Background
Achievements of the private industry

The dialysis sector of our healthcare industry has grown by leaps and bounds in the past 25 years. In 2012, the sector provides regular dialysis treatments for almost 30,000 patients with ESRD at an economic cost of about RM 1.2 billion and provides employment opportunities for large number of health professionals. The sector is also positively unique in many ways:

• Dialysis is the only catastrophically costly treatment for a high prevalent disease that is universally accessible to all Malaysian ESRD patients, in sharp contrast to other costly treatments such as cancer where patients are still routinely denied access.
• The sector is also highly liberalized in that publicly funded patients by and large may choose to be treated wherever they like, be it in the public, NGO or private sector. Almost all publicly funded healthcare in Malaysia, except dialysis, is tied monopolistically to designated providers as a matter of policy; the business is off limit to other equally qualified providers regardless of price and quality.
• Dialysis treatment is probably one of the most cost-efficient health services in Malaysia, measured in terms of cost per life year saved. Unfortunately hardly any medical treatments have published data on cost and health outcomes to allow an objective comparison.
• And finally dialysis treatment is highly equitable; there is minimal disparity in access to treatment by socio-economic status or geographic location; a big contrast to other therapies like cancers.

These are no mean accomplishments, and undoubtedly the private dialysis sector has contributed significantly to this in many ways:

• Private dialysis providers accounted for the care of 45% of HD patients in 2012
• This is testament to the accessibility of private services (private centres could be found in more places, whether urban or rural, than public or NGO centres because private entrepreneurs who invest in these centres must necessarily be customer driven). The same customer focus is associated with more patient centred and responsive services and probably better quality dialysis care
• The highly competitive private dialysis sector has kept cost down and kept the sector honest. Malaysian public payers could enjoy the lowest reimbursement rate in the world largely on account of the competition that has resulted from the liberalization of the sector.
• The private dialysis sector has effectively subsidized the public sector which has been able to enjoy huge discounts in its purchasing of equipment and consumables (EPO, dialyzers etc) on the back of profits that suppliers were able to reap from private buyers.
• And finally, without a private sector providing geographically widely distributed services throughout the country at highly competitive prices, it is doubtful the remarkable equity achievement of dialysis care in Malaysia is possible

Challenges facing the dialysis industry
However, the growth and success of the private dialysis industry has also brought forth many challenges such as:

• Availability of qualified competent dialysis nurse, MAs, technicians and other allied health workers to undertake dialysis therapy has been a long standing issue, and the related matter of access to affordable training (in both monetary and time costs) for private sector personnel.
• The dialysis industry is subject to increasingly stringent regulations. As an industry, we welcome regulatory oversight to protect patient safety, to enhance practice standards, to winnow out underperforming providers and to motivate all to comply with best practices. Many of us already comply with ISO standards in our practices, so meeting local regulatory requirements is natural extension to that.

However it is reasonable to expect that:
- Private dialysis providers be consulted and due process is followed before any new regulations are issued
- Any new regulations be backed by scientific justification, especially if they deviate from international norms (such as ISO standards)
- The rules are applied fairly to all, and not selectively targeting private providers
- And finally due consideration be given to the cost of compliance with a new rule (for example, if dialyzer reuse is to be banned, then current reimbursement rate must be adjusted accordingly)

• Reimbursement is the financial life blood of the industry. Third party reimbursement whether by taxpayers, employers, or charity account for about 70% of dialysis funding. Reimbursement rates however have remain low and flat for many years despite increasing cost. The large number of payers with varying coverage and reimbursement rates is a matter of concern not just for providers but for patients too.
• There are also concerns with several emerging trends in dialysis practices that we as an industry need to monitor and if necessary take actions:

- Death rates on HD have been rising and this surely must raise quality concerns.
- There may be increasing anti-competitive behavior in channeling patients to preferred providers thus restricting patients’ choices
- Tiered pricing in dialysis equipment and consumables to the disadvantage of private sector

These challenges require the collective resolve of the industry to address; they are beyond the effort of a single company. Like other healthcare industry associations such as APHM, PhAMA, MMDA etc, we ought to collectively, rather than individually, engage stakeholders and sympathetic policy makers to help resolve these challenges. We need an industry association to speak with one voice, and the corresponding leadership to galvanize the commitment of all companies to overcome these challenges and to advance the industry in Malaysia.

The APKCPM is thus conceived through the joint efforts of private dialysis providers, and is motivated by the recognition of dialysis as an important industry in our country as well as by the fact that dialysis is a rigorous science and technology based therapy with its own body of requisite knowledge and skills those working in the field are expected to possess to demonstrate professional competence.

Aims Activities