KUALA LUMPUR, March 9 — IHH Healthcare Malaysia CEO Dr Kamal Amzan has directed hospitals under the private health care group to treat insurer-driven delays to urgent treatment as patient safety incidents, warning that coverage decisions that stall care can worsen outcomes.
In an internal memo dated March 3 circulated within IHH Malaysia, Dr Kamal said access barriers that delay urgent care should not be managed as routine insurance coverage issues.
“When coverage decisions delay urgent care, we treat it as a patient safety incident,” Dr Kamal wrote in the memo sighted by CodeBlue. “In health care, time is not a neutral variable. When time is lost, outcomes shift, suffering expands, and accountability becomes harder to pin to any one pair of hands.”
“That is why access barriers that delay urgent care cannot be managed as routine ‘coverage issues’. They must be treated as safety risks and governed accordingly.”
Responding to CodeBlue when contacted, Dr Kamal said administrative processes should not override clinical urgency.
“As I have communicated to our teams internally, when administrative processes delay clinically indicated urgent care, we treat it as a patient safety matter,” Dr Kamal said.
“Time is not neutral in health care, and our clinicians are expected to prioritise medical urgency while administrative issues are addressed in parallel.”
Dr Kamal also said the Healthcare Partners Protocol & Solutions Committee (HPPSC) serves a different function from the internal directive on managing delays to urgent care.
“The HPPSC serves a separate purpose, ensuring due process and fairness in panel management decisions,” he said. “Its operational framework is still being finalised and will be reviewed by the Joint Committee before formal implementation.”
The memo described a recent case involving a patient with multiple facial injuries and fractures who required urgent surgery.
Coverage was denied because the treating surgeons had reportedly been removed from the insurer’s panel without explanation to the hospital or clinicians.
“As a result, the patient had to be transferred to another facility to obtain time-critical care,” Dr Kamal wrote. “This is the wrong kind of normal.”
Dr Kamal said hospitals were increasingly encountering situations where doctors were removed from insurer panels without clear communication.
“Across the market, we are seeing doctors removed from payor panels without clear communication to hospitals or clinicians,” he wrote.
“Whatever the stated rationale, the practical result can be the same: delayed treatment, forced referrals, distressed patients, and clinicians left to absorb the fallout of decisions made far from the bedside.”
IHH Orders Same-Day Escalation Of Insurer Delays
Dr Kamal instructed IHH hospitals to escalate cases where insurer restrictions delay urgent or emergency care. “Any case where panel restrictions or denials delay clinically indicated urgent or emergency care must be escalated within the same day,” he wrote.
Doctors were also told to document cases carefully. “Record the clinical urgency, the recommended plan, the denial or panel restriction with exact wording, and the impact on care (delay, transfer, altered plan). Keep it factual and contemporaneous.”
The memo said IHH Malaysia would also seek clarification from insurers regarding panel removals affecting urgent care access and set up an oversight committee to assess such decisions.
“If a removal is inappropriate, we will engage the payor formally and, where necessary, refer the matter to the relevant authorities through proper channels. If a removal is appropriate, we will review the doctor’s practice and manage it through our governance framework,” Dr Kamal wrote.
“Our work is ultimately a test of responsibility towards the vulnerable, especially when processes make it easier to look away.”
IHH Healthcare Malaysia’s network of health care facilities includes four Gleneagles Hospitals, Island Hospital, 11 Pantai Hospitals, Prince Court Medical Centre, and Timberland Medical Centre.
Health Minister Dzulkefly Ahmad told Parliament last month that insurer intervention in patient treatment violates the law, warning that actions undermining doctors’ clinical independence may contravene existing legal provisions.
The Health Ministry said it takes serious concerns over insurers, takaful operators, and third-party administrators influencing treatment decisions in private hospitals.
Concerns about insurer involvement in clinical decisions have surfaced repeatedly in Malaysia’s private health sector.
A CodeBlue poll of 855 private hospital specialists last October found that 99 per cent perceived insurer interference in treatment decisions, with many reporting coverage denials or delays for tests, procedures, drugs, or admissions.
Insurance disputes have also affected patients directly, including a stage four tongue cancer patient who paid tens of thousands of ringgit out of pocket while his insurer investigated past medical records.
