Healthy break for insurers

THE extreme upward pressure on medical insurance premiums in the last two years or so may vanish soon.

There may be a chance for premiums to cool or normalise, or perhaps insurers may achieve better profit margins following successful cost containment after recent negotiations with panel hospitals.

StarBiz 7 recently learned that a number of private hospital players in the country have agreed to hospital bill discounts ranging from 30% to 45% for insurance companies.

The Life Insurance Association of Malaysia (LIAM) says these discounts are aimed at making healthcare costs more manageable, which in turn supports more affordable insurance premiums in the long run.

“The industry welcomes the close cooperation between insurers and private hospitals to control the rising cost of medical treatment. Nevertheless, it is important to note that insurance premiums depend on many factors, such as medical inflation, the number of claims, and the overall cost of healthcare,” LIAM’s chief executive officer Mark O’Dell tells StarBiz 7.

Mark also notes of its main objective which is to make medical insurance more sustainable and affordable for everyone.

He also notes that if healthcare costs remain stable over time, it could help alleviate pressure on future premium increases, enabling insurers to offer better value to policyholders.

Commenting on this, IHH Healthcare Malaysia’s chief executive officer, Dr Kamal Amzan, highlights that the discounts the company provides to its insurance partners have nearly doubled compared to previous rates.

Traditionally, private hospitals offered discounts of 10% to 20%.

“This will impact our earnings. While we support the government’s efforts to cap premium increases and protect patients, this approach is not sustainable if costs continue to rise,” Kamal tells StarBiz 7.

IHH Malaysia, one of the country’s top three private healthcare providers, operates brands such as Gleneagles, Pantai, and Prince Court.

“To ensure long-term sustainability, we have focused on improving operational and clinical efficiency. Since 2019, we have transitioned to value-based healthcare, prioritising better patient outcomes,” he adds.

Rising cancer cases, but claims payouts flat

Meanwhile, it is learnt that there have been rising cases of cancer in the country and despite this, claims related to the disease have been rejected by insurers.

Kamal says IHH Malaysia has seen a steady rise in cancer cases across its hospitals since the Covid pandemic.

“After a brief dip in 2020, numbers began climbing in 2021 and are now nearly 50% higher than pre-pandemic levels,” he says.

Despite this sharp rises, Mark says data by Insurance Services Malaysia (ISM) shows there has been no spike in cancer claim payouts over the past three years.

The ISM is a service provider that compiles actuarial and statistical information for the industry, including data on medical and health insurance.

“Cancer claims accounted for 14% each year of total claims paid from 2022 to 2024,” Mark says.

Mark claims the association does not have the figures in relation to reports that there has been a rise in denials and delays for cancer treatment, especially for outpatient therapy and biologics.

“LIAM and its members are dedicated to fair and transparent practices in handling medical claims.

“We prioritise timely access to critical treatments like cancer care, working with regulators, medical experts and healthcare providers to improve processes and meet expectations,” Mark says.

He notes the insurance industry continuously reviews its claims and underwriting guidelines to ensure they are in line with evolving medical standards and treatment protocols.

“Insurers are also strengthening engagement with policyholders to provide better understanding of coverage, pre-authorisation processes, and options for treatment.

“LIAM also collaborates with the relevant authorities and stakeholders to promote greater consistency, data sharing and clarity in medical billing and treatment costs,” Mark adds.

Apart from cancer, IHH Malaysia’s Kamal points out while official claims rejection rates reported by insurers remain under 10% on the surface, the situation on the ground appears different altogether.

“Claims today are being reviewed far more closely, which often results in partial payments, disputes, or delays.

“In some cases, newer or more advanced treatments, those that can genuinely benefit patients – are not covered or are excluded from the approved bill.

“This creates a gap between what insurers approve and what the treatment actually costs,” Kamal says.

“That difference ends up being carried by hospitals or patients. It adds pressure on both sides and shifts focus away from care, which is the part that concerns us most,” he adds.

Covid vaccine link to cancer cases?

There is a growing number of reports linking the Covid vaccine to a rise in cancer cases, based on a recent study.

A population-based study in Seoul, South Korea, published in Biomarker Research, suggested a connection between Covid-19 vaccination and increased cancer rates, varying by age, sex, and vaccine type.

The study identified six specific cancers – thyroid, gastric, colorectal, lung, breast, and prostate – that may have a higher risk associated with vaccination.

This large-scale population-based retrospective study was conducted in Seoul estimate the cumulative incidence of overall cancers one year after Covid-19 vaccination.

Using the Korean National Health Insurance database, 8,407,849 individuals were analysed between 2021 and 2023.