KUALA LUMPUR: Malaysia’s move to shift private healthcare towards a value-based, data-driven payment system is still in its early phase, says the Health Minister.
Datuk Seri Dr Dzulkefly Ahmad said his ministry is now focused on collecting data for the Diagnosis-Related Group (DRG) mechanism.
He said DRG is a system that classifies and standardises hospital cases based on three main components – diagnosis, treatment procedures and illness severity.
He added that this is to ensure that payments and case classification are fair, transparent and aligned with clinical needs.
“At this stage, DRG implementation focuses on collecting and standardising clinical and financial data to develop the DRG algorithm or logic, as well as setting appropriate treatment ranges for each medical case,” he told the Dewan Rakyat during Question Time on Wednesday (Feb 4).
He was replying to Rodziah Ismail (PH–Ampang), who asked for the latest status of DRG implementation in the private healthcare industry and the safeguards to prevent insurer or takaful interference in clinical decisions.
He said DRG is expected to support ongoing reforms to move the healthcare system towards value-based care by promoting efficiency, cost transparency and more prudent use of resources in private hospitals.
“So far, 80 out of 104 private hospitals that have registered for DRG training have participated in about 23 training sessions organised by the Health Ministry through ProtectHealth Corporation (PH Corp).
“This shows a good level of acceptance and commitment from private hospitals towards DRG implementation,” he said.
On concerns over interference by insurers, takaful operators and third-party administrators (TPAs), Dr Dzulkefly said the ministry views the matter seriously.
He said any action that undermines the professional independence of medical practitioners in treating patients could be seen as inconsistent with existing provisions under the Private Healthcare Facilities and Services Act 1998 (Act 586).
He added that a grievance mechanism committee comprising Bank Negara, the Malaysian Medical Association, the Association of Private Hospitals Malaysia and associations representing insurers, takaful operators and TPAs is also in place to address disputes and issues raised by stakeholders.
