Medical Fee Structure - Deregulate

Doctors and dentists in private clinics and hospitals can soon decide how much to charge their patients, following a decision by the Cabinet to deregulate the fee structures and let free market reign.

The latest decision will strengthen the consumers' power to choose their doctors.

Health Minister Datuk Seri Dr Dzulkefly Ahmad, who announced this, said the Cabinet had assessed the matter holistically and comprehensively as well as taken into consideration the recommendations from the National Cost of Living Council.

The Cabinet is also concerned about the need to amend the Seventh Schedule of the Private Healthcare Facilities and Services (Private Medical Clinics and Private Dental Clinics) Regulations 2006, which has not been amended since it was enforced in 2006, he said.

"With the control of consultation fees abolished, doctors can now determine their own consultation fee rates," he said in a statement on Friday (Dec 6).

The abolition of the fee control will include all registered facilities (in the Seventh Schedule) and licensed facilities (13th Schedule), said Dzulkefly.

The fees for GPs and dentists, as stated in the Seventh Schedule, have not changed in 27 years and doctors have been calling for the fee harmonisation as provided for in the 13th Schedule of the regulations when it was revised in 2013.

In 2013, the consultation fee was gazetted for medical officers working in private hospitals under the 13th Schedule, but was overlooked for GPs and dentists working in private clinics under the Seventh Schedule.

The current fees of RM10 to RM35 for GPs and dentists practising in shoplot clinics have not been revised since 1992 while medical officers at private hospitals who have the same qualifications have been charging between RM30 and RM125 per consultation.

After much protest from doctors, on May 9, Dzulkefly said the Cabinet did not reject the proposal but it would be discussed at the National Cost of Living Council meeting before being brought up in the Cabinet again.

In the statement, Dzulkefly also said the measure was seen as a mechanism that would motivate doctors to improve on their skills, professionalism and quality of service.

"It is also hoped that it will motivate the private health services sector," he added.

Following this, Dzulkefly said the ministry would look into new rules to strengthen the current regulations for them to be more transparent and friendly in the service delivery for patients.

"Among others, the consultation fees must be displayed clearly so that patients are aware of the fees before getting treatment," he said.

If patients are not happy with the charges or services received in any of the private facilities, they can lodge a complaint with the Private Medical Practice Control Section at ckaps.aduan@moh.gov.my for further investigation, he said.

The ministry will also hold sessions to explain the matter to various groups.

Sasa - 5 Lessons To Learn

When Sasa announced closure of its Taiwan outlets in February 2018, I asked its Singapore office if Singapore would be affected. The official statement brushed off the idea, pointing to the opening of a new concept store, modelled after its “successful predecessor” at Causeway Point that opened in October 2017.

This week, less than two years later, the house of cards came crashing down. The cosmetics retailer announced it will be closing all 22 stores in Singapore, citing “less than satisfactory” performance of six-year losses.

As a beauty editor and an industry observer, I was not surprised by the closure at all.

NOT BECAUSE OF THE RISE OF E-COMMERCE - When the news broke, many netizens pointed to high rental rates as the main cause. But while Singapore’s retail malls charge notoriously high prices, I don’t think these are the chief culprits in this saga.

After all, successful beauty retailers take up huge physical retail spaces in upscale districts. Sephora opened a 5,300 sq ft outlet in Westgate in 2018 and, after a two-month renovation, re-opened its Ngee Ann City outlet.

Watsons also recently revamped its 7,000 sq ft flagship store in Ngee Ann City, with most of the space dedicated to displaying beauty products. So what were other retailers doing right? Where did Sasa come up short?

1. NO FUN EXPERIENCES - The beauty landscape in Singapore is competitive. Consumers are exposed to international trends, savvy about how to get hold of products to achieve trending looks, and have enough to set aside a substantial budget.

The discerning beauty shopper now looks for more hands-on experiences with brands and products.

With so many options at their fingertips, consumers are inclined towards retailers they can try on and experiment with – and will return for more if they have a good experience.

