KUALA LUMPUR, Dec 9 — PKR MPs today highlighted a complaint from a self-pay patient, whose insured wife was charged double his bill for cataract surgery that both underwent at a private hospital.
According to the complaint, the couple were both admitted as day care cases for the eye procedure at the private hospital in Perak, after which they were discharged on the same day. This occurred eight years ago.
The uninsured complainant was billed a total of RM3,000, but his wife with a medical insurance policy was charged 100 per cent higher at RM6,000.
“The operation was done by the same specialist, same operative time, but different charges,” said the complainant in an email that PKR legislators shared with the media at a press conference in Parliament.
“How come the insurance company did not raise any queries for the hospital levelling such charges? The consequence is the premiums for my wife’s policy for this year is RM20,000.”
The group of PKR MPs – Bayan Baru MP Sim Tze Tzin, Tebrau MP Jimmy Puah, Sungai Petani MP Dr Taufiq Johari, Segamat MP R. Yuneswaran, Miri MP Chiew Choon Mun – as well as Senator Amir Ghazali said they have also received feedback from specialist doctors with decades of experience in private hospitals.
“They believe that among the reasons for the rise in private hospital charges is unnecessary admissions; overdoing procedures; redundant MRI, CT scan, PET scan and screenings; escalating compensation awards by courts to medical negligence cases; and private hospitals chasing profit,” they said in a joint statement.
The PKR MPs said according to a letter from an insurance company, the increase in health insurance premiums was due to 18 per cent annual medical inflation for three consecutive years.
They pointed out that two major private hospital operators – KPJ Healthcare Group and IHH Healthcare Group – recorded “healthy profit” over the past few years.
KPJ’s gross profit was 39.6 per cent in 2019, rising to 41.9 per cent in 2023, while profit after tax was reported at 8.6 per cent in 2019 and 7.9 per cent last year. KPJ operates 29 hospitals in Malaysia, one in Bangladesh, and one in Thailand.
For IHH Healthcare, which operates 18 hospitals, earning before interest, tax, depreciation and amortisation (EBITDA) was reported at 21.5 per cent in 2020, reaching 22.2 per cent in 2023. Profit after tax and minority interests (PATMI) jumped from 2.1 per cent in 2020 to 14.1 per cent last year.
“The question is, is this linked to the rise in premium inflation that is being felt by Malaysians?” questioned the federal lawmakers.
The PKR MPs urged the Ministry of Health (MOH) and Bank Negara Malaysia (BNM) to form a joint taskforce with specialist doctors, actuarial scientists, public health policy experts, and experts of various fields to find a “win-win” and sustainable solution for private hospitals, insurance companies, and policyholders.
They also called for a Public Accounts Committee (PAC) inquiry and public hearing into rising medical insurance premiums and private hospital bills.
The Health parliamentary special select committee (PSSC) has already launched an inquiry into the issue, summoning three insurance associations, the Association of Private Hospitals Malaysia (APHM), and BNM and MOH officials for three separate briefings tomorrow.
Health PSSC member Young Syefura Othman told CodeBlue that APHM’s briefing is set for 5pm tomorrow, after BNM and MOH at 2.45pm, and the Life Insurance Association of Malaysia (LIAM), Malaysian Takaful Association (MTA), and Persatuan Insurans Am Malaysia (PIAM) at 11am.
She added that the Health PSSC will hold a press conference in Parliament on Wednesday morning.
Separately, Health Minister Dzulkefly Ahmad posted on X yesterday that the MOH supported BNM’s mandate for the insurance industry to publish private hospital charges to insurers for common procedures.
“BNM and MOH have been working (quietly) together all this while on health transformation initiatives,” he claimed.
“We are fully supportive and engaged on improving informed consumer choice with greater price transparency as suggested by BNM. We (MOH) are indeed on the same page with BNM on this agenda.”
