Healthcare should not come with a surprise bill — Azanin Ahmad

SEPTEMBER 19 — A parent walks into a private clinic with a coughing child due to bad haze. The consultation is brief. Several medicines are prepared. Only at the payment counter does the parent learn that the bill exceeds RM100.

The amount may be entirely reasonable. A doctor’s expertise has value, clinics have operating costs and medicines are not free. The troubling part is not necessarily the final figure. It is that the figure appears only after the consultation has ended, the medicines have been packed and the patient is standing at the counter with little practical room to reconsider.

This is a familiar situation in Malaysian healthcare. Patients may not be told clearly which medicines will be supplied, what each one is for, how much each item costs or whether a cheaper generic is appropriate. Some return home to discover that they already have similar fever, cough or allergy medicines that have not expired. The household medicine cabinet grows, money is wasted and unused products eventually become a disposal problem.

If fish, vegetables and chillies at a market carry visible prices, why can a patient still struggle to see the price of medicine at the point of care? The comparison is deliberately uncomfortable. Consumers are usually most vulnerable when they are unwell, anxious or caring for a sick child. That is precisely when transparency should become stronger, not weaker.

Of course, medicine is not a bunch of chillies. A doctor cannot recommend treatment according to price alone. Diagnosis, dosage, age, weight, allergies, interactions and clinical risk must come first. A long price list on a wall cannot replace professional judgment. Yet medical complexity is not a convincing reason to keep costs obscure. It is a reason to explain them better.

The author argues that patients should know the cost of medicines before they are dispensed, making price transparency and informed choice part of fair healthcare. — Unsplash pic

Malaysia has already recognised this problem. The Price Control and Anti-Profiteering (Price Marking for Drug) Order 2025 came into force on May 1, 2025. It sought to require medicine-price information at community pharmacies and specified private healthcare facilities, allowing consumers to make more informed choices.

The legal position, however, is not straightforward. On May 21, 2026, the High Court granted a stay on enforcement while a judicial review brought by medical and dental groups proceeds. It would therefore be unfair to accuse every clinic without a visible price list of breaking a rule whose enforcement has been suspended. But a legal pause need not become an ethical pause. Regardless of the court outcome, the underlying question remains: should patients know the cost before they are expected to pay?

Clinics have legitimate concerns. A practice may carry hundreds of medicines in different brands, strengths, formulations and pack sizes. Supplier prices change. A technically correct list can still be incomprehensible to the ordinary patient. The final bill may include consultation, procedures, tests and consumables, not medicines alone. Compliance also creates administrative work, particularly for small general practices already managing staff shortages and rising costs.

These objections challenge the design of price transparency, not its purpose. A policy that produces a dense spreadsheet pinned behind a counter will satisfy paperwork more than patients. What people need is not every price in the building. They need the prices of the items being offered to them, presented before those items are dispensed.

Evidence suggests that formal rights do not automatically become usable rights. A 2021 study of 680 consumers in Malaysian private healthcare settings found that only 15.9 per cent said they always obtained an itemised bill, even though awareness of the entitlement was high. A right that depends on a sick or anxious person knowing the correct question to ask is a weak form of protection.

A better system would make clear information the default. Before medicines are packed, a clinic could provide a short paper or digital summary listing the medicine name, purpose, quantity, unit price and total price, together with a generic alternative when clinically appropriate. The patient would then be able to ask a question, accept the supply or explain that the same medicine is already available at home.

One simple question from the doctor or dispensing staff could prevent considerable waste: ‘Do you still have any of these medicines at home, and are they still within their expiry dates?’ This is not merely a cost-saving gesture. It encourages medicine reconciliation, reduces duplication and gives the clinician a clearer picture of what the patient may already be taking.

Patients should also be able to ask whether all the medicines are necessary and whether they may take a prescription to a pharmacy of their choice. This does not transfer clinical decision-making from doctor to patient. The doctor remains responsible for recommending safe and appropriate treatment. The patient gains the ability to understand and consent to the purchase that follows.

Price transparency must also extend beyond medicine. Clinics should display the consultation fee or explain the applicable range, identify charges for common procedures and provide an itemised receipt automatically rather than only when requested. Where an exact total cannot be known in advance, a reasonable estimate and an explanation of possible additional charges would still be better than silence.

The Health Ministry and the Domestic Trade and Cost of Living Ministry should work with medical associations, pharmacists and consumer groups on a single national format that is simple enough to use at the counter. Small clinics should receive free digital templates or software support. Receipts should state where a patient can seek clarification or lodge a complaint. Transparency should be designed as part of care, not imposed as an awkward poster on the wall.

Consumers have responsibilities too. Patients should bring a list or photograph of medicines already at home, check expiry dates, disclose allergies and ask four basic questions: What is this medicine for? Is every item necessary? Is there a suitable generic? What will the estimated total be? Polite questions are not an accusation against a doctor. They are participation in one’s own healthcare.

The goal is not to turn the consultation room into a supermarket aisle or to encourage patients to choose the cheapest treatment regardless of need. It is to prevent illness from becoming a moment when ordinary consumer rights quietly disappear.

Visible prices will not cure a cough. They can, however, treat another weakness in the healthcare experience: the feeling of being powerless at the counter. Patients should not have to choose between trusting their doctor and protecting their household budget. A fair system must allow them to do both.

* Dr Azanin Ahmad is a Senior Lecturer with the Marketing Department, College of Business, Universiti Utara Malaysia.

** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.