduates and

foreigners.

3. Additional

Requirements for

overseas

graduates from

certain countries

and private

institutions.

Education Act 1996

(ammd. 2006).

Medical Act (1971)

– Amend 2012

Private Higher

Education Act 555

(1996 amend 2006)

Medical

Regulations 1974

Medical (Setting for

Provisional

Registration)

Regulations 2012

Nurses Act 1950

(Amend 1980)

Medical Qualifying

Exams.

Registration of

Pharmacist Act


(MOE)

Ministry of Health

(MOH)

Ministry of Human

Resource

Malaysian Medical

Council (MMC)

Malaysia Nursing

Board.

Pharmacy Board

Malaysia Dental

Association (MDA)

Midwives Board



18

STAGE ACTIVITIES /

PROCESSES

ACTS /

REGULATIONS

REGULATORS /

GOVERNMENT

BODIES

1951

Midwives Act 1966

(Rev 1990)

Malaysia

employment Act

1955.

General

Practitioner

and

Advancement

-

Specialisation

MOH Hospitals:

1. Requirements for

entry into

practice.

2. Career

advancement-

availability of

patients and

cases to improve

competencies /

Continuing

Professional

Development

(CPD)

3. Requirements to

qualify for

Specialisation.

4. Obtaining

specialisation -

field of study :

Fitting supply with

Medical Act (1971)

– Amend 2012

Medical

Regulations 1974


Provisional

Registration)

Regulations 2012

Nurses Act 1950

(Amend 1980)

Registration of

Pharmacist Act

1951

Midwives Act 1966

(Rev 1990)

Private Healthcare

Facilities &

Services Act 1998.

PDPA 2013

Malaysian Health

Promotion Board


(MOE)

Ministry of Health

(MOH)

Ministry of Human

Resource.

Ministry of Domestic

Trade, Co-operatives

and Consumerism.

Ministry of Trade and

Industry (Tourist

Development

Corporation-TDC)

Malaysian Medical

Council (MMC)

Malaysia Nursing

Board.

Pharmacy Board

Malaysia Dental

Association (MDA)

Midwives Board



19

STAGE ACTIVITIES /

PROCESSES

ACTS /

REGULATIONS

REGULATORS /

GOVERNMENT

BODIES

demand.

5. Code of Conduct

6. Registration and

Licenses to

practice

Private Practices:

1. Qualification to

practice in private

practices.

2. Statutory

Registration.

3. Professional

Registration/

Licenses.

4. Sales of Drugs.

5. Codes of Conduct

: Private

Healthcare

Regulations

6. Maintenance and

Administration of

practice location /

professional

license/

registration/

medical

Act 2006.

Fees Act 1951 –

Fees Medical Rev

1994)

Registration of

Pharmacists Act

1951 (Rev- 1989)

Medicines

(Advertisement &

Sales) Act 1956

(Rev-1983)

Dental Act 1971

Dangerous Drugs

Act 1952 (Rev

1980)

Malaysia Tourism

Board Act 1992

Malaysia

Employment Act

1955.

Medical Devices

Act.

Malaysia Healthcare

Travel Council

(MHTC)



20

STAGE ACTIVITIES /

PROCESSES

ACTS /

REGULATIONS

REGULATORS /

GOVERNMENT

BODIES

employees.

7. Provide support

for Health

Tourism

Termination/

Exit

Exit process

1. While under

contract

2. After contract

expiry

3. Natural attrition

(retirement).

4. Disciplinary –

Force to exit

Medical

Regulations 1974


Provisional

Registration)

Regulations 2012

Nurses Act 1950

(Amend 1980)

Medical Qualifying

Exams.

Registration of

Pharmacist Act

1951

Midwives Act 1966

(Rev 1990)

Malaysia

employment Act

1955.

Occupational

Licensing of

Healthcare


(MOE)

Ministry of Health

(MOH)

Ministry of Human

Resource

Malaysian Medical

Council (MMC)

Malaysia Nursing

Board.

