When the Covid-19 pandemic started in Malaysia in early 2020, all patients who were diagnosed with Covid-19 were treated in Government health facilities, mostly in Ministry of Health (MOH) facilities. But recently, from the end of last year when the number of cases rose with daily numbers running into the thousands, the government decided that patients at Levels 1 and 2 can be quarantined at home (if suitable) and only those at Levels 3 to 5 are admitted to government facilities.
But because the number of daily infection keeps going up, the government is now considering using private facilities to treat patients. Right now, if one is diagnosed with Covid-19 in a private hospital, the hospital is obliged to send you to the designated government facility as soon as possible. Treatment in government facilities are free like the seven other infectious diseases given exemption under the MOH Fees (Medical) Order (Perintah Fi (Perubatan) for everyone (including non-citizens).
Under the Emergency Ordinance, the MOH has the authority to instruct private hospitals to take in and treat Covid-19 patients. The government has started talking to the Association Private Hospitals Malaysia (APHM) regarding the management of Covid-19 patients in private hospitals.
The APHM President has reportedly urged the government to compel insurance companies to revise their policies and cover the treatment costs of Covid-19 patients. APHM said that private hospitals can treat Covid-19 patients who are self-paying but not others who cannot afford to pay. APHM can also assist the government in taking non-Covid-19 patients from MOH hospitals to spare more beds in MOH facilities for Covid-19 patients. This will be funded from the RM100 million that the government is providing.
The insurance and takaful companies are supportive of the government’s call on the private and public partnership in the management of Covid-19 patients. According to the Life Insurance Association of Malaysia (LIAM), General Insurance Association of Malaysia (PIAM) and Takaful Association, at present pandemic-related risks are generally not covered under any insurance and takaful plans. It is difficult to price this type of policies because of limited knowledge and the evolving nature of the disease.
For me, there are five parties to this discussion, namely the patient, insurance companies, private hospitals, the government and medical practitioners in private hospitals (mostly specialists). As mentioned above, the Government’s SOP for the management of Covid-19 patients is for all of them to be managed by designated public facilities.
At present, all Covid-19 patients (even foreign patients) are given free treatment. Therefore the government should continue to pay a substantial costs of the management of Covid-19 patients (perhaps 50-60 per cent). The remaining portion (40-50 per cent) should be shared by the insurance companies, the private hospitals, patients (if they have medical insurance, or else this portion must be borne by the government) and the specialists.
The insurance companies can pay part of the costs as many of them have offered payouts for Covid-19 diagnosis to new policyholders who take up new medical policies. Bank Negara can consider an amendment to existing policies to provide for this coverage. Private hospitals can absorb some of the costs with extra business from the government, and so can the specialists who are carrying out consultations in these private hospitals.
After determining the portion of the costs to be shared by the major stakeholders, the main issue to be resolved will be how much to pay for the management of these patients in the private hospitals. I am not sure whether the government know the costs of treatment of these patients in their hospitals.
Without knowing their costs, it will be difficult for the government to reimburse the costs to the private hospitals as the cost structure is very different in the private sector hospitals. This will also be a major challenge if the MOH send their non-Covid patients to the private hospitals as a way to decongest their hospital beds to take in more Covid patients.
The APHM prefers this option rather than take in Covid-19 patients. Therefore there are still many details to work out before this public-private partnership in the management of Covid-19 patients in the private hospitals can be implemented.
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