Healthcare should not come with a surprise bill — Azanin Ahmad

On September 19, a parent visited a private clinic with a coughing child due to poor air quality. The visit lasted briefly, and various medicines were prepared. Only at the checkout did the parent discover that the bill exceeded RM100. While the cost may be justified, the issue lies in the fact that the final amount only becomes apparent after the consultation has concluded, the medications have been packaged, and the patient is at the counter, leaving little room for reconsideration.

This scenario is common in Malaysian healthcare, where patients often do not receive clear information on which medications will be provided, their purpose, cost, or whether a less expensive generic alternative is available. Some patients return home to find they already possess similar medicines that have not expired, leading to waste and disposal issues.

The question arises: why can consumers easily see the prices of fish, vegetables, and spices in a market, yet struggle to understand the cost of medicine at the point of care? Transparency at the point of care should be stronger during vulnerable moments, not weaker. Although medicine is not equivalent to market goods, medical professionals must prioritize diagnosis, dosage, age, weight, allergies, interactions, and clinical risk over price considerations.

Complexity in medical care should not justify obscurity in costs. Instead, it should drive better communication.

The Price Control and Anti-Profiteering (Price Marking for Drug) Order 2025, enacted on May 1, 2025, aimed to require medicine-price information at community pharmacies and selected private healthcare facilities. However, the enforcement of this law has been temporarily suspended due to a judicial review brought by medical and dental groups.

This legal pause should not translate into an ethical lapse. Regardless of the court outcome, the core question remains: should patients know the cost before making a payment? Clinics have valid concerns, as they may deal with numerous medicines in various brands, strengths, formulations, and pack sizes. Supplier prices fluctuate, and even a technically accurate list can be challenging for the average patient to comprehend.

The final bill may encompass consultation fees, procedures, tests, and consumables, not medicines alone. Compliance may require additional administrative work, especially for small practices grappling with staff shortages and mounting expenses.

The design of price transparency should focus on presenting the cost of items being offered to patients before dispensing them. Rather than providing a dense spreadsheet behind a counter, clinics should offer a concise paper or digital summary listing the medicine name, purpose, quantity, unit price, and total price, along with a generic alternative when clinically appropriate.

This approach allows patients to ask questions, accept the supply, or inform the clinician that they already possess the same medication at home. A straightforward inquiry from the doctor or dispenser could prevent unnecessary waste, such as asking, ‘Do you still have any of these medicines at home, and are they still within their expiry dates?’

This practice not only saves costs but also promotes medicine reconciliation, reduces duplication, and provides clinicians with a clearer understanding of the patient's current medication regimen.

Patients should also be empowered to inquire whether all prescribed medications are necessary and whether they can obtain a prescription from another pharmacy. This does not transfer clinical decision-making from doctors to patients; rather, it enables patients to understand and consent to the purchase that follows. Moreover, price transparency should extend beyond medicines, covering consultation fees, common procedures, and providing automatic itemized receipts when possible.

When an exact total cannot be determined in advance, a reasonable estimate and an explanation of potential additional charges would be preferable to silence. The Health Ministry and the Domestic Trade and Cost of Living Ministry should collaborate with medical associations, pharmacists, and consumer groups to establish a unified national format for price transparency that is user-friendly for clinics and patients alike.

Smaller clinics should receive free digital templates or software assistance to facilitate compliance. The receipts should clearly indicate where patients can seek clarification or lodge complaints. Ultimately, transparency should be integrated into the care process to foster informed decision-making and enhance patient trust.