Pharmacy Board

Malaysia Dental

Association (MDA)

Midwives Board



21

Table 4.1 may not show the full process in delivering the professional services, but it is

intended to assist respondents to gauge the scope of regulatory burden imposed on

these Professionals at every stage of the profession. Professionals may encounter

numerous regulations other than those stated above such as regulations pertaining to

professional fees charges, rules in delivering services, contract administration,

professional risk and indemnity, etc. may also be raised. Therefore, additional

information that may be relevant from the respondents’ experience and perspective are

welcomed including suggesting any additional regulations which should be added to this

list.



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5.0 YOUR OPINION ON UNNECESSARY REGULATORY BURDENS

The MPC has developed a standard set of questions for its reviews and these are listed

directly below. In addition, some specific issues are nominated followed by some

questions. The MPC would like to hear what you consider are regulatory costs which

require modernisation, irrespective of whether they are listed here.

5.1 The General Questionnaire

1. Which regulations, including those written and/or administered by Professional

associations, concern you the most? Why?

2. Which regulations are the hardest to comply with?

3. Which regulations do you think are too burdensome given what they are trying to

achieve?

4. Do you think any regulations are not justified at all?

5. Are some regulatory requirements inconsistent? Are all requirements publicly

accessible?

6. Do you consider the Professional associations and other regulatory

administrators do a good or a poor job? In what ways?

7. Do you find the Professional associations and administrators are consistent in

their decisions?

8. Do you find they are helpful or unhelpful in advising you how to comply? Are

there any publicly available guidelines?

9. How long do the Professional associations and other regulators take to respond

to applications to register, etc.?

10. Do you have any suggestions for reducing the burden of compliance of

regulations whether administered by the Professional associations or

Government administrators?

11. Some practice guidelines, technical instructions, circular letters and other forms

of administrative controls implemented by the regulators are not gazetted, do you

have trouble in knowing when they have been issued and in accessing them?



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12. Is there any administrative controls implemented by the regulators and

Professional associations which you believe are unnecessary?

5.2 Some Of The Issues That Were Raised By Professionals

5.2.1 Controls on professional administration

The regulation and administration of professional practice by the professional boards

are made with the authority provided under an Act of Parliament. Through the

professional Acts, the relevant boards regulate the practice of its professional members

and makes rules and regulations to be adhered by its members. Amendments to the

Acts must be formalised by a gazette in Parliament. Rules and regulations made by the

Boards can be gazetted under the minister and are not required to be tabled in

Parliament, though they must be formalised through the Ministry’s approval.

Although the Federal Government holds the highest authority in the legislative structure,

state and local governments are also empowered to issue gazetted state and

municipality regulations, rules and by-laws as long as they do not contradict the Act of

Federal Parliament.

Besides the Acts of Parliament, gazetted regulations and rules, it is also common for

regulators to issue other forms of controls such as technical and non-technical

statements of policies, practice guidelines, circular letters, letters of instructions, desk

instruction and technical instructions. While these controls do not constitute a law under

the legislation they form the administrative procedure required to be fulfilled by

practitioners and as such will be treated as regulation. The administrative controls may

be introduced by the regulators from time to time to facilitate the administration of the

practice of its members.



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Que 13: What is your view over statutory non-professional task to the professional

practitioners such as government service tax collection/ Goods & Services Tax?

Que 14: Do you think it is easy or not easy to access all regulations relating to the

medical professions? Are circulars, etc easy to understand?

5.2.2 Professional services regulators

Through the provisions of the respective Acts, there are various regulators that are

administering some Acts that are affecting the practice of medicines in the country. An

example of this is the Clinical Waste Management regulations that are administered by

the Department of Environment (DOE) and the Private Healthcare Facilities & Services

Act 1998 that is regulated by the Ministry of Health (MOH). Within the regulation, a pro-

rated charge for all types of private practices regardless of the amount of waste

produced is being imposed (e.g.: a Psychiatric clinic with minimum or zero clinical

waste must pay the same rate of charges as imposed by the law on Dentists who

produce more wastes in their service delivery). PDPA is also seen by practioners as an

additional burden and redundant as it has been postulated earlier under the Private

Healthcare Act (PHCA).

