KUALA LUMPUR – Namlifa, which stands for the National Association of Malaysian Life Insurance and Family Takaful Advisors, has called upon the authorities to tackle the substantial pricing gap between individuals using health insurance coverage and those paying out-of-pocket expenses at private healthcare facilities. They have cautioned that these differences might render medical insurance unviable.
President Krishnan Appanu of Namlifa stated that the administration should consider establishing a national social insurance program, controlling hospital charges, and most crucially, maintaining the determination to prioritize patient well-being over profit-making.
Krishnan expressed concern that this long-standing problem imposes excessive financial strain on policyholders, all while permitting private hospitals to hike their fees for insured patients without restraint.
He mentioned that it’s widely known private hospitals charge more for insured patients than those paying out of their own pockets.
Healthcare is more than a commercial venture; it is an essential service.
Krishnan stated that healthcare should be viewed as a necessity rather than merely a business.
He pointed out that approximately 54 percent of the populace presently possess health insurance.
He stated that this practice impacts not just the policyholders but also drives up the costs of medical insurance premiums.
As reported in the media, numerous policyholders intend to cancel their policies because of increasing premium costs.
Krishnan called for the Health Ministry (MOH) to intervene and establish regulations on hospital charges to guarantee equity, noting that Namlifa has consistently received grievances from policyholders regarding discrepancies in invoicing.
He emphasised that the government needs to promptly step in to regulate and standardize these fees. Without such intervention, insurance premiums will keep increasing, making health care coverage progressively more expensive.
The PAC report aims to tackle the problem
Recently, this matter has attracted more attention after Deputy Finance Minister Lim Hui Ying told Parliament towards the end of last month that an extensive analysis must be conducted to look into the disparities in fees at private hospitals for patients utilizing guarantee letters compared to those paying up front before getting reimbursed.
The problem is anticipated to be the main point of attention in the Public Accounts Committee (PAC) report concerning increasing health insurance and takaful premiums along with expenses at private hospitals. This report is scheduled to be presented during the Dewan Rakyat session in June.
Krishnan expressed optimism that the report will facilitate long-term healthcare policy reforms, with a focus on tackling premium repricing issues, a significant worry among elderly policyholders.
We anticipate that the PAC report will offer a transparent structure ensuring equitable pricing mechanisms and viable insurance rates.
He warned that without solid solutions, the rising expense of healthcare could lead to increased financial struggles for more Malaysians.
Propose a social insurance program
Apart from regulatory measures, Namlifa urged the government to consider setting up a nationwide social insurance program. This initiative would allow Malaysians to receive medical care at either public or private health institutions.
A properly structured social insurance program has the potential to harmonize the needs of policyholders, insurers, and healthcare providers.
"By doing this, we can avoid excessive dependence on private insurance and ensure fair access to good medical care for everyone," Krishnan stated.
He mentioned that without robust political commitment and firm policy measures, the healthcare system would keep being influenced by profits rather than prioritizing public health and welfare.
By highlighting that healthcare should be seen as a necessity rather than merely a business, he asserted that the government needs to implement strong measures to guarantee patient well-being doesn’t get compromised by profit motives,” he emphasized.
Regulators must act
Namlifa likewise called upon Bank Negara Malaysia (BNM) to guarantee that consumer rights are safeguarded during medical insurance premium reassessment processes.
The recently implemented cap restricting premium hikes to a maximum of 10 percent until 2026 is indeed a positive move.
He stated that policyholders should not encounter unjustified hold-ups or refusals in the process of settling their claims.
Namlifa suggested that the administration ought to contemplate merging large-scale claims insurance pools into bigger entities to enhance the effectiveness of risk management, thereby aiming for greater stability within the medical insurance sector.
We additionally urged a joint initiative between the MOH, BNM, and the Finance Ministry to implement stricter rules on overly high yearly medical caps in insurance policies, as these have led to increased healthcare expenses.
"In addition, Namlifa suggested the use of technology to monitor and enforce fair pricing for medical treatments and pharmaceutical supplies, ensuring that insured patients are not unfairly charged higher rates compared to cash-paying individuals," Krishnan said.
Ensuring sustainable medical premiums
In addition to governmental efforts, Namlifa emphasized the significance of informing the public about using medical insurance responsibly and promoting insurers to provide more adaptable and sustainable coverage options.
Krishnan stated that the insured individuals should view medical insurance as a necessity instead of a luxury to be excessively used.
"He further stated that misusing insurance policies, like making frequent claims and undergoing unwarranted procedures, leads to increased expenses," reported BERNAMA.