In 1998, Malaysia took a bold step to formalise private health care through the enactment of the Private Healthcare Facilities and Services Act (PHFSA).
When the enabling Regulations were enacted in 2006, it was a time when the doctor-patient relationship was at the heart of medicine, and third-party influence was minimal.
But today, in 2025, the health care landscape looks very different.
A growing number of corporate intermediaries (or middlemen)—known as Third Party Administrators (TPAs) and Managed Care Organizations (MCOs)—now influence much of the private health care system.
These entities have come to dictate how patients should access doctors, how doctors are paid, and in some cases, even how specific medical decisions are made.
The Competition Commission should rightly investigate if the modus operandi of many of these middlemen contravenes the provisions of the Competition Act 2010.
This shift raises a fundamental question: Who truly decides your care—your doctor, or a business interest?
Doctors today often find themselves squeezed between two uncomfortable choices:
- A skewed “free market”, where powerful corporate networks dictate fees and terms, or
- Capitation models, where doctors are paid a fixed, often inadequate amount, regardless of the complexity or effort involved in treating each patient.
These systems may seem efficient on the surface, but they risk sidelining the quality and continuity of care. Worse, they chip away at the patient-doctor relationship, replacing it with impersonal and fragmented transactions managed by administrators who do not understand your individual medical needs.
In addition, with advent of the Internet, the application of a wide array of apps, and the use of AI (Artificial Intelligence), the system has grown even more impersonal, reducing the exchange between health care providers and patients to algorithmic agencies.
As these structures expand, many patients are unaware that their health care decisions may no longer rest solely with their chosen doctor. To start with, even their choice of doctor may be restricted.
Clinical autonomy is under pressure, and with it, your right to receive the care that best fits your condition and requirement.
Even as more regulatory frameworks are introduced—purportedly to be in the interests of patients—the lack of oversight concerning these third-party players raises valid concerns.
When those tasked with regulation are perceived to have overlapping commercial interests, it challenges the integrity of the system.
We must ask: Who benefits from these reforms and transformations in health care?
Is it the patient? The doctor? Or the growing machinery of the health care business complex?
It has been a lifetime for me, almost 50 years as a doctor. It is my observation that, unless we pause to reflect and re-focus health care around patients and their doctors, Malaysia may soon find itself facing the same challenges that have weakened health care systems elsewhere.
The time has come for the rakyat to speak up—for the preservation of patient choice, quality care, and the sanctity of the doctor-patient bond.
We must appeal to relevant government and regulatory agencies to continue to protect public interest and public good keeping in mind the preservation of the patient-doctor relationship in the healing process. Any process that is aimed to toxify this relationship will eventually be to the detriment of the patient.
Let your voice be heard. Because when it comes to health care, you should be the one calling the shots.
Dr Steven KW Chow is the immediate past president of Federation of Private Medical Practitioners Associations, Malaysia (FPMPAM).
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
