KUALA LUMPUR, March 21 — The Federation of Private Medical Practitioners’ Associations Malaysia (FPMPAM) has urged private doctors to report health insurers and managed care organisations (MCOs) that impose restrictive conditions on guarantee letters (GLs) which interfere with clinical decisions or deny coverage, compromising patient care and safety.
The association said any interference in medical decisions by insurers or MCOs must be documented and escalated to the Ministry of Health’s (MOH) Medical Practice Division (CKAPS) and Bank Negara Malaysia (BNM).
“FPMPAM strongly advises private doctors to report any insurer or MCO GL conditions that interfere with clinical decisions or contain exclusion clauses that compromise patient care and safety,” FPMPAM president Dr Shanmuganathan TV Ganeson said in a statement today.
Dr Shanmuganathan said it was crucial that patient care remained the top priority, free from “undue influence by payers seeking to profit at the expense of medical decisions.”
FPMPAM also backed the Association of Private Healthcare Malaysia (APHM) in rejecting a call by insurance and takaful operators (ITOs) to freeze private health care costs and restrict medication choices based solely on price instead of medical need and cost-effectiveness.
“The rising costs of medical care are influenced by multiple factors beyond the control of the doctor, including staff wages, higher prices for medical supplies, increased operational costs, and the growing burden of medical liability, such as rising insurance premiums for doctors and hospitals,” Dr Shanmuganathan said.
“Any attempt to artificially freeze costs could compromise the quality of health care services and restrict patient access to timely and necessary treatment.”
The ITOs had earlier proposed a three-year freeze on private hospital costs and government regulation of pharmaceutical pricing as part of efforts to manage rising health care expenses and insurance premium hikes.
However, APHM, representing private hospitals, rejected the proposal, citing increasing staff wages, supplier costs, utilities, and medico-legal expenses as factors that make cost freezes unfeasible. Instead, it suggested developing industry guidelines for managing medical inflation, referencing standards such as the Medical Consumer Price Index (M-CPI).
APHM also warned that price regulation on medications could limit access to new treatments in Malaysia’s relatively small market. The association advocated for a balanced approach to ensure affordability while fostering innovation.
Separately, APHM has raised concerns about insurers withdrawing GLs during a patient’s treatment based on assessments made by in-house medical officers rather than specialist doctors.
“During patient visits, insurers may feel there is an issue—these can vary. It could be a patient issue, an unpaid premium, or the patient’s coverage nearing its ceiling. In such cases, insurers may withdraw the GL,” Dr Kuljit said on the Keluar Sekejap podcast.
“But sometimes, there is no reason why. Maybe the reason will come out at a later stage. Or maybe sometimes insurers say their information might not be enough. But doctors will give all the information.”
Dr Kuljit noted that insurance medical teams may not have specialists in certain fields, leading to misunderstandings with private hospital doctors.
“They may not have expert specialists who are very detailed like what we have in the hospital—that is indeed their difficulty because sometimes it is just an ordinary medical officer, not a nephrology specialist, not a cardiothoracic specialist, so maybe there is a bit of misunderstanding between their medical team and the specialist at the private hospital,” he said. “So that’s where sometimes GL withdrawal can happen.”
FPMPAM said it would continue working with all stakeholders, including APHM, to advocate for a sustainable health care financing model that safeguards professional autonomy and ensures patients receive necessary care.
