Malaysia is grappling with a significant challenge in its health care sector: a medical inflation rate that consistently outpaces global and regional averages. In 2024, the reported rate of 11.9 per cent stood markedly higher than both the worldwide average and the Asia Pacific average.
This trend is further highlighted when compared to neighboring countries, with Indonesia reporting 10.1 per cent, Singapore 9.5 per cent, and Thailand a considerably lower 7.1 per cent. Projections for 2025 paint an even more concerning picture, with Malaysia’s medical inflation rate expected to climb to 12.6 per cent, while the global rate is anticipated to be 7.2 per cent.
This persistent and rising inflation has unfortunately led to a growing perception among the public that medical professionals are primarily driven by financial gain rather than patient well-being. Doctors frequently find themselves unjustly blamed as the principal architects of this escalating cost, leading to a rapid erosion of trust.
Patients, increasingly burdened by health care expenses, often view medical practitioners with suspicion, believing that monetary considerations supersede their commitment to health.
However, a crucial aspect of this complex issue remains largely unacknowledged by the public: the immense pressure exerted on doctors by insurance companies and third-party administrators (TPAs).
Almost annually, medical professionals face demands from these companies to offer substantial discounts on their consultation fees. This constant financial squeeze, often unseen by the general public, significantly impacts doctors’ ability to maintain their practices and deliver comprehensive care. Yet it contributes to the broader narrative of rising health care costs.
The intricate interplay between inflation, public perception, and the operational realities faced by medical professionals creates a challenging environment for all stakeholders in the Malaysian health care system.
Intertwined Relationship
Insurance companies incentivise their agents handsomely and market products that can be financially burdensome for consumers. To draw customers, they offer features like cashless coverage, no co-insurance, and coverage extending up to 100 years.
New policies are frequently launched—almost every one to two years—and customers are encouraged to upgrade, pushing yearly or lifetime coverage amounts to astronomical figures. This, coupled with human nature, means that as premiums rise, patients are inclined to seek and request admission for treatment in private hospitals, even when outpatient care would suffice.
As insurance claims surge, insurers discover that current premiums are insufficient to cover costs (or the profit is not high enough?). Their response typically involves two strategies.
Firstly, insurance companies would introduce more safeguards: This includes implementing panel arrangements with certain hospitals and doctors and most of the time, forcing panel doctors or hospitals to give unrealistic discounts and threatening to cancel doctors or hospitals as their panels. Or to a more extreme, suspending pre-authorisation for specific hospitals with high claim volumes.
Secondly, raising premiums: in order to make more profit amid fast-paced medical inflation, premiums have seen sharp increases in recent years. Consequently, many policyholders, especially seniors, have cancelled their medical card policies.
They have come to realise that paying thousands or even tens of thousands of ringgit annually in premiums is not justifiable and insurance companies cannot promise no premium increase in the near future.
Government Inertia To Push For Reform
It is profoundly disheartening to witness the persistent disparity in health care cost regulation within Malaysia. Despite stringent laws that cap doctors’ professional fees, which have, in essence, remained stagnant for years, a glaring absence of legislation to control hospital charges continues to plague the system.
This imbalance creates an increasingly unaffordable private health care landscape. I have personally raised this critical issue during a town hall meeting with Ministry of Health (MOH) officers years ago. Regrettably, the consistent response has been that the government faces significant challenges in effectively regulating hospital fees.
This lack of control has severe ramifications for the entire health care ecosystem. While many Malaysian public hospitals grapple with aging infrastructure and chronic understaffing – a testament to years of underinvestment – the unchecked escalation of health care costs, particularly within the private sector, places an immense and growing strain on these already burdened public institutions.
As private health care becomes increasingly prohibitive for the average citizen, a larger proportion of the population is compelled to rely on the public health care system, exacerbating its existing challenges and potentially compromising the quality of care for all. This situation highlights an urgent need for comprehensive policy reform to ensure equitable and affordable health care access for all Malaysians.
It is with profound sadness that we acknowledge the continuous and alarming brain drain plaguing our nation’s health care sector. The situation is particularly dire when we observe our highly skilled and dedicated medical professionals consistently being targeted and enticed by our neighbouring country, Singapore. This persistent exodus of talent is not merely a cause for concern but a deeply unsettling reality that threatens the very foundation of our health care system.
