Sihat Malaysia premium going up

By M. KRISHNAMOORTHY

KUALA LUMPUR: The largest health insurance programme, Sihat Malaysia, will increase its premium by more than 30% from next month. 

Malaysian Assurance Alliance Bhd (MAA) vice-president (composite insurance) Kevin Choong Wui Teck said the National Insurance Association of Malaysia (NIAM) which managed Sihat Malaysia, was forced to raise the premiums following bad claims experiences with hospitals. 

“The hospitals are imposing exorbitant hospitalisation and surgical charges and in some cases they charged above the recommended rate in the Malaysian Medical Association's (MMA) schedule of fees,” he said. 

“One hospital overcharged by billing RM8,000 for appendicitis surgery when another hospital charged only RM3,000. 

Choong said they were left with no choice but to increase premiums.  

He said the increase was based on claims experiences. Sihat Malaysia's premium was based on average claims cost and average incidence rate, he added. 

Choong said they had deregistered 12 leading hospitals from the panel.  

MAA holds about 60% of Sihat Malaysia's market share. 

The consortium has over 70,000 policies covering more than 100,000 people. 

“Once they are deregistered they are out of our list for six months until they renegotiate with us with fair terms and conditions,'' he said in an interview. 

Fomca president Datuk Hamdan Adnan also raised the question of conflict of interest in some hospitals where doctors were shareholders and practitioners at the same time. 

He claimed that in one case, a patient who was overcharged queried the hospital management and was informed they could not give a discount. 

“As a shareholder of the hospital group, the doctor refused to budge and reduce the bill. 

“The hospital did not even want to follow the schedule of fees and the charges exceeded way beyond that recommended by MMA. 

He said the shareholder-doctor conflict was unethical. 

MMA president Datuk Dr N. Athimulam said patients who were not happy with doctors overcharging them could write in to the association.