I refer to an article published on CodeBlue on December 9, 2024 titled “Cataract Surgery Bill 100% Higher For Insured Patient Than Self-Pay Patient: MPs”, that highlighted an anecdotal case from eight years ago, where the cost of surgery billed to insurance was allegedly much higher than the amount paid in cash.
This article casts an unfairly negative light on doctors in general and ophthalmologists in particular. I have received numerous messages from concerned members of the public and doctors requesting clarification on this issue.
Firstly, it is important to understand that doctors’ fees in Malaysia are strictly regulated by the 13th Schedule of the Private Healthcare Facilities and Services Order 2013, enforced under Act 586 (Private Healthcare Facilities and Services Act 1998) and published by the Attorney General’s Chambers.
This schedule, which dictates the fees billed to insurance, has not been updated for over a decade, despite increasing living costs, exchange rate fluctuations, and inflation. Therefore, the fees charged to insurance reflect the true, regulated costs of such procedures.
However, other components of medical expenses – such as the cost of medical equipment, surgical supplies, staff salaries, operational expenses, and medication – are not regulated by the government.
Additionally, hospitals often face delayed payments from insurance companies, with payment terms typically spanning three to six months. In some cases, disputes between insurance companies and their clients can lead to even longer delays, or non-payment altogether.
These factors impose significant financial challenges on health care providers.
The article should have instead focused on the remarkably low fee charged to the cash-paying patient. Based on the costs of materials and implants, it is likely that the surgeon received only about 30 per cent of their potential fee to accommodate the discounted rate. Few industries regularly provide discounts of 70 per cent or more.
The surgeon’s motivation was likely influenced by market competition, the patient’s financial circumstances, or a genuine desire to help. Hospitals also frequently extend discounts to support patients in need.
It is worth emphasising that cataract surgery is a highly skilled and precise procedure that requires years of experience and the use of expensive surgical equipment. Any complications during such a procedure could result in serious consequences, including blindness.
In summary, rather than criticising the discrepancy between cash and insurance bills, the surgeon should be commended for providing substantial discounts to cash-paying patients.
If there is concern over this discrepancy, the appropriate solution would be to raise cash-payment rates to reflect actual costs, rather than lowering the regulated fees billed to insurance.
Dr Miswan Muiz Mahyudin is the president of the Malaysian Society of Ophthalmology.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
