The recent memo by MediExpress (Malaysia) Sdn Bhd ordering panel hospitals to “prioritise local anaesthesia (LA) over general anaesthesia (GA), unless there are clear contraindications” is not only deeply troubling — it is outright unlawful under Malaysia’s Private Healthcare Facilities and Services Act (PHFSA) 1998 (Act 586) and its Regulations.
At its core, this directive is a blatant intrusion into the doctor–patient relationship. The PHFSA is unambiguous: only registered medical practitioners have the right and responsibility to determine appropriate medical treatment for their patients.
A third-party administrator (TPA), whose primary role is to process claims, has no statutory authority to dictate clinical protocols, least of all the choice of anaesthetic modality. This is the domain of the qualified doctor in charge, be it the primary physician, the anaesthesiologists and or the surgeon, exercised in consultation with the patient.
By substituting clinical judgement with a corporate memo, MediExpress has crossed a dangerous line. Anaesthesia is not a “one-size-fits-all” decision.
As exemplified, a sebaceous cyst entangled with nerves, a cataract patient with spinal issues, or an anxious child undergoing surgery may all legitimately require GA for their safety.
To reduce such complex decisions into an administrative checkbox for profit motivation to cost containment ignores medical realities and endangers patients.
Worse, this policy undermines patient autonomy. Informed consent requires that patients are given options based on medical need and their choice. For some, LA may be acceptable; for others, fear, pain, or co-existing conditions make GA the safer, kinder option.
Patient safety and dignity cannot be held hostage to corporate reimbursement policies.
The PHFSA was enacted precisely to safeguard standards of care, patient safety, and the integrity of medical practice. There are specific regulations that prohibit non-medical parties from interfering with the professional judgement of practitioners.
MediExpress’ directive, by conditioning coverage approval on compliance with its “LA-first” policy, is in breach of these provisions. Such interference not only places patients at risk but also exposes doctors and hospitals to medico-legal liability when adverse outcomes occur because corporate interests overrode clinical best practice.
This is not an isolated incident. The public will recall MiCare’s “generics-only” prescribing policy, also condemned by professional bodies as unsafe and unethical. Left unchecked, TPAs and managed care organisations (MCOs) will continue to push cost-driven directives that erode clinical freedom, compromise patient rights thus endangering the standard of health care in Malaysia.
The government cannot remain passive. While the health minister has acknowledged that TPAs fall under multiple jurisdictions, this issue strikes at the heart of health care regulation. The relevant authority must act decisively to ensure TPAs operate within their lawful mandate — as claims processors, not clinical gatekeepers.
Clear regulatory frameworks must be enforced, with penalties for TPAs that breach PHFSA provisions or issue directives that compromise safety. The question now arising is whether the MOH has any oversight of the contracts of the MCOs and TPAs.
If not, then who is regulating this business that is dictating terms and conditions for proper patient care?
Doctors, too, must stand firm. Professional medical bodies and patient-safety advocates have a duty to resist unlawful interference and protect the integrity of medical practice. No doctor should be compelled to subordinate patient welfare to corporate profit.
At stake here is more than a debate over anaesthesia. It is about who decides what is safe, ethical, and medically necessary — the attending doctor who is accountable to patients and the law, or administrators accountable only to their balance sheets.
The answer must be clear; medicine must remain in the hands of those trained and entrusted to practise it.
Patients deserve nothing less.
This statement was issued by Dr Steven Chow, founding chairman of DRSFORALL/ DRS UNITE, the Federation of Private Medical Practitioners’ Associations, Malaysia (FPMPAM).
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.
