KUALA LUMPUR: The “base plan” medical insurance framework will not only make coverage affordable for more people, it will also alleviate concerns over steep premium hikes.
The plan aims to encourage people to seek treatment at private hospitals, thus easing pressure on public healthcare facilities, said Bank Negara.
However, government hospitals will continue to be the backbone of the public healthcare system.
In a closed-door media briefing, Bank Negara gave assurances that the base plan will offer comprehensive coverage for most health conditions.
“It will cover about 99% of hospitalisation bills. Premium adjustments will also be gradual and reasonable and not sudden or steep. Renewal of the coverage is also guaranteed up to age 85,” Bank Negara said during the briefing.
It added that the initiative was drawn up amid rising healthcare demands, sharp hikes in medical insurance premiums and concerns over overcrowding in public hospitals.
“By channelling patients who can afford it to private care, the plan aims to improve efficiency across the healthcare system,” Bank Negara said.
It said the key principles in drawing up the base plan was to ensure as many people as possible had coverage at affordable prices, while preserving space for market competition.
Bank Negara said the plan was drawn up after meticulous planning and discussions by the Joint Ministerial Committee on Private Healthcare Costs (JMCPHC) which was comprised of officials from Bank Negara, the Health Ministry and the Finance Ministry.
A consultative council made up of doctors, representatives of private hospitals, insurance and takaful industry players, consumer groups and academia members was also part of the committee.
The initiatives the committee has agreed to work on in the immediate term are:
> Simplify and improve the process of guarantee letter (GL) issuance
> Review the pre-authorisation form to minimise back-and-forth communication between third-party administrators (TPA) and medical practitioners
> Define what is claimable for specific treatments
> Set up medical professional hotline by TPAs
The TPAs should provide facilities that allows treating doctors to consult directly with a qualified medical professional under the TPA when needed to clarify diagnoses and proposed treatments, thereby reducing disputes.
There should also be clear and transparent procedures for reviewing and potentially de-panelling doctors or hospitals.
Bank Negara said a health calculator is also being developed to help consumers plan and manage healthcare expenditures, and will be made available soon.
The health calculator will recommend the monthly savings required to meet future premiums and co-payments based on age and gender.
