Kuala lumpur: The Public Accounts Committee (PAC) has revealed that the primary factor behind rising health insurance premiums is the increase in non-professional charges levied by private hospitals. These charges, unrelated to doctors' professional fees, are significantly contributing to the upward trend in premiums.
According to BERNAMA News Agency, PAC chairman Datuk Mas Ermieyati Samsudin highlighted that while doctors' professional fees have been regulated since 2013, non-professional charges-covering medical supplies, equipment, medicines, and diagnostic and laboratory tests-remain unregulated. She pointed out that these charges also encompass the rising costs of medical technology and treatments, operating expenses at private hospitals, and the impact of litigation and defensive medicine practices.
In a statement presented in the Dewan Rakyat by PAC member and Kapar MP Dr. Halimah Ali on behalf of Datuk Mas Ermieyati, it was noted that the absence of a standardized billing structure among private hospitals undermines transparency, complicating the determination of actual medical service costs. The report also indicated that high medicine prices are often used to offset operating costs not billed separately, such as nursing services and utilities.
The committee's findings also highlighted instances of unbundling, where hospitals charged separately for basic items like clinical waste disposal and alcohol swabs, which should typically be included in room charges. Additionally, evidence of price discrimination was found, with hospitals charging higher rates to patients using guarantee letters compared to those paying in cash or through the pay-and-claim method.
PAC identified significant median mark-ups within the pharmaceutical supply chain, including cases where generic medicines were priced higher than branded drugs. The situation is exacerbated by the presence of over 1,500 medicines with only one registered manufacturer in Malaysia, creating monopolies that allow high prices without competition.
To tackle these issues, PAC presented 17 recommendations to the government, such as speeding up the implementation of the Diagnosis-Related Group (DRG) payment system and amending legislation to regulate private hospital charges beyond professional fees. Recommendations also included establishing mechanisms to regulate medicine and medical equipment prices and exploring direct procurement from manufacturers to reduce reliance on suppliers.
The committee suggested amending the Private Healthcare Facilities and Services Act 1998 to empower the Ministry of Health (MOH) to regulate private hospital service charges beyond doctors' fees. The report sparked a debate among 12 Members of Parliament from both government and opposition blocs, who urged tighter regulation of private hospital charges and medicine prices, enhanced transparency in the insurance industry, and expedited implementation of the DRG payment system.
MPs also called for increased investment in the public healthcare system, a review of insurance-related laws, a freeze on fee increases at university hospitals, and higher taxes on private hospitals profiting from medical tourism. They emphasized the need for strengthened cooperation between the MOH, Bank Negara Malaysia (BNM), and relevant stakeholders to address medical cost inflation.