Cover Story 09
July-August . 2024 | The HEALTH
Cover Story 09
clear communication and understanding between insurers and policyholders .
Minimal impact of private hospitals
The success of this adaptation largely hinges on consumer understanding and readiness to embrace the co-payment model
The co-payment requirements in Malaysia ’ s healthcare sector have sparked a discussion on its implications for hospitals and patients alike . Private hospitals are expected to be the least affected as they cater to a diverse patient demographic .
“ We have patients who pay out of pocket , those whose treatment is fully covered by insurance ,” said Association of Private Hospitals Malaysia ( APHM ) President Datuk Dr Kuljit Singh .
“ Through personal coverage or corporate plans . We also have a significant number of medical tourists who are happy to pay in full for treatment in Malaysia .”
The diversity in patient types and payment methods enables these hospitals to remain resilient against potential changes brought about by the co-payment requirements .
However , as co-payment becomes more prevalent , private hospitals will need to adapt to a changing healthcare landscape . The success of this adaptation largely hinges on consumer understanding and readiness to embrace the co-payment model , underscoring the need for clear communication .
Dr Kuljit stressed consumer education , deeming it a vital aspect of the co-payment policy . The policy could lead to more increased insurance purchases due to lower premiums associated with co-payment packages .
However , patients need to clearly understand that co-payment involves paying a portion of medical costs out-ofpocket . This amount could range from a minimum of five per cent or higher , depending on the policy .
Hospitals may explore alternative arrangements for patients unable to meet co-payment obligations , though the long-term sustainability and impact of these strategies still need to be determined .
Despite the introduction of co-payment , there needs to be more dialogue between private hospitals and insurers regarding its implementation , highlighting the urgency of the situation .
Consumers are primarily responsible for understanding the financial implications of co-payment , while hospitals focus on maintaining their operational and economic stability .
The policy includes provisions for waiving co-payments in cases of financial hardship , but these decisions are expected to be negotiated directly between patients and insurers rather than hospitals .
Regardless of how payments are made , hospitals must ensure cost coverage for the services they provide . This arrangement emphasises the need for
Dr Kuljit Singh
Dr Marimuthu Nadason
IMPACT ON CONSUMERS
The Federation of Malaysian Consumer Associations ( FOMCA ) is concerned that insurance providers might withdraw MHIT products without co-payment options , potentially replacing them with products that do . It leaves consumers with fewer options .
FOMCA , however , is concerned that the implementation of co-payment could disproportionately impact lowerincome individuals , potentially leading to delays or avoidance of essential treatments due to cost concerns . This could affect the affordability and accessibility of healthcare services for these groups .
“ For low-income consumers , even small co-payments can add up , leading to significant financial strain . Out-of-pocket expenses may force these individuals to choose between healthcare and other essential basic needs , such as food and housing ,” said FOMCA President Datuk Dr Marimuthu Nadason .
To mitigate these issues , FOMCA advocates for a sliding-scale copayment system with income-based caps . This ensures affordability and prevents excessive out-of-pocket expenses .
Additionally , exemptions for essential medications and chronic illness treatments , along with government subsidies , could help lower-income groups access necessary healthcare services .
FOMCA also recommends expanding health insurance coverage , increasing funding for public healthcare resources and improving transparency in medical billing practices .
The Ministry of Health and BNM should play a crucial role in monitoring regularly to track the impact of copayment policies on different income groups . This data will provide insights and evidence to support policy adjustments and improvements .
According to Marimuthu : “ These data will provide insights and evidence to support policy adjustments and improvements .”
To guide consumers in making informed decisions , BNM should have a website dedicated to healthcare insurance and costs . This website would allow them to access details about different insurance options , compare treatment prices , and evaluate various products .
For an equitable and sustainable copayment policy , FOMCA collaborates with the National Consumer Complaints Centre ( NCCC ).
They work together to address transparency issues within the insurance industry and to manage complaints related to high premiums and denied claims .
“ NCCC will continue to receive feedback and complaints from the public through its portal , www . nccc . org . my and feedback to FOMCA regularly ,” he said . – The HEALTH