KUALA LUMPUR: Private hospitals in Malaysia are getting ready to play a bigger role in combatting COVID-19, following the enactment of an emergency ordinance to mobilise resources of the private healthcare sector.
Hospitals involved are currently converting some of its wards to accommodate COVID-19, while some like Sunway Medical Centre, located in the Klang Valley suburb of Subang Jaya, are expanding their capacity to take in more cases.
In total, 96 out of 210 registered private hospitals throughout Malaysia have agreed to provide COVID-19 treatment during the country’s state of emergency, which is effective from Jan 11 to Aug 1.
They will add an additional 1,344 beds and 65 beds in intensive care units (ICU) for COVID-19 treatment, according to Prime Minister Muhyiddin Yassin on Thursday (Feb 4).
This came as Malaysia's total COVID-19 cases surpassed the 200,000-mark in late January, and the public healthcare system was described to be at a "breaking point".
Back on Jan 11 when announcing the reinstatement of the movement control order (MCO) to break the infection chain, Mr Muhyiddin had said that 15 public hospitals saw non-ICU bed usage at over 70 per cent.
In the Klang Valley, ICU bed usage had reached maximum capacity at two major hospitals, while another hospital had reached over 83 per cent capacity, he added.
As part of the emergency effort, the government would integrate both public and private hospital services for better coordination, said Chief Secretary to the Government Mohd Zuki Ali on Jan 26.
Both public hospitals and participating private ones will operate in a “hybrid cluster” under the Malaysian government’s COVID-19 Integrated Control Centre to treat both COVID-19 and non-COVID 19 patients, based on the Ministry of Health's directions.
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While the private sector was willing to play its role, there were constraints to its resources and capabilities, Dr Kuljit Singh, head of the Association of Private Hospitals Malaysia (APHM), told CNA.
CONVERTING WARDS FOR COVID-19
Given the infectiousness of COVID-19, careful separation of patients from the general hospital populace is needed at participating private hospitals.
In Melaka, Mahkota Medical Centre’s chief executive officer Stanley Lam explained that as part of the building’s design and infection control, there was already a dedicated ward with a standalone air filtration system and maintenance system.
“We are currently converting this ward for COVID-19, with its own monitoring equipment and separate waste-handling,” he said.
Other aspects such as separate entrances and lifts for the COVID-19 ward, and separate healthcare teams and workflows were being instituted.
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At Sunway Medical Centre, Sunway Healthcare Group managing director Lau Beng Long said the centre was already warding a limited number of COVID-19 patients of varying severity.
“However, we are in the midst of expanding our capacity and capability to manage more COVID-19 cases,” he said.
Likewise, infection control is also a priority and Mr Lau explained that the dedicated COVID-19 beds are located in a separate section of the hospital complex, with dedicated entrances and lifts as part of the centre’s infection prevention and control measures.
"COVID-19 patients will have their own dedicated team of doctors, nurses and even housekeeping staff," he told CNA.
The hospital has also allocated extra resources to curb infection, such as negative pressure cabins outside their accident and emergency Department and ICUs (to prevent any possible COVID-19 aerosols from escaping into open air), a disinfection robot as well as isolation pods to transfer infectious disease patients safely.
Mr Lam of Mahkota Medical Centre said prep work and readiness had been ongoing since the Ministry of Health’s announcement on private involvement in mid-January.
“We’ve always ensured we have sufficient PPE and supplies, and are now setting up a dedicated COVID-19 ward for 15 normal beds and two with ventilators,” Mr Lam told CNA.
Likewise, Sunway Medical Centre has moved to allocate 10 per cent, or 50 of its operational beds, for its COVID-19 ward, and invest in extra resources.
"We've devoted adequate hospital resources for the care of non-COVID 19 patients, hence there is no diversion of resources when it comes to treating those with COVID-19," Mr Lau told CNA.
He added that based on the current situation, patient loads were manageable and the medical facility's resources were able to cope with current demand.
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CHALLENGES FACED BY PRIVATE HOSPITALS
Ninety-six out of the 210 registered private hospitals agreeing to provide COVID-19 treatment is a realistic number, APHM's Dr Kuljit said.
He explained this was based on factors such as hospital size and layout, which might not be conducive for dedicated housing of COVID-19 patients.
“The infrastructure and expertise, we do have it, just not on the same scale as the government, as private hospitals are built in a certain way to cater for a certain group and number of patients,” he told CNA.
Private hospitals, he said, could not “overdo” in terms of seeing or treating more COVID-19 patients due to their pre-existing infrastructure or insufficient personnel, from specialist doctors to nurses.
“Each hospital is managing COVID-19 based on their capacity and capabilities. The major ones in particular are seeing the number of patients they can manage depending on the normal and ICU beds they’ve allotted for COVID-19 patients” Dr Kuljit said.
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From a regulatory perspective, he added, a private hospital’s number of beds and patients it could cater for was also governed by its operating licence and legislation regarding private healthcare facilities and services.
“Thus we are constrained by operating costs, regulations as well as basic patient and healthcare practitioner safety,” said Dr Kuljit.
However, Dr Kuljit noted that private hospitals, whether or not they were one of the participating 96, were still compelled to treat any patients, even if they have tested positive for COVID-19.
“When you get a patient on your doorstep, you don’t have a choice, you treat the patient first, even if he or she’s positive (for COVID-19).
“Most of the time, especially now, government facilities are full, so like it or not, you have to treat, whether they are Category 1 to 5 (classification of COVID-19 symptoms by severity), or stabilise them, then get ready to transfer them to either a government facility or one of the 96 private facilities which can treat them,” he added.
PATIENTS HAVE TO PAY FOR COVID-19 TREATMENT
A issue in this hybrid public-private scheme is the payment, as private hospitals have to generate revenue to continue operating.
According to Sunway’s Mr Lau, COVID-19 patients who sought treatment at the medical centre were private pay.
“The fee structure for COVID-19 patients is in line with current fees for non-COVID-19 patients,” he said.
According to Dr Kuljit, Malaysia’s insurance providers have decided not to provide coverage for COVID-19 treatment for policy holders currently.
He said it has now been left to the health and finance ministries, as well as Bank Negara Malaysia, the country's central bank, to deal with the insurance industry.
As things stood, Dr Kuljit said, private hospitals’ revenues had fallen far below 2019’s. The economic downturn and resulting effects such as cost-cutting measures or businesses folding meant patients would hold off treatment or seek more affordable treatment at government facilities, he said.
In addition, the ban on international travel meant that medical tourists, normally a large component of Malaysia’s private healthcare revenue, were practically non-existent.
“But costs remain fixed, in terms of maintaining and upgrading our equipment and our trained staff,” Dr Kuljit said.