KUALA LUMPUR, March 19 — The Association of Private Hospitals Malaysia (APHM) said rising health insurance claims are driven by worsening health conditions, not excessive use of coverage, rejecting insurers’ claims of a “buffet table syndrome.”
APHM president Dr Kuljit Singh dismissed “buffet table syndrome” – the tendency for insured patients and providers to request or utilise more services than necessary – as a myth, saying both public and private hospitals are seeing an increase in more severe cases, such as pneumonia and fatal dengue, with no clear explanation.
“I don’t think it’s that way because right now, for strange reasons that I cannot explain, why after the pandemic we have found that many patients are suffering from severe cases.
“In the past, pneumonia was just pneumonia, but now they come with bad pneumonia, literally medically bad pneumonia. And even if they get dengue, it is severe, to the point of being fatal,” Dr Kuljit said on the Keluar Sekejap podcast aired March 7, hosted by Khairy Jamaluddin and Shahril Hamdan.
Dr Kuljit said even the Ministry of Health (MOH) has observed a rise in certain cancers with no apparent cause.
“If you look at private hospitals, most of the patients you’ll see in ER, they are genuinely sick. They are not coming just to use their medical card, no. They are genuinely sick and they need admission and treatment, and we have that data.”
Malaysia is facing a non-communicable disease (NCD) crisis, with millions affected by conditions such as diabetes, hypertension, high cholesterol, and obesity. According to the National Health and Morbidity Survey 2023, more than two million Malaysians have at least three NCDs, while half a million live with four.
The country now has the highest diabetes rate in the Western Pacific and one of the highest globally, costing an estimated RM3.1 billion annually. This year, seven million adults are expected to be either prediabetic or diabetic, with many undiagnosed and unaware of their condition.
Dr Kuljit dismissed claims that insured patients overuse medical services. “This (buffet syndrome) myth will always be churned out but I don’t think that is the case, especially with the current generation of people. I mean, nobody finds being in a hospital cool.”
APHM honorary secretary Anwar Anis said NCDs are overwhelming both private and public hospitals, which he attributed to worsening lifestyles.
“The figure that is often repeated is 12.6 per cent medical inflation. Actually, there are two components to this figure. One is the increase in the cost of items. Meaning, if it used to be RM1, now it’s RM1.06, so the actual price inflation is 6 to 7 per cent out of the 12 per cent. The remainder is actually the increase in claims.
“The increase in claims in Malaysia after Covid has indeed been quite high. Not just in Malaysia, but we are among the highest,” Anwar said.
Anwar pointed to the lack of incentives for preventive health care, noting that only 6 to 7 percent of the MOH’s budget goes to prevention, while the rest funds treatment.
“Maybe the problem is, if I remember when you (Khairy) were the minister, you were talking about how we should focus more on prevention.
“So, if I’m not mistaken, from the total budget for MOH, only 6 or 7 per cent is used for preventive measures, the rest is for curative. At private hospitals, we do curative. Even if we want to be involved in preventive care, there are actually no incentives – that’s not our business – there are no incentives from either the government or the private sector.
“So it really is a problem where our lifestyle has been getting worse,” Anwar said.
