KUALA LUMPUR, Nov 3 — Patients going directly to private hospitals for conditions that general practitioners (GPs) could manage are contributing to rising medical costs, the Association of Private Hospitals Malaysia (APHM) says.
APHM honorary secretary Anwar Anis said a World Bank report commissioned by the government found that increased health care utilisation accounted for more than 70 per cent of rising medical insurance and takaful claims costs, compared with higher prices for the same medical services.
“Although we are an association of private hospitals, we believe that not everybody needs to come to hospital,” Anwar said during a panel discussion at the Industry Leadership Summit 2026 here on October 28.
“Most patients just need to go to a GP clinic and let primary care manage their condition first. Only if it cannot be managed at primary care level should they move on to secondary or tertiary care at a hospital.”
Anwar said strengthening primary care and making GPs the first point of contact could help manage hospital utilisation, which he identified as the main contributor to medical inflation.
He said hospitals had sought to contain the cost of individual items, but managing utilisation required closer collaboration among employers, insurers, third-party administrators (TPAs), and health care providers.
Syarikat Takaful Malaysia Keluarga Berhad chief distribution officer Yassir Azlin Abdul Ghafar similarly advocated empowering GP clinics, saying medical inflation had reached between 10 and 15 per cent over the past three years.
He said rising premiums when employers renewed their group medical insurance policies had prompted some companies to reduce employee medical benefits, introduce co-payment arrangements, or restrict access to private hospitals.
Under Takaful Malaysia’s GP care programme, employees are encouraged to seek treatment at panel GP clinics before being referred to hospitals when necessary.
Takaful Malaysia Claims GP Day Care Can Cut Dengue Costs By 80%
Yassir cited dengue treatment under Takaful Malaysia’s GP care programme as an example of how changing the treatment pathway could reduce employers’ medical expenditure.
He said treating an employee with dengue at a private hospital could cost employers about RM5,000, partly due to hospital admission, compared with less than RM1,000 through a GP-based day-care arrangement.
“If the employer allows the staff to go straight to the private hospital, the cost is at least RM5,000 because the hospital would like to treat it as a ‘staycation arrangement’, rather than treat the disease itself,” Yassir said.
He said Takaful Malaysia instead directed eligible employees with dengue to day-care arrangements at participating GP clinics, rather than admitting them to hospital.
“We are not reducing employees’ benefits. However, we change the process flow,” he said, claiming that the arrangement achieved almost equally effective treatment outcomes and maintained patient satisfaction at a lower cost.
Yassir, who is not a medical doctor, did not elaborate on the clinical criteria for determining which dengue patients could safely receive day-care treatment, or how the programme monitored patients whose condition might deteriorate.
Dengue can progress to severe illness, and some patients require hospital admission, intravenous fluids and close monitoring. Whether a patient can safely receive outpatient care depends on clinical assessment, including warning signs, and the availability of monitoring and prompt referral if necessary.
Doctors from several specialties previously told CodeBlue that insurance classifications of dengue and pneumonia as outpatient conditions should not replace clinical assessment, as both illnesses can deteriorate rapidly.
The cost comparison therefore does not, on its own, establish that GP-based day care is appropriate for all patients with dengue.
APHM’s Anwar cautioned against focusing solely on immediate cost savings, saying employers should not cut preventive care, rehabilitation or post-hospitalisation follow-ups, as poor treatment adherence could lead to higher costs later.
Employee Perceptions Also Affect GP Utilisation
Affin Bank Group chief people officer Mohd Syukri Ahmad Sudari identified employee perceptions of primary care as another barrier to reducing hospital visits.
He said some employees preferred going directly to specialist hospitals because they perceived GP clinics as providing inferior care.
“The perception among many of our employees, especially senior leaders, is that GPs are not good. That’s why they want to go straight to specialist hospitals,” he said.
Syukri also said requiring employees to produce medical certificates (MCs) for minor illnesses could lead to unnecessary medical consultations and medication costs, even when a day of rest might be sufficient.
“Most of us have probably experienced this. You just need two Panadol tablets and you’re fine the next morning. But because you need to produce an MC, you go to the hospital or clinic and receive medication prescribed by the doctor for cough or flu.
“Usually, you get at least three types of medication. And what happens? You just throw them away. So we need to be creative as well,” Syukri said.
He said Affin Bank currently allows employees to take up to five days of sick leave without an MC, so those with minor illnesses can rest without visiting a clinic solely to obtain a medical certificate.
