• There is growing dissent within healthcare community regarding TPAs, with claims they interfere with doctors ' professional duties.

• Malaysia is experiencing high medical inflation, exceeding global averages, with significant rise in health insurance claims that threatens the sustainability of the insurance pool.

• Concerns are raised about the erosion of trust in the healthcare system if doctors lose autonomy in decisionmaking. that coordinate among insurance companies, customers, and healthcare providers.

They enable cashless hospitalisation and

BY PROF DATO DR HANAFIAH HARUNARASHID

Some may dismiss this as the occasional storm in a teacup, brought about by disgruntled, insecure doctors with compensation grievances against payers and insurance companies.

After all, isn ' t there a responsibility for insurance providers to manage the pool of funds sustainably so that there is always e n o u g h money for quality services to be consistently and reliably provided to policyholders?

TPAs have always been an essential part of medical insurance practice, serving as separate entities

Prof Dato Dr Hanafiah Harunarashid Pro Vice Chancellor, UKM KL Campus payments, while closely monitoring resource and service use so clients receive the best service for the price they pay.

VALUE FOR MONEY

Since premiums are paid to the insurance company, they should act on behalf of their clients to obtain the best possible value for services and avoid overcharging for unnecessary procedures and treatments.

In light of Malaysia experiencing doubledigit medical inflation, which is higher than global and Asia-Pacific averages according to the 2024 Bank Negara Malaysia Annual Report, something must be done to address this problem quickly and decisively.

Between 2021 and 2023, the total cost of Medical Health Insurance and Takaful claims has increased by 73 per cent, surpassing the 21 per cent growth in the premiums collected. In 2023, there are, on average, 25 claims per 100 policyholders— a worrying trend that could deplete the pool too quickly, leading to a possible collapse of insurance cover.

The insurance sector has already taken steps to address this with government support, adjusting strategies to optimise profitability under more challenging conditions while bracing for increased regulatory risk. Some would even argue that steps to regulate TPAs can disrupt efforts to control medical inflation effectively.

Even though this is a significant developing crisis that cannot be ignored by anyone, let alone the government of the day, does it take precedence over the principal purpose of health care itself?

Should doctors no longer be able to make decisions for the benefit of patients, based

QUALITY FIRST: Balancing healthcare quality and insurance demands amidst rising costs

on their professional role guided by evidence and experience, as expected by patients who seek care from qualified doctors, there will be erosion of trust in modern healthcare, public apathy, and eventually, possibly the collapse of the healthcare system itself.

MEDICAL MALPRACTICE

This has been demonstrated before in mature democracies such as the USA, where patients sue both the doctor and the insurance for medical malpractice and liability because of delayed diagnoses and medical errors that resulted from doctors losing complete control of judgement to the TPA.

It has to be understood by all that physicians and all medical practitioners in the various disciplines, given their ethical, moral, and legal obligations to patients, should not permit themselves to be corrupted or controlled by any external party such as TPAs – as they will always remain liable for any harm that results from bad decisions, regardless if forced or coerced by another.

Malaysia has demonstrated it could lead with both excellence and empathy, as seen in the success of the recent ASEAN summit. Our strength is the ability to understand the underlying problem in great detail and wisdom, trusting collaboration over negative competition to solve difficult, complex issues.

The Minister of Health has rightfully recognised that the problem does not solely rest with the ministry, and that it requires the joint scrutiny and involvement of other ministries, including the insurance sector, professional bodies, and patient interest groups.

It is time for both sectors and stakeholders to exercise the courage to work together to create a solution that benefits all and protects patients ' rights and safety.- The HEALTH