Insurers’ Intervention In Patient Treatment Violates Law – Dzulkefly

KUALA LUMPUR, Feb 4 (Bernama) -- The Ministry of Health (MOH) has emphasised that any action that could undermine the freedom of medical practitioners in carrying out their duty to treat patients may be interpreted as inconsistent with existing legal provisions.

Health Minister Datuk Seri Dr Dzulkefly Ahmad said the ministry views the matter seriously following concerns over the involvement of insurance operators, takaful providers and third-party administrators (TPAs) in treatment management, which could potentially influence doctors’ clinical decisions in private hospitals.

He said any such form of intervention would be contrary to the provisions under the Private Healthcare Facilities and Services Act 1998 (Act 586), which guarantees the professional responsibility of medical practitioners in providing treatment to patients.

“MOH plays an active role through the Grievance Mechanism Committee (GMC), a platform involving various stakeholders, including Bank Negara Malaysia, the Malaysian Medical Association, the Association of Private Hospitals Malaysia, representatives from insurance companies, takaful operators and TPAs, to discuss and find solutions to issues raised.

“It is a committee to discuss and seek comprehensive solutions for matters raised together with the stakeholders,” he said during the question-and-answer session in the Dewan Rakyat today.

Dzulkefly was replying to a question from Rodziah Ismail (PH-Ampang) on the latest status of the implementation of Diagnosis-Related Group (DRG) in the private healthcare industry, as well as regulatory and monitoring measures to ensure that insurance and takaful operators do not interfere in specialists’ and doctors’ medical decisions, in addition to curbing excessive claims by private hospitals.

Commenting on the progress of the DRG implementation, he said 80 of the 104 registered private hospitals have participated in training through 23 sessions organised by the Ministry of Health (MOH) via ProtectHealth Corporation, and that implementation is currently at the stage of collecting clinical and financial data to develop the system’s algorithm.

Dzulkefly said that although there is no specific provision on DRG under Act 586, the data collection is being carried out through circulars issued by the Health director-general following engagement sessions with industry stakeholders.

“The findings of this analysis will later determine the direction of implementation, including the possibility of drafting new legislation related to the transformation of healthcare financing,” he said.

Responding to a supplementary question from Datuk Dr Ahmad Yunus Hairi (PN-Kuala Langat) on concerns that private hospitals may only select simple cases, he explained that the DRG payment structure takes into account the severity of illness and patient complications, with more complex procedures receiving higher payments, thereby providing incentives for hospitals to handle more difficult cases.

DRG is a hospital case classification system that groups patients based on diagnosis, treatment procedures and disease severity, enabling standardisation of treatment costs and payment methods.

-- BERNAMA