Health Care is perhaps one of the biggest issues facing many people in developing countries. If a country insists all citizens buy medical care insurance and provide medical care benefits to all the people then it’s fine. But, some countries just like Malaysia has a multitude of medical care systems working at the same time. We have Government-run hospitals. These hospitals are for the general public. Government employees are given free medical treatment. If you are not a government employee, you will have to pay for the benefits but it’s usually a nominal fee. The poor can even get exemptions or apply for welfare aid. But, these hospitals work under tremendous pressure. They have just too many patients and find it difficult to cope. Often treatment takes a long period especially if it’s a critical illness. Then we have general practitioners who run their clinics but for basic health care. Their charges are affordable for the middle class and above but the poor can’t afford them. But, many see GPs only for minor ailments like cough and cold. Then we have the Private hospitals run by blue-chip companies which have revolutionised medical care and have turned it into a multimillion-dollar business. They have invested millions in providing hospitals with state of the art facilities. Patients are usually seen by specialists and super specialists. Then they also have to pay the drug companies and device manufacturers. They are also given genuine medications as compared to generics by other hospitals. So it’s pretty costly to seek treatment here. These hospitals are mainly patronized by the rich and those with medical insurance. At the same time, such hospitals have created opportunities for giant insurance companies to invest in the medical care industry. These companies have turned medical care into big opportunities to reap profits. Unfortunately, their role is filled with persistent misconceptions on how to care for the insurance holders.
Operation : By: Olga Guriyanova from Unsplash
Medical insurance is not cheap. It poses a huge challenge for the middle class and the poor to buy a coverage policy. The cost of medical coverage depends on the age of the policyholder and the amount the policyholder can claim for medical care. In Malaysia, we have many companies in the industry providing insurance coverage for the people. And, they all want is for you to believe that they are being magnanimous in giving you coverage. But it is a huge business opportunity for all the companies. Thus, there is stiff competition in selling their products. They say they are always working hard to provide better benefits. They may, but at the same time, the companies are always increasing the costs of policies. They also have very well trained agents who go out and sell the insurance coverage policies. They are trained in convincing potential buyers to buy insurance coverage policies. They even have devised various methods for policyholders to pay their coverage. Among the terms are, a one-of payment yearly where the policyholders are given a discount. Then they have half-yearly, quarterly and even a monthly payment method with additional charges. The company agents are paid based on the number of policies they sell. They don’t have basic pay and their income is based on commission. So, the agents work very hard to sell as many policies as possible. The companies usually reward their agents very well. The agents work on a platform based quite close to the pyramid system. They have many levels. First, they have the senior group manager who rakes in tens of thousands. Then there are group managers who also make a lot of money. This is followed by unit managers and it goes down until the agents. The payment system is also something like how they pay in the pyramid system used in multi-level marketing companies. The agent gets a commission for what he sells. He can also recruit other agents as his downline. He trains and guides them to sell. When they sell he gets paid too, a certain percentage from their commission. This goes on as he increases and expands his line of agents. The more agents he has, the more he earns. An agent who has been in the industry for about 10 years and has a significant number of agents as his downlines can even earn up to RM20.000.00 or more. Many agents have made lots of money through their sale of insurance policies. How does the company pay them? Obviously from the portion of the sum paid by clients as coverage. As they are well enumerated many people choose to become full-time agents By taking into account the profits made by insurance companies, plus the amount paid back by the company to their insurance agents the amount of money used to cover the insurance owners are a much smaller sum compared to the actual amount paid by the insurance owners. As such the companies must be smart to play around with the coverage provided to the owners. The amount of coverage may be only half of the total paid by the insurance owner.
The agents give all kinds of promises when they sell you the coverage for medical benefits. A lot of promises are made to attract clients. They will usually tell the potential buyers that medical treatment in medical centres is expensive so why spend the hard-earned savings to pay hospital costs. They even warn that one will spend all the savings if one has a critical illness. It is true, so many people get anxious and agree to buy a medical insurance plan. When the insurance owner signs the dotted lines many do not do so after reading. Usually, the agent is someone they trust so they sign the terms and conditions blindly. And, on top of it, the terms and conditions are quite technical and the contract can be misleading. Even educated clients don’t understand the contract. The problems only arise once they fall unwell and try to seek treatment. I believe one must be admitted to the hospital to qualify for insurance coverage. If they are not admitted then they can’t expect the insurance companies to cover the cost of treatment. Only then, do many realise they have been short-changed? The registered insurance companies pay their agents so well that they have to find means and ways of cutting down spending on the clients who need medical treatment. At this point, the agents who signed up can’t do much to help you.
The insurance companies usually say that one cannot claim insurance coverage if the doctor admits for investigation. But, how is the doctor going to find out the problem without investigations? The doctor might need the patient to do an X-Ray, MRI or some blood tests to pinpoint the problem accurately. The doctor cannot afford to use the trial and error method. These tests can be very expensive and if the cardholder can’t claim from the insurance companies it’s going to be a frustrating situation. Many such incidents have happened and the poor ones have to fork out their hard-earned money. Once they have spent their hard-earned money they are forced to continue treatment in government hospitals. Many have gone through such situations so it’s best to sort out the terms and conditions before signing a medical insurance coverage. Another common problem used to their advantage is the term called the “exclusion clause”. Many medical insurance owners have had this problem. Once one has claimed for a particular medical problem, then at the next renewal they will execute this term. They will include a clause saying that the coverage will not be renewed if the insurance holder doesn’t sign a declaration saying you won’t claim for the same problem again. This is not fair. Anyone who has taken medical coverage doesn’t take it with the hope of having medical problems. They take it with the hope to cover themselves if, unfortunately, they have a medical issue. So, it’s simply not logical for insurance companies to do so. These issues are not something new. It’s been happening for a long time quietly. Coverage owners are usually confused and just because these insurance companies are humungous ones, they think they can’t win them and just leave it to rest. What a shame!. Why do you think insurance companies act in such a manner?
In my opinion insurance companies are not magnanimous in providing this service. They are in this business to make money. The government must try to sort out and advise people who have problems with covering the medical expenses from their medical policies for medical problems. The government must have a one-stop centre where insurance owners can make a complaint easily. All must have access to this place. Today, I believe it’s a complicated process to make a report if insurance owners are turned down by insurance companies. Where do they go to make a complaint? A big number of consumers, especially those without education are at a losing end today and many just put their problems to rest if they are not successful. Not that they are not able to run around but are ignorant of where to run. Frustrated ones refuse to continue paying and their policies are terminated. A lot of money is lost by such consumers. Someone must help. If the government doesn’t who will.
Palaniappan Karuppan is a content writer under Headliner by Newswav, a programme where content creators get to tell their unique stories through articles and at the same time monetize their content within the Newswav app.
Register at headliner.newswav.com to become one of our content writers now!
*The views expressed are those of the author. If you have any questions about the content, copyright or other issues of the work, please contact Newswav.