This is why retail spaces are still important as far as cosmetics is concerned.

The reopened Sephora Ngee Ann City, for instance, introduces new features such as a fragrance discovery bar, a beauty studio that offers personalized consultations, including a skin analysis app.

Guardian also opened a concept store at Ang Mo Kio Hub, with a layout that highlights the beauty brands it stocks. Featuring lit-up mirrors, wider aisles, and tissues and cotton pads to facilitate trials, the retailer is definitely trying to please beauty consumers.

In comparison, Sasa’s traditional layout with narrow aisles doesn’t make it easy to explore the offerings in-store. Store assistants are more pushy sales representatives than beauty consultants who can help consumers discover and find the right products.

2. BRANDS THAT DO NOT EXCITE CONSUMERS - Given that beauty consumers in Singapore are savvy, the line-up a beauty retailer offers can be a make-or-break. Bringing in trendy brands encourages consumers to visit more frequently.

Sephora brings in new Western brands regularly. Most recently, it introduced Charlotte Tilbury Beauty, one of the most sought-after international brands well-loved by celebrities.

Earlier this year, Sephora also introduced a good mix of brands with cult followings worldwide, including luxury brands (e.g. Pat McGrath), clean beauty brands (e.g. Biossance), and up-and-coming indie brands (e.g. BYBI Beauty).

Sasa had a good opportunity to corner the Asian brand market, particularly since Korean beauty is such a big trend in Singapore.

However, while it has managed to stock popular Korean brands like Banila Co. and Chosungah22, the retailer failed to drive marketing and ride on the hype.

In fact, if you were to ask around, most people wouldn’t know Sasa carries these brands.

Guardian, however, recognised this gap and is eagerly filling it. In the last few years, the retailer has been turning its focus on bringing in exciting K-beauty brands to Singapore.

In September alone, it announced the availability of 14 new, popular Korean brands in its stores including By Wishtrend, Huxley, Dear, Klairs, and I’m Meme.

Just last month, Guardian also announced a partnership with Olive Young, the largest health and beauty retailer in South Korea, to bring a “Myeongdong Street” beauty shopping experience to local consumers.

Guardian launched this collaboration with a pop-up event in ION Orchard featuring four Olive Young house brands previously unavailable in Singapore.

If you ask me, Guardian is definitely playing its cards right.

3. POOR CUSTOMER RELATIONS - Given the wide variety of options in Singapore, retailers are out of mind when they are out of sight. Successful beauty brands and retailers are investing in public relations (PR) and marketing to amplify their messages on different platforms – especially online ones – so that their target audience always has them in mind.

Compared to many beauty brands and retailers in Singapore, Sasa is awfully quiet in the digital space, where a lot of product discovery, conversations, and purchase decisions are made.

PR and marketing can also come in the form of strong loyalty programs. Sephora, for instance, offers more than loyalty points for its members. Members in the highest tiers are also given birthday gifts, early access to private sales, invitations to exclusive events and launches, and custom makeovers.

4. POOR ONLINE PRESENCE - Sasa also has a weak online presence. Case in point: Watsons Singapore has more than 50,000 followers on Instagram. That’s almost four times more than Sasa, which only has 13,900 followers.

Brands exclusive to Sasa such as Suisse Programme, Dr. G and Cyber Colors also do not seem to draw online discussions.

Almost 63 per cent of respondents said that they will not consider buying a product if they are unable to find online reviews, according to the Daily Vanity Consumer Survey 2019. 

Respondents specifically mentioned Google and Instagram as two of the top online platforms they search for product reviews on.

5. OLD MARKETING TECHNIQUES - Sasa had focused more on tactical marketing – through attractive prices and regular promotions. However, price-sensitive consumers attracted by these can turn to other retailers like Venus Beauty, which offers competitive pricing with parallel imports, or even platforms like Carousell for budget buys.

Sasa did not manage to read the writing on the wall early enough to evolve with the times, build on its strengths, and seize opportunities.

