January-February . 2024 | The HEALTH

Marimuthu calls for increased public health expenditure to at least five per cent of GDP over the next five years , aligning with the World Health Organisation ’ s recommendations .

Additionally , he advocates for funds to promote healthier lifestyles and continuous engagement with at-risk communities . This dual approach aims to enhance healthcare infrastructure while fostering preventive measures , ultimately alleviating the burden on consumers . – The HEALTH

premium to maintain the sustainability of the pool .

The study noted that insurers and takaful operators typically factor in future inflation projections for two to three years during repricing to anticipate and accommodate rising healthcare costs .

However , as premiums increase over time , healthier insured individuals may seek coverage from other companies offering lower premiums for similar coverage levels , causing the pool to shrink and deteriorate in quality . This will necessitate subsequent repricing at even higher levels .

The cyclic nature of repricing exercises contributes to the sustainability issues within insurance pools , prompting insurers to close unsustainable pools and introduce new products to attract healthier individuals .

This move may adversely affect policyholders by depriving them of coverage and impacting consumer confidence in purchasing medical insurance products . The study suggested offering new pools with enhanced benefits to retain healthy insured individuals amidst repricing exercises .

The study concluded with recommendations such as promoting awareness of insurance sustainability tests , enhancing consumer education on responsible healthcare utilisation , and implementing innovative pricing models to help alleviate the burden on policyholders and ensure the long-term viability of medical insurance products .

DISPUTES can arise between consumers and financial service providers ( FSPs ) in the complex financial services landscape , often leaving individuals feeling unheard and frustrated .

Therefore , the Ombudsman for Financial Services ( OFS ) is a vital entity offering an independent avenue for resolving such conflicts , including those relating to medical insurance claims . Formerly known as the Financial Mediation Bureau , the OFS has been operational since January 2005 , functioning as the operator of the Financial Ombudsman Scheme ( FOS ) approved by Bank Negara Malaysia ( BNM ).

At the core of OFS ’ s mandate is resolving disputes in an unbiased , fair and timely manner . As a non-profit organisation , it serves as an alternative dispute resolution channel , facilitating communication and reconciliation between FSPs and consumers .

Its board comprises its Chairman Tan Sri ( Dr ) Foong Cheng Yuen , Deputy Chairman Tan Sri ( Dr ) Tay Ah Lek and Non-Executive Independent Directors Tan Sri Zaleha Zahari , Sujatha Sekhar Naik , Dato ’ Dr Paul Selvaraj , Datin Veronica Selvanayagy , Antony Fook Weng Lee , Ratna Sha ’ erah Kamaludin and Shahariah Othman . Its CEO is Marina Baharuddin .

How effective has the OFS been in settling disputes ? How many disputes or complaints has it resolved in recent years , and what is the average time to mediate and settle a dispute ? How many settlements were in favour of the complainant ?

Based on the OFS 2022 Annual Report , the

OFS had :

• Received 5,909 new enquiries / complaints

• Registered 1,394 eligible disputes ( 21 per cent increase from the previous year )

• Closed 1,108 disputes amounting to RM37 million

• Resolved 24 per cent of the disputes through an amicable settlement amounting to RM10 million , and

• Resolved 48 per cent of the disputes within six months from the registration date , while 69 per cent of the disputes are pending six months and below as of Dec 31 , 2022 Does that mean the remaining disputes could take more than six months to even a year or more to resolve ?

The HEALTH sent a set of queries to OFS to gain insights into its dispute-handling processes and resolution timeframes . At the time of writing , it had yet to respond .

WHO CAN LODGE A DISPUTE ?

Individuals , small and medium enterprises ( SMEs ), insured persons under group insurance , beneficiaries , and guarantors of credit facilities , among others , are eligible to lodge disputes with the OFS . However , third-party disputes are accepted only under specific circumstances , emphasising the importance of direct involvement and accountability .

Initiating a dispute resolution process

with OFS involves a systematic approach :

• As a first step , refer to the financial service provider ( FSP ) before lodging a dispute with the OFS . Individuals are encouraged first to approach the concerned

FSP to explore amicable settlements .

• The second step will be to lodge the dispute with the OFS if the resolution remains elusive . Consumers can formally lodge disputes with the OFS within specified timeframes , ensuring a structured and transparent escalation process . The OFS specialises in resolving monetary disputes across various financial domains , including banking matters ( such as unauthorised transactions and e-money ) and insurance / takaful claims ( covering motor , life , and medical insurance , among others ). This broad scope underscores the OFS ’ s commitment to addressing diverse consumer concerns effectively .

ENSURING FAIRNESS IN FINANCIAL DISPUTES

According to the OFS , it is dedicated to providing efficient , quality alternative dispute resolution services . Its mission emphasises independence , trustworthiness , and the delivery of fair outcomes for both consumers and FSPs .

It says by providing a platform for constructive dialogue and resolution , it plays a pivotal role in upholding consumer rights and promoting industry integrity . – The HEALTH