KUALA LUMPUR, Oct 7 — Dr Mahathar Abd Wahab issued a stern warning to health insurers and third-party administrators (TPAs) today against interfering with doctors’ clinical decisions to the extent of breaching the law.
Without referring to any specific case, the Health director-general cited Sections 82 and 83 of the Private Healthcare Facilities and Services Act 1998 (Act 586) that he said set out clear principles and statutory safeguards to protect clinical decision-making from undue influence.
Section 82 contains the interpretation of managed care organisations (MCOs), while Section 83 underlines the contracts between a private health care facility or service and an MCO.
“While cost-efficiency is an important consideration in health care financing, it must never override the professional judgement of registered medical practitioners or the rights of patients to informed, consensual care,” said Dr Mahathar in a statement today.
“Decisions regarding anaesthesia, treatment modality, and admission status must remain grounded in clinical need and ethical standards, not administrative directives or financial gatekeeping.”
The top Ministry of Health (MOH) official said any arrangement that interfered with a practitioner’s authority over patient management, or pressured them to act contrary to professional ethics, was “not only unacceptable, but it may also constitute as inconsistent with legal provisions.”
“Conditioning guarantee letter approvals or any form or arrangement, directive or contractual condition or setting reimbursement on predetermined clinical choices, may constitute a breach of these principles,” said Dr Mahathar.
“The Ministry will continue to monitor developments closely and engage with all stakeholders, including health care providers, insurers, and professional bodies to uphold good clinical governance.
“We urge all parties to respect professional boundaries and to place patient welfare above administrative or financial considerations.”
Dr Mahathar’s statement is likely the first issued by a Health DG in recent history about doctors facing problems with health insurers or TPAs interfering with their clinical decision-making, despite years of complaints by the medical profession.
CodeBlue reported last Thursday an October 1 memo by MediExpress (Malaysia) Sdn Bhd to panel hospitals to prioritise local anaesthesia (LA) as the first-line anaesthesia modality over general anaesthesia (GA) for daycare procedures and surgeries, instructing health care providers to provide a “detailed justification” of the need for general anaesthesia.
The TPA’s directive triggered uproar among the medical profession, with 10 doctors’ groups, including the anaesthesiology fraternity, issuing statements to condemn MediExpress’ LA-first policy as a threat to patient safety.
