Kuala Lumpur:Data supporting Malaysia's new MediAsas Diagnosis Related Group (DRG) pricing framework shows that third-party payers covered RM3.9 billion in hospital billings, while patients paid RM932 million out of pocket.

According to BERNAMA News Agency, ProtectHealth Corporation Sdn Bhd's CEO, Wan Mohd Hazwan Wan Mohd Najib, announced the introduction of DRG pricing. This system will shift hospital reimbursement from itemised fee-for-service billing to fixed whole-case pricing based on diagnosis, procedure, and severity. The implementation will adopt a phased and hybrid approach, combining DRG and fee-for-service elements to prevent sudden disruptions to hospital revenue structures.

Wan Mohd Hazwan emphasized that DRG does not alter clinical decision-making or the patient journey but changes the payment method for hospitals. More than 150 private hospitals and over 2,500 healthcare professionals have already been trained in clinical coding and data standards necessary for accurate grouping and reimbursement under the DRG system.

ProtectHealth, a government-owned, not-for-profit entity under the Ministry of Health, is responsible for supporting the rollout by building provider networks, managing data platforms, and enhancing industry capacity. The media briefing clarified that MediAsas is not designed to eliminate medical inflation, as healthcare costs will continue to rise due to various factors such as disease burdens and medical advancements.

The broader RESET Strategy will address the drivers of medical inflation, while MediAsas aims to improve access to medical coverage. The plan seeks to offer an affordable healthcare protection option that supports long-term sustainability, especially for Malaysians lacking coverage or facing difficulties in obtaining it. MediAsas complements broader efforts to transform healthcare delivery but is not intended to replace the universal coverage provided by the public healthcare system.