Another example is the renovation requirements for clinics and private hospitals.

Although the regulations are governed by MOH under the Private Hospital Act 1998, its

practice is also administered by the Local Council who determines the annual business

license renewal. There are issues regarding the differences in regulations interpretation

and also the enforcement approach. In addition to that, issues also arise when the

inspections by various regulators are done at isolated time leading to encumbrances to

medical professionals operating private practices.



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Que 15: Do you think there are too many regulations and regulators? If so which ones

are not required or could be improved or merged? Do medical practioners find they

have to provide the same information to more than one regulator?

Que 16: Do you find any regulations and/or regulators to be inconsistent? For example,

some ….LG vs the Act – MoH, DoE, LGs

Que 17: Have you experienced difficulty with waste material management this regards

and how do you think the situation could be improved?

5.2.3 Regulations pertaining to practicing certificates

Based on initial discussions with the respective respondents operating within the

healthcare industry, some of the most pertinent regulatory issues faced by Medical

Professionals in the healthcare industry are the burdensome processes in dealing with

service delivery. These processes consist of a wide range of procedures from

application for registration with the Council or relevant professional Boards,

examinations, registration for Annual Practicing Certificates (APCs) and renewal to the

administration of fees involved to comply to these certifications. In many cases, the

process may also include the requirement for private Medical Professionals such as

Doctors and Dentists to obtain separate APCs for each place of practice, hence

subjecting a locum serving 10 clinics to acquire and administer 10 APCs on an annual

basis.

Under the Medical and Dental Acts 1971, both medical Doctors and Dentists must

register with the respective Malaysian Medical Association (MMA) and the Malaysian

Dental Council (MDC) and must acquire the Annual Practicing Certificate (APC) for

each place of practice, in order to legally practise. These licenses must be renewed on

an annual basis as opposed to other countries like Singapore that allows a validity

period for practicing certificate or PC to up to two years.



26

Que 18 : What purpose do these demanding and lengthy requirements serve? How do

you think the situation could be improved?

5.2.4 Intervention by government and agencies

The general purpose of the present professional Acts generally is sufficient to govern

the practice of the Professional boards. However in some cases, the boards do not

enforce some aspects of these Act, thus, the Government through various agencies

imposes extra regulations to enforce the practice of the Professionals. For an example,

the Professional Board of Nurses together with the MOE administers the development

of training faculty curricula and facilities for nurse training. However, many private

institutions providing nursing education are not affiliated with any hospitals whilst the

Department of Public Services (JPA) is expecting a nurse to function in a clinical setting,

not just teaching and managing. A local study, “Basic Nursing Competencies for

Recent Diploma Graduates” by MOE revealed that student nurses from such private

institutions had difficulty getting clinical experience. If the regulation in nurses training is

not improved, candidates could be disadvantaged from further career opportunities.

Where the Government senses inefficacy of regulation by the professional boards, it

may introduce additional measures to stiffen the regulation. Frequently, the introduction

of additional regulations are meant to protect the interest of the public and to improve

the administration of the professionals, however, sometimes they may not work as

intended. Under the new Regulatory Impact Assessment (RIA) requirements, the

regulators need to analyse any proposal for new regulations before their implementation

to avoid overlapping regulations by multiple agencies.

Que 19: Respondents are encouraged to give feedback and suggestion on their

experience and concerns in dealing with these regulations.



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Que 20: Can you suggest ways to address this overlap in functions and regulations

which would be less burdensome?

5.2.5 Entry requirement of professional registration

Prior to acceptance of registration as professional member with the professional boards,

a graduate must undergo specialised training consisting of recognised education

programme, practical experience and professional examination or interview to qualify for

the registration. Professional board may prescribe their own entry rules and requirement

to be fulfilled by the prospective professional.

Professional boards through their professional accreditation councils or agencies also

set the criteria for assessment and accreditation of programmes offered by institutions

of higher learning. Subsequently, the institutions are required to apply for renewal of the

accreditation validity before expiring of the terms to ensure continuous validity of the

programme.

