KUALA LUMPUR, July 29 — Health economy experts have criticised the “flawed” Bank Negara Malaysia (BNM) mandate for copayments in all new health insurance products, calling for a cap on the copay percentage.
Prof Dr Nirmala Bhoo Pathy, a clinical epidemiologist and public health medicine specialist at University Malaya Medical Centre (UMMC), warned that the minimum 5 per cent copayment mandate for new medical and health insurance and takaful (MHIT) products could ironically create the financial catastrophes that health insurance is supposed to prevent.
“This policy could expose households to significant financial hardship. For low- and middle-income patients, copayments can be a trade-off when seeking necessary cancer care, limiting health care utilisation. Even small extra costs can make it harder for these patients to access treatments they need, leading to delayed care and poorer health outcomes,” Dr Nirmala told CodeBlue when contacted.
Dr Nirmala, who has conducted many studies on financial toxicity associated with cancer care, outlined several potential impacts of the policy on cancer patients in Malaysia:
- Access to treatment: Patients may delay or forgo vital treatments due to the added costs, jeopardising their recovery.
- Increased costs: The mandatory copayment adds to the already high cost of cancer treatments, making it harder for patients to afford care.
- Financial burden: Patients may need to use savings, borrow money, or seek financial aid to cover copayments, which can be challenging and not universally accessible.
- Equity and fairness: The policy disproportionately affects low- and middle-income groups and women in traditional societies with limited financial resources, exacerbating health inequalities.
Dr Nirmala said the new policy could push more cancer patients towards public health care services, which are already under strain.
“Many patients, especially those from low-and middle-income backgrounds, already struggle with high out-of-pocket costs even with insurance. This additional financial burden will make private health care unaffordable for many, leading them to seek more affordable options in public hospitals,” she said.
“This is a critical issue. Public hospitals in Malaysia are already under high pressure. Our research shows that many cancer patients moved their care from private to public hospitals due to excessive out-of-pocket costs, and this trend is likely to accelerate with the new copayment policy,” she added.
Dr Nirmala warned that public hospitals, already stretched thin, would have to accommodate an influx of patients, potentially resulting in longer waiting times, overworked health care personnel, and compromised quality of care.
Dr Nirmala suggested that BNM consider capping copayments or adjusting them based on income to ensure health care remains accessible to all.
“A fixed cap, like RM500, could promote responsible use without bankrupting people,” she said. “Health care should not become a luxury item, and no one should have to choose between a lifesaving surgery and essential expenses like education.”
She also recommended improving access to financial aid, such as the Social Security Organisation (Socso) or zakat, to help cover copayments. However, capping copayments and reconsidering the 5 per cent requirement should be mandatory, Dr Nirmala said.
Chua Hong Teck: Cashless Payments Drive Up Health Care Costs
Health economist Chua Hong Teck attributed rising health care costs to the increase in “free at access” or cashless payment systems, which can lead to abuse by both consumers and providers.
Chua said there have been two instances of insurance charge and premium repricing over the past few years for those wishing to maintain their existing coverage. However, premiums can be reduced by switching to a deductible plan or downgrading policy benefits to fit new needs if one disagrees with these repricings.
“I support BNM’s policy allowing insurance and takaful operators (ITOs) to offer medical health insurance or takaful (MHIT) products with copayment features, including deductible or co-insurance/ co-takaful options. This approach can lower premiums, reduce the need for frequent repricing, and hopefully mitigate rising health care costs.
“The amount or percentage of copayment should be determined by ITOs in their plans to meet individual needs. Consumers should have the flexibility to upgrade or downgrade their coverage based on their needs and affordability.
“As this is a new policy, BNM should allow ITOs and consumers to review and provide feedback on its implementation.”