The core issues driving this alarming trend are multifaceted, primarily stemming from the limited opportunities for substantial career advancement within our local health care institutions and the comparatively low remuneration offered to our doctors. In a profession that demands years of rigorous training, unwavering commitment, and constant personal sacrifice, the lack of a clear and rewarding career trajectory, coupled with financial incentives that fail to reflect their expertise and effort, creates an environment ripe for disillusionment.
As a direct consequence, it has become an undeniable inevitability that we will continue to lose more and more of our most talented and experienced doctors to Singapore. Our neighbouring nation, recognising the immense value of these professionals, offers them not only significantly more attractive salaries and benefits but also a more robust and diverse landscape for professional growth, specialisation, and research.
The long-term implications of this sustained loss of medical talent are catastrophic. It will lead to critical shortages of experienced specialists, increase the burden on an already strained health care workforce, compromise the quality of patient care, and ultimately undermine public trust in our health care system.
Medico-Legal Cases
In a worrying trend, senior doctors in private and public practice are reportedly leaving the profession at an unprecedented rate. While physician burnout is a well-recognised occupational hazard with prevalence estimates varying widely from 2 per cent to 81 per cent, personal observations suggest a growing number of private practitioners are now opting to see fewer patients.
The reasons behind this shift are understandable and rooted in increasingly challenging practice environments. One significant contributing factor is the evolving stance of some insurance companies, who have begun refusing to reimburse doctors for what were previously considered standard two-time treatment fees. This directly impacts the financial viability of private practices.
Compounding this financial strain are the historical highs in medical indemnity costs. For instance, neurosurgeons face an astonishing annual fee of RM151,800 for their Medical Protection Society (MPS) coverage in 2025. This exorbitant expense, coupled with record-breaking compensation payouts in medical negligence cases, has profoundly dampened the morale of many doctors.
The cumulative effect of these pressures is a professional landscape where financial security is tenuous and the risk of litigation looms large, making the continued practice of medicine less appealing and ultimately contributing to the exodus of experienced practitioners.
During the Covid-19 pandemic, health care workers were widely lauded as heroes for their selfless dedication and tireless efforts on the frontlines, despite the significant personal risks involved. However, the current narrative has shifted dramatically, with health care professionals now being accused of greed and self-interest.
This stark contrast in public perception is disconcerting, as it disregards the substantial sacrifices made by these individuals. This experience has shown me that organisations in this country always view us as easy and vulnerable targets.
Illness, Not Death, Is The Most Fearful Thing
Illness, more so than death, can be the most fearful aspect of life due to its prolonged impact on physical, emotional, and financial well-being. Unlike the swift finality of death, illness can inflict prolonged suffering, diminish quality of life, and erode independence. It can force individuals to confront a gradual decline, altering their daily routines and relationships.
The physical toll of illness can be relentless, ranging from chronic pain and fatigue to debilitating symptoms that restrict mobility and impair bodily functions. This ongoing physical struggle can deplete an individual’s energy, making even simple daily tasks feel monumental and leading to a significant loss of personal autonomy. The body, once a reliable vessel, can become a source of constant discomfort and limitation, forcing individuals to confront a gradual decline in their physical capabilities.
Emotionally, illness can be a deeply isolating experience. The constant struggle can lead to feelings of helplessness, despair, and anxiety. Patients may grapple with depression as they mourn the loss of their former lives, their hobbies, and their roles within their families and communities.
The fear of the unknown, the uncertainty of recovery, and the potential for increased suffering can cast a long shadow, affecting mental clarity and overall emotional resilience. Relationships can also be strained as loved ones become caregivers, navigating the complexities of the illness alongside the patient. This can alter established dynamics, sometimes leading to feelings of burden or resentment on both sides, despite underlying love and concern.
Financially, the burden of illness can be catastrophic. Medical treatments, medications, therapies, and long-term care can incur exorbitant costs, often draining life savings and forcing families into debt. Even with insurance, co-pays, deductibles, and non-covered services can accumulate rapidly, adding immense stress to an already difficult situation.
The inability to work or a reduction in earning capacity further exacerbates the financial strain, leading to a precarious future for both the individual and their dependents. This financial pressure can often be as debilitating as the physical symptoms themselves, creating a vicious cycle of worry and stress that impedes recovery and well-being.
While death is a personal matter, illness affects society as a whole. Access to reasonably good health care should be a fundamental right for every Malaysian citizen. Regrettably, we have not been courageous enough to implement necessary changes to our health care system.
The author is a consultant nephrologist.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