Graduates who have completed their study from unrecognised programmes will not be

able to be registered as graduate members of professional boards, unless after going

through additional trainings, courses, examination or interview as determined by the

professional boards. The Board only accepts application from graduates graduating

from recognised institutions as per the Schedule 2 of the Medical Act, although there

were cases where these institutions were approved by the Ministry of Public Services

(JPA).

The Ministry of Health (MOH) regulation states that foreign medical professionals are

prohibited from participating in private practice. Provisional registration is available only

to practitioners with the following nationality, rights and qualifications:

Holding a basic medical degree from a recognised institution (as per the Second



28

Schedule ( ) of the Medical Act 1971);

Malaysian citizens;

For non-citizens, exemption is given only to local graduates or those related or

married to Malaysians.

Exemption is only given to non-citizens who are local graduates and those related or

married to Malaysians. To that effect, candidates should submit relevant

documents/testimonials from consultants where the rotations were previously done. The

testimonials should state the date of commencement and completion of each posting

and that the work and conduct was satisfactory. Pursuant to the Medical Act 1971, an

application is accepted only if the graduate has completed internship in a foreign

country to the satisfaction of the Medical Qualifying Board.

As the ‘Compulsory Rotating Internship’ is part of a medical programme, fresh

graduates from training institutions in India are not qualified to apply for exemption or

full registration, even though they are fully registered with the Indian Medical Council.

The Registration of Pharmacist Act has been amended [Act A1207 - The Registration of

Pharmacists [Amendment] Act 2003] to make it mandatory for pharmacists to serve the

government for a period of 4 years. In this compulsory service, Pharmacy graduates are

required to be provisionally registered with the Pharmacy Board of Malaysia and on

being provisionally registered, engaged in employment as a public servant in a listed

premise for a period of not less than one year, before serving the government for

another 3 years. Failure to serve the government on full registration may lead to a fine

not exceeding fifty thousand ringgit. However, it is not clear the MOH hospital can

provide enough training facilities and dental experts to train these graduates?

Like other medical professionals, Nurses are also subject to registration with the Nurses

Board upon satisfying the requirements. That also applies to individuals trained outside

Malaysia as stated in Nurses Act 1950.



29

Que 21: What is your opinion on the academic qualifications and practical experience

prescribed by the professional board for graduates to register as professional

members? Are they justifiable or otherwise?

Que 22: What is your opinion of the self-regulation practised by the professional boards

to regulate their members?

5.2.6 Setting up of clinics / business

The usual type of registration of private clinics with CCM is via either partnership or

body corporate, whereby the registration of sole-proprietor practice with CCM is

optional. Conventionally, the registration of body corporate (private limited company) is

governed under the Companies Act 1965, and the registration of partnership practice is

under the Registrations of Business Act 1956. The conventional partnership setup has

no limitation of risk of liability, however, a recently enacted Limited Liability Partnerships

Act 2012 shall give options for practitioners to setup their partnership practice with

limited liability under the Limited Liability Partnerships Act.

One example of an arduous regulation with regards to starting a practice is a

requirement stated under the Private Healthcare Act that requires a maternity

centre/hospital to have a resident anaesthetist and a paediatrician. The regulation may

cause serious cost implication to small hospitals as they need to maintain the cost of

resident specialists when the number of delivery cases especially caesarean is low.

Que 23: Is this regulation too onerous for most maternity centres or are they justified by

health and safety concerns?



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5.2.7 Registration with government

Besides registration with the professional board for the professional practice and CCM,

firms also need to be registered with the Ministry of Finance (MOF) as a prerequisite for

delivering panel professional services to the government and its agencies. The

encumbrance of being a panel clinic is the presence of a 3rd party administrator.

These practices, if not governed effectively may impose serious financial burdens on

Medical Professionals. An example was cited that a third party administrator currently

owes 35 doctors in Malaysia an amount of RM500,000 for the medical services

rendered to patients registered under their medical panel.

Another hurdle in the registration system with the Government is the single registration

entitlement for every individual person. Any person or business owner who is registered

with MOF under any company name, is prevented from registering with another

company, hence, the second company must appoint new directors, source :

http://home.eperolehan.gov.my.