The beauty retail space is changing so rapidly, it can be a boon for some but a bane for others like Sasa. Complacency can be terminal. They must constantly keep up with the evolving preferences of consumers.

Sasa has said that it will focus on its Malaysia market, which has a higher potential for further development for the retailer. But it has to remember that Singapore is often seen as a bellwether for future trends regional counterparts will eventually experience.

Sasa should learn from the mistakes made in Singapore to have a shot at making it big in Malaysia.

HIV - Insuring AIDS

In an ideal world, the people who need help the most would receive the assistance they rightly deserve. However, a recent study commissioned by the Malaysian AIDS Foundation (MAF) has found that is not the case when it comes to people living with HIV (PLHIV) seeking health insurance.

A lack of awareness of affordable and effective HIV treatment means companies either exclude HIV from their coverage plans entirely and for those that do cover the condition, the applicant has to fit within a narrow set of criteria for their claims to be approved.

Researchers Dr Sharuna Verghis and Dr Kana Kulasingam found that out of 11 insurance companies surveyed in Malaysia, only three cover HIV with certain conditions, which are in policies without medical underwriting, group life and group medical insurance, and critical illness plans (which covers full-blown AIDS, HIV infections due to blood transfusions, and occupationally acquired HIV).

And it’s not just PLHIV who are often left in the dust by this practice, because insurance companies unaware of improvements in the long-term outlook for PLHIV are losing out on a huge chunk of income by discriminating against them.

A respondent with HIV said the sooner insurance companies realise that PLHIV can live longer and healthier lives, the more money they can make.

“If somebody was smart enough to sell me an insurance policy when I was diagnosed positive, I would be paying my premiums for 26 years and (the insurance company) would have got 26 years of premiums without paying out anything. There’s a huge loss of income for insurance companies because people are surviving longer now and if you multiply that by 3,334 people getting diagnosed per year, that’s a lot of money potential,” the person was quoted as saying.

In their study, Dr Sharuna and Dr Kana cited literature stating that PLHIV on antiretroviral therapy (ART) in their first year since testing positive have a 99.4 per cent of survival compared to a 63.4 per cent chance of survival in PLHIV who are not on ART.

Within a 10-year period, PLHIV on ART have a 78.8 per cent chance of survival while those not on ART only have a 7.4 per cent chance of staying alive.

The study also found that conditions that facilitated private health insurance for PLHIV in other countries are present in Malaysia.

These include the availability of treatment on par with international guidelines, free and/or highly subsidised ART provided by the government and accessible at the primary to tertiary care levels, and integrated care addressing comorbidities such as tuberculosis.

Armed with this evidence, MAF hopes to spark a dialogue between stakeholders to improve access to private healthcare insurance for PLHIV.

It also aims to tackle the pervasive stigma and discrimination against PLHIV in Malaysia that may deter some from even applying for a financial product or filing a claim in the first place for fear of being rejected or having their status exposed to their employers.

During a panel discussion at Hilton Kuala Lumpur, Malaysian AIDS Council president and MAF honorary treasurer Bakhtiar Talhah said that Malaysia can take a leaf out of other countries’ books when it comes to providing health insurance to those with HIV.

“What struck me from the study is the level of HIV knowledge amongst insurance companies in Malaysia relative to other countries around the world, especially within the region. We see places like the Philippines, Thailand, and Sri Lanka being much more advanced in their insurance policies for PLHIV,” said Bakhtiar.

A legal framework that makes it mandatory for private insurance companies to cover HIV in their healthcare insurance plans remains absent in Malaysia, said lawyer and panel speaker GM Tan.

However, the government and other stakeholders can’t afford to rest on their laurels when it comes to protecting PLHIV.

The latest data from the Health Ministry shows that a majority of the 3,293 new HIV infections in 2018 are in those aged 20 to 29 (45 per cent), with those in their 30s making up 31.7 per cent of new cases.

Dr Kana said many of the newly-diagnosed are in their productive years with much to contribute, adding that Malaysia’s economy and workforce is at risk should these individuals fail to receive the necessary care.