I am an unapologetic selfish consumer of health insurance.
The insurance industry, private hospitals, Bank Negara Malaysia (BNM), the Ministry of Health (MOH), and MPs have spoken at length about the urgent issue of soaring medical insurance premiums and private hospital bills.
But the consumer’s perspective is missing – beyond valid complaints about double or even triple-percentage hikes of health insurance premiums.
Under my AIA medical plan with an annual medical limit of RM1,375,000, my yearly premiums increased from RM1,551 in 2023 to RM1,679 this year, rising again to RM2,242 for next year. In just two years, my premiums jumped 45 per cent from 2023 to 2025.
I have half a dozen insurance policies from three insurers covering life, medical, critical illness, and retirement. In total, I pay about RM11,500 annually in premiums. Only my AIA medical insurance has a premium hike (for now).
I’m particularly sensitive to the need for health insurance because my father died from cancer at the age of 41, when I was 16 years old. My mother doesn’t have medical insurance because she can go to a government hospital as a pensioner if needed (my father was a civil servant).
Although at retirement age, my mother has not had to go to hospital because she maintains good health (daily light exercise and cycling, fortnightly 10-lap swims, gardening, and eating oats).
The only hospitalisation episode I’ve had, throughout all my years of paying insurance, was a decade ago when I dislocated my kneecap while on holiday in Penang. I went to Penang GH, where a doctor saw me in about four hours and fixed it quickly. Now, critically ill patients are being stranded for nearly a week in the emergency department in government hospitals.
Contrary to allusions from BNM and the insurance industry about Malaysians wanting to go to hospital and maxing out their coverage, nobody likes to go to the hospital. My dislocated kneecap was excruciatingly painful.
Should I ever need to be hospitalised again, I’ll simply use my medical insurance at a private hospital and follow whatever treatment plan recommended by my doctor.
I told an MOH official that the ministry’s mandate for drug price displays in private hospitals didn’t make sense because I wouldn’t bother looking at my hospital bill (much less prior medicine price displays) if I were fully covered by insurance.
“Well, your attitude in terms of, ‘if insurance is paying for it, I don’t really care’, is what helps contribute to the increase in insurance premiums – because medical practitioners would just prescribe, knowing you don’t question since insurance is paying,” he replied.
First of all, I believe that health care professionals want the best for their patients. If my doctor gave me options for treatment – a more expensive one with better outcomes like a shorter hospital stay, versus a cheaper one that still does the job but requires longer hospitalisation – I would obviously choose the pricier treatment that gets me up and running quicker, if I were covered by insurance.
Why do insurers begrudge me picking the costlier treatment?
What’s the point of giving me an annual medical limit of nearly RM1.4 million if my insurer doesn’t want me to use it? Since I’ve been paying my premiums diligently for years, I’d want to maximise my coverage and get the best drugs and procedures with the latest medical equipment for the one occasion that I need hospitalisation.
Insurance companies gripe about policyholders getting hospitalised, yet their preventive health benefits are pathetic. My AIA medical plan only gives me RM300 every two years for both health screening and vaccinations. A typical health screening package at a private hospital costs RM1,000. My HPV shot alone cost me RM600.
In the 2019 Spanish horror film, The Platform, prisoners in a tower-style facility with 250 levels only get to eat once a day. Enough food for everyone arrives on “the platform” that lowers from level 0, stopping for two minutes on each level.
If people only eat their share, then everyone – down to the lowest level – gets to eat. But if the prisoners at the highest levels gorge on the buffet on the platform, then less and less food gets lowered down and people at the lower levels will have nothing to eat.
The insurance industry and BNM blame high medical inflation (figures differ; first they say it’s 12.6 per cent, now it’s 56 per cent) on our “buffet table syndrome”. The payer wants us to be responsible health care consumers who consume only what, to them, is necessary so that everyone insured can tap on the pool of funds for what they need.
Insurance companies and the central bank justify rising premiums because the pool of funds is shrinking at supposedly an unsustainable level, either due to “extravagant” claims or because too many people are making claims. Worse, BNM has mandated minimum 5 per cent copayments, without setting a cap.
Their models fail to understand simple consumer behaviour. Insurers think that insurance is like flipping a coin – i.e. they don’t take into account however long we have been paying our premiums because what matters is today.
No matter how many times you flip a coin, the probability will always be 50-50 the next time. Similarly, insurers perceive that what we have been paying all along was to cover the probability of hospitalisation yesterday, the day before, and every day in the past ever since a policy was taken up.
In the insurer’s mind, years’ long premium payments should not add up like a bank account that policyholders feel entitled to withdraw from some time in the future. But that is exactly how consumers like me think.
Like the movie The Platform, why shouldn’t I gorge on the buffet when everyone else is doing the same thing? If an insurer’s pool of funds is dwindling, that’s not my problem. Insurance companies recorded higher revenue or profit this year, just like private hospitals.
As far as I’m concerned, I have (literally) paid my dues and I maintain a healthy lifestyle to keep myself out of the health care system, which, by the way, I’m not being rewarded for. (My medical insurance is too stingy with its points system for healthy behaviours).
By not being a patient, I am a model policyholder.
Even if I were to refrain from behaving like a selfish consumer and voluntarily choose a cheaper treatment, I would still be punished with premium hikes and copayments.
My insurer won’t look at my history of zero or low claims and reward me by maintaining my premium quantums because, again, the past doesn’t matter to them. In fact, the future doesn’t matter to insurance companies either.
I took insurance early because I wanted to ensure sufficient health care coverage in my retirement age. Instead, senior citizens were hit this year with incredulous premium hikes from more than 70 per cent to 275 per cent.
So health insurance isn’t actually intended to cover us in the faraway future – it’s only meant for today. If you are old or unhealthy today, insurers will jack up your premiums no matter how many decades you have been faithfully paying them without ever making claims.
I believe that the insurance industry and BNM are overestimating people’s willingness to cooperate. I can afford the 45 per cent increase in my medical insurance premium, but many other Malaysians have already terminated their policies because they just can’t afford the premium hikes.
There appears to be little political will to resolve the issue of increasingly unaffordable health insurance for middle class Malaysians. BNM is clearly siding with the insurance industry and even interfering with MOH’s jurisdiction by mandating the Life Insurance Association of Malaysia (LIAM) to publish a comparison of charges by different private hospitals to insurers for common procedures – a pointless exercise.
If I had the luxury of time to choose a private hospital for admission, I would look at LIAM’s comparison, which is expected to be published mid-2025, and pick the most expensive hospital because my insurance is paying for it.
Do I need to go to a fancy hospital with a grand piano in the lobby? No, but I want my money’s worth from all the premiums I have been paying for years.
LIAM’s data won’t be helpful to patients paying out of pocket either because private hospitals often charge lower rates or give “discounts” to non-insured patients.
The insurance industry, private hospitals, BNM, and MOH must find the way forward in an open forum, since the finance and health ministers have not proposed any substantive solutions.
Boo Su-Lyn is the co-founder and editor-in-chief of CodeBlue.
