KUALA LUMPUR, Dec 12 — Dzulkefly Ahmad has cited the Ministry of Health’s (MOH) outsourcing exercise to private hospitals as an example of how private health care charges might be regulated.
The health minister also estimated the second quarter of next year to mandate the diagnosis-related group (DRG) payment model for private hospitals, after the Private Healthcare Facilities & Services Act 1998 (Act 586) is amended.
“With the DRG system, there will be greater transparency, so patients will know what they are being charged. For example, in our outsourcing arrangements, we use a bundle payment system.
“It’s not about paying for each individual service. For specialties like cardiothoracic surgery, cardiology, and nephrology, we use bundled payments. In this model, the DRG will also function similarly, so patients will know their charges upfront,” Dzulkefly was quoted telling reporters in Parliament yesterday.
DRG involves paying a fixed amount based on the complexity of the case, rather than itemising each charge. Hospitals receive a set amount – which is pre-negotiated between the payer and the hospital – and manage their resources within that budget. Private hospitals in Malaysia currently operate on a fee-for-service model.
Dzulkefly added that the MOH is focusing on drug price transparency in the private health care sector.
The MOH has mandated drug price displays in private hospitals and general practitioner (GP) clinics next year. Doctors’ groups like the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM) and the Malaysian Medical Association (MMA) have vociferously opposed medicine price displays, saying it will severely affect the operations of GP clinics.
Prime Minister Anwar Ibrahim, who is also the finance minister, told the Dewan Rakyat last Tuesday that the government plans to amend Act 586 next year to mandate the DRG payment model to regulate private hospital charges.
Act 586 currently only caps doctor fees; all other charges by private hospitals, clinics, and other facilities and services are unregulated. Specialist doctors’ consultation fees and their fees for various procedures are controlled under Schedule 13.
In briefings to MPs yesterday on medical inflation and rising health insurance premiums, Bank Negara Malaysia highlighted “different and non-transparent” charges by private hospitals, pointing out that insured patients with guarantee letters are billed 286 per cent and 158 per cent higher than insured pay-and-claim patients for dengue and pneumonia treatment respectively.
