KUALA LUMPUR, Feb 21 — A group of private specialists have told health insurers that diagnostic approaches in medicine continually evolve, as AIA seeks to limit advanced testing for its panel hospitals.
The Association of Specialists in Private Medical Practice Malaysia (ASPMP) pointed out that in the mid 1980s in the United Kingdom, many cases of stroke could be managed conservatively even without a CT scan when the MRI had just arrived.
“This approach is no longer correct as the doctor, especially the specialist, must know the extent and nature of a stroke, and even the danger of treating a stroke blindly with a blood thinner when it is an internal bleeding,” ASPMP adviser Dr Sng Kim Hock told CodeBlue in a statement.
“Diagnostics, including blood tests, can run into thousands of ringgit. This is where, perhaps, the specialist bodies can set Good Medical Practice guidelines on various conditions and their necessary tests.”
CodeBlue reported yesterday a February 6 letter from AIA Berhad to its panel of private hospitals, requesting them to contain costs by prioritising simpler diagnostic tests over advanced ones and substituting innovative drugs with generics.
Galen Centre for Health and Social Policy chief executive Azrul Mohd Khalib previously noted that not all innovator therapies have biosimilar or generic equivalents.
AIA’s panel hospitals include those from major private hospital groups like IHH Healthcare, KPJ Healthcare, Asia OneHealthCare, and Sunway.
The major health insurer attributed its decision directly to Bank Negara Malaysia’s (BNM) interim measures to curb rising medical insurance premiums that were described by AIA as coming at “great cost to the industry.”
“With regards to medical litigation, following the trend in the West, it will definitely lead to more careful and hence ‘defensive medicine’, requiring the doctors to do certain tests to avoid missing a treatable condition,” Dr Sng said.
“In the meantime, ASPMP feels that insurance bodies should never sell million-dollar policies without some exclusions or caveats or it will mean that the ordinary subscriber has to pay for much more. Rather, they should strategise and sell policies which are basic, premium and unlimited.”
Dr Sng, who attended a town hall organised by Parliament’s Public Accounts Committee (PAC) in Penang last February 14 on medical insurance and private health care, expressed surprise to learn at the session that pensioners, like teachers, were buying private health insurance policies.
“Why is this necessary? ASPMP appeals to the government to ensure that public hospital facilities continue to improve and be upgraded so that the public including pensioners are not ‘forced’ to seek health care in private medical centres.”
