Kuala lumpur: The Ministry of Health (MOH) has issued a stern warning that any interference undermining the autonomy of medical practitioners in treating patients could be seen as a violation of existing laws. Health Minister Datuk Seri Dr Dzulkefly Ahmad highlighted growing concerns about the involvement of insurance companies, takaful providers, and third-party administrators (TPAs) in treatment management, potentially swaying clinical decisions in private hospitals.
According to BERNAMA News Agency, Dr Dzulkefly emphasized that such interventions would contravene the Private Healthcare Facilities and Services Act 1998 (Act 586), which ensures the professional responsibility of medical practitioners in patient care. He pointed out the Ministry's active role through the Grievance Mechanism Committee (GMC). This platform, comprising stakeholders like Bank Negara Malaysia, the Malaysian Medical Association, and insurance representatives, aims to address and resolve related issues collaboratively.
During a session in the Dewan Rakyat, Dzulkefly responded to Rodziah Ismail (PH-Ampang) regarding the status of the Diagnosis-Related Group (DRG) implementation in private healthcare. He stressed the importance of regulatory and monitoring measures to prevent undue influence from insurance entities and curb excessive claims by private hospitals. He noted that 80 out of 104 registered private hospitals have undergone training sessions conducted by MOH via ProtectHealth Corporation. The initiative is currently in the phase of collecting clinical and financial data to develop the DRG system's algorithm.
Although Act 586 does not specifically address DRG, Dzulkefly mentioned that data collection is proceeding through circulars issued by the Health director-general following stakeholder engagements. This analysis will guide future implementation strategies, possibly leading to new healthcare financing legislation.
In response to Datuk Dr Ahmad Yunus Hairi (PN-Kuala Langat) about concerns over private hospitals selecting simpler cases, Dzulkefly explained that the DRG payment structure considers illness severity and patient complications. This ensures that more complex procedures receive higher payments, incentivizing hospitals to tackle challenging cases. The DRG system classifies hospital cases based on diagnosis, treatment procedures, and disease severity, facilitating standardized treatment costs and payment methods.