PETALING JAYA: The Malaysian Medical Association (MMA) says immediate reforms are needed in private healthcare to address critical issues affecting specialists and general practitioners, the sustainability of private healthcare facilities, costs, and the sector's ecosystem.
MMA president Datuk Dr Kalwinder Singh Khaira said the increasing cost of treatment is largely influenced by hospital services and supplies rather than doctors’ professional fees.
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"Despite this, many private medical specialists are still facing pressure to reduce their chargeable fees, directly and indirectly, which ultimately will affect the quality and sustainability of specialist treatment services in the private sector.
"In addition, there exists a gap in private health insurance coverage, with many policies not covering modern and newer treatments such as immunotherapy and targeted therapies.
"As a result, patients are at times left in a quandary and forced to seek partial treatment at private hospitals before needing to move to public hospitals due to financial caps and restrictions, causing disruptions in the continuity of healthcare," he said in a statement on Friday (March 7).
Dr Kalwinder said another key issue that needs to be addressed is the role of third-party administrators (TPAs), which remain unregulated despite being a major contributor to rising costs in private healthcare.
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"TPAs, the middlemen providing managed care services, determine treatment prices, delay payments, and impose unnecessary administrative burdens, ultimately increasing costs for doctors and patients.
"MMA has urged Bank Negara Malaysia, as well as the Health Ministry, to intervene and take a more active role in regulating TPAs," he said.
In addition, Dr Kalwinder said delays in processing claims and excessive pre-approval requirements by insurance companies continue to restrict patients’ access to timely treatment, especially for critical illnesses.
He added that the diagnosis-related group (DRG) system has been highlighted many times as a possible panacea for increasing costs, and the resulting increasing insurance premiums also need to be more closely examined.
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"The MMA has reviewed the results and challenges faced by many countries that have implemented DRG and has concluded that if it is not well studied and implemented, it will lead to failure.
"DRG is implemented in countries backed by a national health insurance scheme and has been implemented in phases in those countries.
"It is vital to learn from these countries to identify the most suitable approach for Malaysia if at all DRG, or a (version of it), is implemented," he said.
