KUALA LUMPUR, Dec 11 — The Health parliamentary special select committee (PSSC) has urged the government to implement “standardised” charges for medical treatments to reduce disparities in private hospital bills.
Health PSSC chairman Suhaizan Kaiat, who is also Pulai MP, called for the swift rollout of a diagnosis-related groups (DRG) system that would categorise payments to health care providers based on diagnosis and procedures, rather than itemised hospital billing.
“We need a system where each patient is categorised according to the illness they have. This would allow us to determine the appropriate treatment and estimate the cost of each treatment,” Suhaizan said at a media conference in Parliament today.
He added that the DRG system would guide all parties in determining standard treatment costs. “While the figures may not be exact, there will be a range set. This will help control discrimination between insured and non-insured patients,” Suhaizan explained.
This recommendation was part of six proposals made by the Health PSSC, following briefings from the Ministry of Health (MOH), Bank Negara Malaysia (BNM), the Life Insurance Association of Malaysia (LIAM), the Malaysian Takaful Association (MTA), and the General Insurance Association of Malaysia (PIAM) yesterday on rising medical insurance premiums.
Earlier today, CodeBlue reported presentation slides by BNM – which were presented to both the government backbenchers club and the Health PSSC in separate sessions in Parliament yesterday – that highlighted “different and non-transparent medical charges” by private hospitals.
According to BNM’s presentation, insured patients with guarantee letters (GL) are charged 286 per cent and 158 per cent higher for dengue and pneumonia treatment respectively than pay-and claim patients, who need to fork out payment first before seeking reimbursement from their insurers.
The Health PSSC also called for a review of existing policies and supported introducing copayment options in medical and health insurance/ takaful (MHIT) products to help share treatment costs between insurers, takaful operators, and policyholders.
“This approach is expected to reduce financial pressure and ensure the sustainability of health care services. It also gives policyholders and takaful participants the option to select a level of service that suits their financial capabilities,” Suhaizan said.
The Health PSSC’s support for copayments is surprising, given that many people are already struggling with rising premiums. BNM’s requirement for copayments in new health insurance policies may exacerbate this financial strain, with no caps on the copay amounts.
LIAM’s Mark O’Dell previously told CodeBlue that insurers are considering copayments between 5 and 20 per cent. This means that if an insured patient receives an RM50,000 hospital bill, a 5 per cent copayment means that the patient has to pay RM2,500 in cash out of pocket – even though they have been regularly paying monthly or annual premiums.
The Galen Centre for Health and Social Policy had warned BNM that its requirement of a copayment option in health insurance could expose households to financial catastrophe.
The Health PSSC further recommended the establishment of a comprehensive health care pricing mechanism, with continuous monitoring of medication, treatment, and procedure costs to avoid undue financial burdens on patients.
It also called for the gradual implementation of price increases for health care services. “We are also aware that there is an increase in medical costs. If there are price hikes, they should be implemented gradually, not all at once, as it could put pressure on insurance and takaful operators, as well as on the public,” Suhaizan said.
The Health PSSC emphasised the strengthening of strategic partnerships through the “Rakan KKM” initiative, aimed at involving the private sector, NGOs, and communities in supporting national health care reforms.
Additionally, the committee advocated for the establishment of a National Health Fund – combining health care revenue from the government, the Employees’ Provident Fund (EPF), and the Social Security Organisation (Socso), among others – to provide sustainable financial resources to meet the increasing medical needs of the population and alleviate the financial burden on vulnerable groups.
Prime Minister Anwar Ibrahim told the Dewan Rakyat yesterday that the Private Healthcare Facilities & Services Act 1998 (Act 586) will be amended next year to regulate private hospital charges by mandating DRGs to replace the current fee-for-service payment model. Schedule 13 of Act 586 only controls specialist doctors’ consultation fees and their fees for various procedures.
When asked in Parliament if the government would impose a moratorium on next year’s increase in medical insurance premiums, Anwar, who is also finance minister, said there will be no moratorium, but an “interim, reasonable, and small increase.”
