KUALA LUMPUR, June 9 — The Ministry of Health (MOH) is targeting a phased rollout of the diagnosis-related groups (DRG) payment system in the Rakan KKM programme by the end of this year.
Rakan KKM, expected to be launched in Cyberjaya Hospital, aims to charge patients above cost for certain services, unlike other government-subsidised health care services in MOH.
Rakan KKM has a CEO – Dr Mohamed Ali Abu Bakar – who recently left the Malaysia Healthcare Travel Council (MHTC) as CEO.
“We’re hoping that the DRG can be rolled out (together with Rakan KKM) before the end of 2025,” Dzulkefly told reporters at the sidelines of the Association of Private Hospitals Malaysia (APHM) Conference here today.
“DRG is based on groupers. It groups, and we’ll start off with the simple ones, and then we develop the momentum and move on to the more complex ones.
“So I’m confident we’ll be able to at least begin Phase One with the simpler groups — just like what we’ve already implemented under the Hospital Services Outsourcing Programme (HSOP) where patients are outsourced from MOH. That’s also bundled payment, kind of a grouping too.
“So we have the experience, and I’m confident that with everyone’s cooperation, especially from APHM, the Ministry of Finance and others, before the end of the year, I’m certain we’ll be able to implement it,” Dzulkefly said.
The health minister’s latest remarks indicate that DRG has indeed “fizzled out” for private hospitals, as previously reported by The Edge. Large private hospital bills had been the main source of complaints from both health insurers and patients.
DRG, a case-mix classification system that groups patient episodes with similar clinical conditions and resource use, has been used in MOH hospitals since 2010 and was extended to all 149 government hospitals by 2023.
However, efforts to implement DRG in the private sector have faced resistance from private hospital groups, who cite pricing complexity, varying service levels, and infrastructure differences.
During his speech at the APHM Conference, APHM president Dr Kuljit Singh said that while private hospitals support the government’s effort to introduce DRG, “accurate clinical data” and a “national Electronic Medical Record (EMR) system” are needed.
“That data is not yet available, and in the absence, it makes DRG implementation complex.”
In response to The Star’s report earlier today on Dzulkefly’s comments about implementing DRG by the end of the year, APHM issued a statement that reiterated Dr Kuljit’s comments at the APHM Conference.
“For the DRG or any DRG-type mechanism to work, accurate clinical data and a national electronic health record system is needed,” APHM said in a press statement.
“At present, this foundational data is not yet available, which presents significant challenges for timely and effective DRG implementation. As the process of gathering and analysing such data is complex and time-consuming, APHM anticipates that a proper rollout will require considerably more than six months.
“To support this national initiative, APHM member hospitals have offered to share relevant clinical data required for the set up of a DRG system with the Ministry of Health and the Ministry of Finance.
“APHM strongly advocates that adequate time and resources be allocated to ensure that the DRG initiative is thoroughly conceptualised, piloted, and implemented, to ultimately deliver sustainable improvements for all Malaysians.”
