KUALA LUMPUR, Sept 3 — The costs borne by private hospitals in Malaysia have been unsustainable, with the lowest charges in Asean, said the Association of Private Hospitals Malaysia (APHM).
APHM president Dr Kuljit Singh pointed out that heart surgery, as an example, is “much cheaper” in Malaysia than any other country in the region.
“Malaysia seems to be the lowest in private health care pricing for any procedure in Asean. It has been the lowest for years. However, inflation has caught up over the last few years. It has become not sustainable to keep the price low, hence the perceived inflation,” Dr Kuljit told BFM’s Morning Brief yesterday.
“So the inflation comes not because hospitals are charging more, but what we procure from the other services, the equipment, medication – all of these prices are actually high for us because we procure it outside Malaysia. We’re not a medical equipment or pharmaceutical producer.”
Dr Kuljit noted that medical tourists still choose Malaysia.
When asked if Malaysians could anticipate further price increases from private hospitals, since Malaysia is still the cheapest in the region, Dr Kuljit said health care prices “anywhere in the world” will go up.
“I’ve not seen anywhere in the world where health care costs have come down,” said Dr Kuljit, who is also president of the Asian Hospital Federation.
“With newer equipment and modernisation of health care delivery, there will be an increase. But we have seen that our increase has never been as high as neighbouring countries.”
APHM also disputed allegations of “dual pricing” in private hospitals, where patients with insurance are charged higher than those who pay cash out of pocket.
“Largely, it’s not true. And if it’s true, it needs to be proven. It’s very difficult to prove,” Dr Kuljit told BFM.
He explained that the reason why private hospitals ask patients, prior to starting treatment, whether they have insurance is because the facility needs to start a process and obtain a guarantee letter from the patient’s insurer.
Dr Kuljit also said private hospitals’ itemised billing is mandated under the Private Healthcare Facilities and Services Act (PHFSA) 1998 because there are no hospital fees in Malaysia, unlike countries like India where hospitals charge a fee and patients can buy their own medications for the hospital to administer.
“This is the only industry where every item is enumerated. You go to a restaurant, no one will tell you how much is the price of onion, how much is the price of oil, in order to make your nasi goreng,” he said.
APHM also maintained that using Diagnostic Related Groups (DRG) to regulate private hospital billing would be problematic without a national health financing system. DRG involves paying a fixed amount based on the complexity of the case, rather than itemising each charge.
“Who’s going to come up with the DRG? Is it going to be the payor, the societies, is it going to be the association? It’s going to be difficult to implement it in Malaysia so soon, until and unless we have national health care financing, where every procedure has got a determination of what the exact cost would be.”
CodeBlue EIC: IHH Made ‘Insane’ Net Profit Of Over Half A Billion Ringgit In Q2
CodeBlue editor-in-chief Boo Su-Lyn pointed out that IHH Healthcare Bhd’s net profit more than doubled to RM623 million for the second quarter this year from a year earlier. The public listed company operates a network of private hospitals, including Gleneagles, Pantai, and Prince Court, among others.
“That’s an insane amount of money – in just one quarter,” Boo told BFM’s Top Story yesterday.
Boo observed that the insurance industry blames private hospitals for overcharging, but private hospitals accuse insurance companies of rejecting patients’ claims.
In the meantime, patients have been burdened with managing medical inflation due to Bank Negara Malaysia’s mandate of minimum 5 per cent copayments on all new health insurance products.
“Both industries claim that their costs are unsustainable. Right now, it seems that the regulators – Bank Negara – heavily regulate the insurance industry, but they seem to be on their side with their recent minimum 5 per cent copayments on health insurance,” Boo said.
“And private hospitals’ charges are still unregulated. The health minister hasn’t said anything about looking into this.
“Who’s looking out for consumers and middle class patients?”
Boo acknowledged that health care is expensive, but urged regulators from the Ministry of Health (MOH) to start looking into various hospital charges, like medical supplies, and average prices across the country to come up with a payment model for private hospitals that is “fair or just not arbitrary.”
In a recent interview with CodeBlue, Life Insurance Association of Malaysia (LIAM) chief executive Mark O’Dell disclosed his 13-page hospital bill of RM18,837.55 from a major private hospital in Kuala Lumpur for a minor hernia procedure last May, involving an overnight hospital stay, that included charges for 95 line items across 13 different categories.
Doctors’ charges of RM2,621 comprised just 14 per cent of the total hospital bill, while medications at RM2,606.68 formed another 14 per cent. The biggest chunk of O’Dell’s hospital bill went to equipment/ instrumentation at RM3,850.30, forming 20 per cent.
CodeBlue’s story on O’Dell’s hospital bill was widely shared on social media. Many Malaysians, including the Consumers’ Association of Penang (CAP), appeared to side with the insurance industry veteran, as they called for regulation of private hospital charges.
Surgeons’ Fees Much Lower in Malaysia Than Indonesia or Singapore
Senior consultant cardiothoracic surgeons in the private sector in Malaysia charge only between RM8,000 and RM16,000 for an eight-hour coronary artery bypass graft (CABG) or heart bypass surgery, according to one such surgeon.
Malaysian surgeons’ maximum fee of RM16,000 for the major heart procedure is much lower than their counterparts in Indonesia’s private sector at about RM20,000 (Rp 72 million) and Singapore at about RM66,000 (SG$20,000).
Specialist fees under Schedule 13 of the PHFSA haven’t been revised for over a decade since 2013.
“The more hours, more effort, and more complex, the higher the charge,” the cardiothoracic surgeon, who declined to be named, told CodeBlue. “To me, it’s about how much you value your time as a professional.”
“If I do surgery for eight hours, I should charge RM16,000, but even so, it’s still cheaper compared to Indonesia and Singapore,” he added.
APHM president Dr Kuljit told CodeBlue that the total hospital bill for a CABG (without complications) in Malaysian private hospitals is between about RM70,000 and RM80,000 on average. Minimal invasive surgery can go up to RM100,000.
Therefore, a surgeon’s maximum fee of RM16,000 for consultation and the procedure comprises only between 20 and 23 per cent of an average total hospital bill of RM70,000 to RM80,000 for a CABG.
