KUALA LUMPUR, August 26 — The Ministry of Health (MOH) has released a roadmap for the creation of a national diagnosis-related groups (DRG) payment system aimed for launch in 2027.
Health Minister Dzulkefly Ahmad told Puchong MP Yeo Bee Yin in a written Dewan Rakyat reply last August 18 that the DRG reimbursement model for private hospitals, however, will be launched earlier next year.
The implementation of DRG for private hospitals will be done via the introduction of a basic medical and health insurance/takaful (MHIT) product created by the government.
“This basic MHIT product functions as a uniform platform to ensure the transparency and effectiveness of a DRG reimbursement system,” Dzulkefly told Parliament.
“Although DRG in the private sector will be implemented earlier, this effort still supports the effort of developing a more inclusive national DRG system by taking into account more accurate data integration and grouper logic analysis together with private hospitals, university teaching hospitals, and military hospitals.”
A five-year plan for the creation of a national DRG system that began two years ago in 2023 is as follows:
- 2023-2024: Set up of a special committee comprising government and private agencies, technical studies, and applications and approval of allocations for the development of a national DRG ICT system.
- 2025: Development of a national DRG system, coordinating workshops, and training on setting clinical codes in government and private hospitals.
- 2026: Development of a national DRG algorithm, modules, cost-setting, and system integration.
- 2027: System tests, implementation of a pilot project, and an official launch of the national DRG system.
“The private sector DRG is an interim measure to contain a rise in medical inflation in the private sector that is burdening the people,” Dzulkefly said.
“Although the methodology differs slightly from the national DRG, the private sector DRG is developed in line with and can be combined with the national DRG through system interoperability.”
Finance Minister Anwar Ibrahim, who is also the prime minister, previously said in a written Dewan Rakyat reply on July 29 that the MOH was looking at amendments to the Private Healthcare Facilities and Services Act 1998 (Act 586) to mandate DRG for private hospitals.
Dzulkefly, however, has yet to announce when an Act 586 amendment bill will be tabled.
