Payment Mechanism

All of us need and love money, it is essential and inevitable for living. That is why this blog is discussing about money yet again. First and foremost payment mechanism for a General Practitioner (GP) is monthly salary paid by the employers to the employees. Both public and private frequently used this same method to pay their employee and the only different is the total of renumeration earned by the GPs. Malaysia and Indonesia both pay their GP with salary, from the tax revenue, but the total income of GP in both country can widely vary. Indonesia GPs can earn unlimited allowance by working simultaneously in the private sectors, with limit of 3 different hospital allowed at a time. In contrary, Malaysia have limited allowances which mostly paid by the government to cover and compensate all the living expenditures and workload of a GP in Malaysia.  According to Suruhanjaya Perkhidmatan Awam (SPA) in Malaysia, the initial salary for a fresh graduated GP started from MYR 2458.39 and when sum up with all the allowances around give a total of MYR 4058.39 per month. This payment does not include the payment from the reimbursement for on call allowance and locum salary. From the news paper cut i read, on call allowance is at the rate of MYR150 per night and locum at the rate of MYR80 per hour.

Salary can be based on the GP contract with the employer, in this case; government because some countries use semi-negotiable salary to solve the "brain drain" of the GP to the big cities, private sector, and even overseas because of better renumeration and better living conditions. In Indonesia, semi-negotiable salary is used to attract more GP to work at the rural areas so they have an equal distribution of GP across the country. The payment is based on the degree of difficulty and rurality of the area. Some payment of salary is based on the capitation mechanism. The payment given to the GP is proportional to the amount of people under the responsibility of the GP, the more patients register under that GP, the more money that will be paid to that GP. This capitation payment can be used both government salary or payment reimbursement from health insurance for privileged GP.

Other payment mechanism to the GP is from the fee-for-service mechanism paid by the patient from out of pocket or from the insurance claims for medical services. Most people believe that this is the best way to maintain the quality of health care given by the GP because the amount of money they receive is totally depend on their patient satisfaction. It is just natural that a persons will try to give their best effort in delivering health care so that their patient pay their more. Happy patient means more money. There's another payment which is fundamentally derived from fee-for-service payment which is called as pay-for-performance (aka "P4P" or “value-based purchasing"). This payment mechanism gives incentive to the GP if there do well in treating their patient and preventive measures with a pre-established criteria and health indicators targets.