KUALA LUMPUR, July 30 — The Ministry of Health (MOH) is looking at amendments to the Private Healthcare Facilities and Services Act 1998 (Act 586) to mandate a diagnosis-related groups (DRG) payment system.
Finance Minister Anwar Ibrahim, who is also the prime minister, told Bayan Baru MP Sim Tze Tzin in a written Dewan Rakyat reply yesterday that setting up a DRG mechanism would require private health care providers to share minimum clinical and financial data.
“The government will consider amending other Acts related to the ministry’s (MOH) jurisdiction, if necessary, to implement the entire Reset strategy,” said Anwar.
Reset is a strategy by Bank Negara Malaysia, the Ministry of Finance (MOF), and the MOH to curb a rise in private health care costs and medical insurance.
The Reset strategy plans to revamp medical and health insurance/takaful (MHIT), enhance price transparency of drug prices through price display, strengthen the digital health ecosystem, expand cost-effective options via Rakan KKM and non-profit hospitals, and transform the provider payment mechanism through DRG.
Act 586 currently only regulates doctors’ professional fees. About 70 per cent of a private hospital bill is unregulated, including the use of consumables, medical equipment, and medical and surgical supplies, among others.
Hospitals are required to issue itemised bills to patients under the law. Private hospitals in Malaysia operate on a fee-for-service model, whereas DRG pays health care providers a lump sum, rather than itemised billing, based on a single episode of care.
Many ordinary Malaysians have slammed Rakan KKM, which is operated by Rakan KKM Sdn Bhd, as an attempt to privatise the public health care system by providing paying patients faster access to elective procedures.
Rakan KKM’s business model seeks to maximise profit by purchasing medical supplies from the MOH at cost price and marking up the prices of supplies and services, including consumables, by 100 per cent for patients – similar to conventional private hospitals.
Seven medical and dental groups, as well as an individual general practitioner (GP), filed a judicial review application in the High Court here last Thursday in a bid to quash the drug price display mandate under the Domestic Trade and Cost of Living Ministry (KPDN).
