KUALA LUMPUR, July 25 — A cancer patient advocate and caregiver in Sarawak described Bank Negara Malaysia’s (BNM) new mandate for copayments in health insurance as an additional barrier to treatment access.
Chris Cheng, president of the Society for Cancer Advocacy and Awareness, Kuching (SCAN), in his personal opinion, expressed concern that lower-income patients, particularly those from rural areas, already face major financial constraints that delay their treatment.
“The added burden of copays or deductibles might force lower-middle-income individuals, who could otherwise afford insurance, to delay treatment further.
“Delays in treatment have been shown to increase the likelihood of late-stage presentation of cancer, which complicates treatment and reduces survival rates. This issue could be exacerbated without a cap on the copay amount,” Cheng told CodeBlue when contacted.
According to the Malaysia National Cancer Registry Report 2017-2021, released by the Ministry of Health (MOH) last Friday, late-stage cancer detection has increased in Malaysia, with the proportion of cancer cases detected at Stage 3 and 4 rising to 65.1 per cent in 2017-2021 from 63.7 per cent in the 2012-2016 period.
Cheng also raised concerns about whether insurance buyers are adequately informed about the limitations of the plans they purchase.
“Patients might opt for plans with hopefully cheaper premiums but end up unable to fully utilise their insurance due to high copay costs, especially for newer, more expensive cancer treatments.”
A report jointly published by the MOH and the World Health Organization (WHO) in 2022 revealed that the average cost per hospital episode for cancer across public and private hospitals was RM7,087, based on 2017 data. This is higher than the average cost per hospital episode for diabetes (RM5,444) and cardiovascular disease (RM5,374).
While there is limited local research on the indirect costs of cancer, many cancer patients and support organisations have reported instances where patients lose their jobs upon diagnosis or caregivers needing to take time off from work to assist family members with logistical arrangements for cancer treatment.
Ann (pseudonym), a caregiver to a 42-year-old stage 3 colorectal cancer patient in Sarawak, told CodeBlue that current insurance schemes already require patients to pay out-of-pocket for medications and procedures that are not directly considered as part of cancer treatment.
“For these, the insurance company will not cover and it is clear-cut out-of-pocket for patients. For example, if there is an infection to the postoperative wound to remove a malignant growth, insurance does not cover for the drugs or subsequent treatments of the infected wound. It has to be paid out-of-pocket.
“This means that there will be instances where patients with full insurance coverage will need to pay out-of-pocket,” said Ann, who requested anonymity.
“With the copayment option, it will certainly add financial strain on cancer patients for other possible complications that are not treated as cancer.”
Ann said the stage 3 colorectal cancer patient, whom she is caring for, underwent colorectal surgery that cost approximately RM60,000, which was covered by insurance. Chemotherapy at a private facility has cost between RM3,000 to RM5,000 per cycle, with the patient needing eight to 12 cycles depending on their situation. So far, RM35,000 has been covered by insurance for chemotherapy.
Radiotherapy costs around RM1,500 per session, with the patient needing 20 sessions. However, the patient has not commenced radiotherapy yet as he is still undergoing chemotherapy.
Ann added that there are additional out-of-pocket costs for non-cancer tests and treatments. These include treatments for hospital-acquired postoperative infections, multiple blood tests, and CT scans ordered by non-oncologist specialists to assess if the cancer has spread to other organs, amounting to over RM10,000.
Prof Dr Nirmala Bhoo Pathy, a public health physician at the University Malaya Medical Centre (UMMC), previously highlighted how cancer patients had to “prove so hard they are ill” to get benefits from their insurance, which costs them delays in accessing vital treatment.
Her 2015 study revealed that 65.1 per cent of patients at UMMC experienced financial catastrophe within a year of diagnosis, compared to 33.4 per cent at MOH hospitals. At private hospitals, this figure rose to 72 per cent.
Overall, 51.4 per cent of cancer patients across hospitals incurred catastrophic expenses, defined as out-of-pocket payments exceeding 30 per cent of annual household income.
The late Sew Boon Lui, founding president of SCAN and a breast cancer advocate for nearly two decades, detailed her five-year battle from 2017 to 2022 with metastatic breast cancer (MBC), which cost nearly RM255,000.
Sew financed most from personal savings, averaging RM50,000 annually (over RM4,200 monthly), excluding travel expenses to Kuala Lumpur. She was first diagnosed with stage 3 breast cancer in 2006.
Ann told CodeBlue that implementing copayments in health insurance to combat the “buffet syndrome” and inflated medical bills will not be possible without endorsement from private health care facilities and private practitioners.
“What is being done to audit and regulate the inflated bills and ‘buffet syndrome’ practices perpetrated by the private health care facilities? Why are genuine patients being ‘penalised’ for such practices by these private facilities?” said Ann.
She suggested implementing a cap to ease financial burdens on patients already struggling with illness.
Cheng called for concrete evidence regarding claims of irresponsible health care service utilisation by insured patients.
“Understanding the root causes of health care overutilization is crucial before implementing policies that may burden patients,” Cheng said. He echoed the call to cap copayment amounts to maintain affordability and ensure access to necessary treatments.
BNM has imposed a mandate, effective last June 1, for insurance and takaful operators (ITOs) to include co-payment features in the design of any new individual medical reimbursement insurance/ takaful products introduced to the market.
The central bank set copayments – which are payments paid out-of-pocket by policyholders at the time of a claim – at a minimum 5 per cent of claimable expenses (after deductible) and/ or an RM500 deductible, leaving the copayment cap to insurers.
By this September 1, ITOs must offer at least one co-payment product with the minimum 5 per cent copayment level and design a new product if they do not already have such products on the shelf.
The Life Insurance Association of Malaysia (LIAM) has defended BNM’s new copayment policy decision, deeming full-coverage products as unsustainable amid high claims inflation.
On the other hand, the Association of Private Hospitals Malaysia (APHM) has criticised copayments in health insurance, while maintaining that private hospital charges cannot be regulated due to the complex factors influencing health care costs.
