THE MMA has emphasised the need for immediate reforms within the private healthcare sector to tackle pressing challenges faced by private healthcare specialists and general practitioners, the viability of private healthcare facilities, healthcare expenses, and the overall ecosystem of the sector.
Malaysian Medical Association President Datuk Dr. Kalwinder Singh Khaira highlighted that the rising costs of treatment in private hospitals are primarily driven by hospital services and supplies, rather than the professional fees charged by doctors.
"Nevertheless, numerous private medical specialists are experiencing pressure to lower their fees, both directly and indirectly, which ultimately jeopardises the quality and sustainability of specialist treatment services in the private sector," he expressed.
Furthermore, he pointed out a significant gap in private health insurance coverage, as many policies fail to include modern and innovative treatments such as immunotherapy and targeted therapies. "This situation often leaves patients in a difficult position, compelling them to seek partial treatment at private hospitals before transitioning to public hospitals due to financial limitations and restrictions, thereby disrupting the continuity of care," he added.
Dr. Kalwinder also identified the unregulated role of Third-Party Administrators (TPAs) as a critical issue, as they significantly contribute to the escalating costs in private healthcare.
TPAs, acting as intermediaries that provide managed care services, influence treatment pricing, delay payments, and impose unnecessary administrative burdens, which ultimately raise costs for both doctors and patients.
"The MMA has called upon Bank Negara Malaysia (BNM) and the Health Ministry (MOH) to take a more proactive stance in regulating TPAs," he stated. Additionally, Dr. Kalwinder noted that delays in processing insurance claims and excessive pre-approval requirements from insurance companies continue to hinder patients' access to timely treatment, particularly for critical illnesses.
MMA believes that BNM needs to step up its regulation and oversight to make sure that insured individuals receive the care they need without unnecessary delays or denials, he mentioned.
He also pointed out that the diagnosis-related group (DRG), often seen as a potential solution to rising costs and insurance premiums, requires a deeper look.
Dr. Kalwinder noted that MMA has examined the experiences and challenges of various countries that have adopted DRG and found that without thorough study and proper implementation, it could end in failure.
DRG has been rolled out in countries with a national health insurance system and has been introduced gradually there.
“So, it’s crucial to learn from these countries to figure out the best way forward for Malaysia, whether that means adopting DRG or a modified version of it,” he said. – March 7, 2025