Que 24: What objectives are served by having a third party administrator and the single

registration entitlement? Do the requirements impose unnecessary burdens? Are there

better ways to achieve the Government’s objectives so that any burdens on business

are lowered?

5.2.8 Limitation of roles

Regulations under the Medical Act 1971 also restrict doctors to two official

treatments/visits during a patient’s hospital stay to protect them from doctors

overcharging (principle-agent theory). On the other hand, some doctors feel that the

regulation is preventing them from charging for services rendered to patients with critical

medical needs. This issue also arises with a patient in labour, who requires a visit by a

doctor every four hours. Although the restrictions were designed to mitigate the

dilemma of information asymmetry within the medical professionals’ services industry,

http://home.eperolehan.gov.my/



31

such restriction may deny patients’ rights to treatment and doctors’ rights to charge,

where genuine needs arise.

Under the CODE OF PROFESSIONAL CONDUCT (Medical Act Section 19(2)),

Responsibility for Standards of Medical Care to Patients, doctors, In pursuance of their

primary duty to protect the public, are expected to provides the following:

1. conscientious assessment of the history, symptoms and signs of a patient's

condition;

2. sufficiently thorough professional attention, examination and where necessary,

diagnostic investigation;

3. competent and considerate professional management;

4. appropriate and prompt action upon evidence suggesting the existence of

condition requiring urgent medical intervention; and

5. readiness, where the circumstances so warrant, to consult appropriate

professional colleagues.

The Council may institute disciplinary proceedings when a practitioner appears

seriously to have disregarded or neglected his professional duties to his patients whilst

the public is entitled to expect that a registered medical practitioner will provide and

maintain a good standard of medical care. Such limitation of roles may subject doctors

to negligence and additional burden in procuring their services.

Que 25: Do you think these restrictions are justified or unjustified? Are there other ways

that could protect patients without such restrictions on services received? Do you know

of other restrictions which might not be justified or which limit the flexibility with which

medical services are provided?



32

5.2.9 Completion / termination of practice

Upon retirement or termination of a professional practice, the practitioner may opt to

terminate their practice licence with consent from the respective professional boards.

Termination of the licence may be voluntary by the professional or by regulatory

enforcement by the professional boards. Professional boards may exercise its power to

cancel the professional registration through provisions of the Acts.

Voluntarily termination by a Professional can be done by informing the relevant

professional board the intent to retire, cancel registration or close the practice.

Supporting documents such as a Letter of Release is required to be presented together

with the application. Voluntarily cancellation of registration may also be achieved by a

Professional by not renewing the annual subscription, thus resulting in the cancellation

of registration by professional boards through enforcement of regulations.

Upon the acceptance of application to terminate the professional registration, a

Professional must cease practice and cease providing professional services. However,

it is often tedious for a Medical Professional to transfer the ownership of the practice to

another professional. That is due to the regulations stated in the Private Healthcare Act.

Que 26: Are there ways to make closing a clinic less burdensome?



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______Medical

______Dental

______Nursing (Please indicate areas of specialisation if any)

______Pharmacy

______Others (please indicate)

APPENDIX 1

Expression of interest

Malaysia Productivity Corporation

RURB ON MEDICAL PROFESSIONALS

Please complete and submit this form with your submission:

By email: [email protected] OR by fax: (03) 7960 0206

Or by post: Malaysia Productivity Corporation

A-06-01, Tingkat 6, Blok A, PJ8

No.23, Jalan Barat, Seksyen 8

46050 Petaling Jaya, Selangor

Organisation……………………………………...……………………………………..

Street address………………………………………..…………………………………

City…………………………………………… State & Postcode

Postal address

…………………………………………..………………………………………

City…………………………………………… State & Postcode

Principal contact ………………………….. Phone ………………….…

Position……………………………………… Fax ………………….…

Email address

………………………………...………

Mobile ………………….…

Please indicate your interest in this review:

Be informed of developments including receiving the draft report

Would like to be interviewed by the MPC

Would like to make a submission

Nature of your activity

mailto:[email protected]

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