KUALA LUMPUR, Oct 9 — IHH Healthcare Malaysia is the first private hospital group to take a stand against insurance interference with clinical decisions that potentially affects quality of care and patient safety.
Without naming specific companies, IHH acting chief executive officer Dr Kamal Amzan said payers’ recent recommendation on anaesthetic use and the compulsory substitution of innovator drugs with generics risked reducing medicine to compliance rather than care.
“Clinical judgement cannot be governed by cost,” said Dr Kamal in an internal memo last Monday to hospital CEOs, among others, as sighted by CodeBlue.
“Anaesthesia is not a preference, but a clinical necessity determined by patient condition, procedural complexity, and the pursuit of safe outcomes. When cost becomes the deciding factor, we trade precision for expedience and in doing so, place both patient and principle at risk.”
The acting CEO of the major hospital operator – with a network of 18 hospitals in Malaysia that includes brands like Gleneagles, Pantai, and Prince Court – said the same applied to medicines.
“Generics are vital in improving access and affordability, and many meet rigorous standards of safety and efficacy. Yet, therapeutic equivalence must be demonstrated, not assumed,” said Dr Kamal.
“Differences in formulation, excipients, dissolution profiles, and manufacturing environments can influence absorption, stability, and clinical response. In narrow therapeutic index drugs, oncology agents, or biologics, even subtle variations may lead to meaningful differences in efficacy or side-effect profile.”
CodeBlue recently reported 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. The third-party administrator (TPA) instructed health care providers to provide a “detailed justification” of the need for general anaesthesia.
Previously, CodeBlue reported a letter by MiCare Sdn Bhd that imposed a blanket generic-only mandate for long-term medications, on the instruction of a corporate client for its employees, with the TPA directing panel clinics, hospitals, and pharmacies to list only the active ingredient in prescriptions.
Dr Kamal did not indicate in his internal memo if a generic-only policy only came from MiCare (for a specific client) or if a blanket mandate to switch from branded drugs to generics or biosimilars was also issued by other insurers or TPAs.
While the Ministry of Health (MOH) adopts a generic-first policy to manage costs, patients in the private sector directly fund their own care through regular health insurance premiums, with the expectation of getting the care that they pay for.
MediExpress’ LA-first policy triggered widespread outrage among the medical fraternity. In a statement last Tuesday, Health director-general Dr Mahathar Abd Wahab issued an unprecedented warning to insurers and TPAs against interfering with doctors’ clinical decisions to the extent of breaching the law.
Citing the Private Healthcare Facilities and Services Act 1998 (Act 586), the Health DG said conditioning guarantee letter (GL) approvals or setting reimbursement on “predetermined clinical choices” may be illegal.
Dr Kamal said IHH’s Pharmacy and Therapeutics (P&T) Governance Framework remained the compass of the hospital group.
“It ensures that every substitution and clinical decision is grounded in evidence, quality, and ethical accountability. This framework is not bureaucracy; it is the architecture of trust, the system that protects both patients and professionals,” he wrote in his October 6 memo titled “Governance, Not Convenience”.
“We will continue to improve efficiency through the right means, by reducing clinical and operational waste, adopting practices such as Enhanced Recovery After Surgery (ERAS) to shorten stay and improve outcomes.
“Cost stewardship must come from excellence, not compromise. Socioeconomic factors should inform access, never dictate care.
“Health care’s true measure is not just about cost containment, but life sustained. Let us continue to act with science, conscience, and compassion, and to always Care. For Good.”
Editor’s note: Paragraph 9 was amended to make clearer that MiCare’s generic-only mandate was initiated on behalf of its corporate client.
