Is the government coming up with any “formula” to control the country’s runaway medical inflation thanks to skyrocketing private hospital charges…?
Amidst the ongoing public outcry in the country over the spiraling cost of medical insurance, particularly among the ageing population, some suggestions offered recently by Dr Paul Selva Raj, the deputy president of the Federation of Malaysian Consumers Associations (Fomca) are worth noting.
For the record, he had stressed that it was now time to “humanise” private healthcare by finding a balance between profit and patient care; he further proposed a collaboration between the government and the private sector so as to find a viable solution to the crisis (before it forces more senior citizens to give up their medical insurance policies)!
Dr Selva Raj further pointed out that while it's understandable that the main priorities of private hospitals are profit and enhancing share value, the government on the other hand has to play a significant role to ensure that patient welfare is at the centre of all healthcare services.
Moreover, according to him, since the ministry of health (MoH) represents the rakyat, including the poor and the vulnerable, rightfully it should have more say in the running of private hospitals; he added that, in fact, in many countries, the government not only regulates the pricing but also their costs and salaries!
Logically, shouldn’t private hospitals be regulated under MoH since they are also providing healthcare services to the country's citizens…?
Interestingly, Dr Selva Raj went on to suggest that humanising private healthcare services can actually begin with the major hospital corporations which are government-linked companies (GLCs), adding that perhaps Putrajaya can introduce “reforms” to the GLC hospital system first by prioritising patient care while making "reasonable profits".
But does the Madani administration have the political will to undertake a major “policy shift” that may ruffle the feathers of some big boys in the industry?
Sadly, as was reported by Code Blue last September, health minister Dr Dzulkefly Ahmad’s office while acknowledging the need to rein in the high medical inflation, had apparently indicated that MOH hasn’t made a policy decision yet under a broader health financing reform on whether to regulate private hospital charges - or to leave them unregulated.
Too little, too late by the health minister…?
Granted, any reform initiative in the private healthcare and insurance industry may require radical, unpopular measures; but is it not the moral duty of the government to safeguard the welfare of its citizens? Hence, the need to find a balance between profit and patient welfare!
Already facing shortage of beds, imagine if more and more sick ones, both young and old, flock to government hospitals…?
In truth, troubleshooting the root cause of the exorbitant private healthcare charges and the resultant ballooning medical insurance premium will require a detailed auditing of the complex internal workings of both industries; it cannot be based solely on data furnished by them as there may be other significant factors “below the radar” that may need to be unearthed and investigated.
For example, while it may be normal for private hospitals, like any ordinary business entity, to assign Key Performance Index (KPI) to its doctors and specialists where the “volume of sales/profit” they bring in may carry a high weightage, the pertinent question here which begs an honest answer is: in deciding on the type, scope and frequency of treatment and medications for the insured person are they in any way influenced by the insurance coverage “limit” of the patient?
Bluntly put, is there a tendency among some private healthcare providers to close an eye to the “manipulation” of the patient’s available insurance coverage limit in order to maximize profit for the hospital?
Meanwhile, as for the insurance industry, another equally significant element involves the role of “actuaries” whose job typically is to forecast the insurance company’s costs, then set premiums and design policies based on those projections for its clients; but the question here is: as “in-house economists” for the insurance companies, is there pressure on them to maximise profit for the company by offering excessively generous and “attractive” annual limits (with some more than RM1 million) to cover hospitalisation charges, professional and surgery fees, cost of medical supplies and services etc? While it may drive sales and bring in higher premium (profit), for some insured parties are such high limits really warranted?
Ironically, won't these unjustified high limits (like open cheques!) then play into the hands of some unscrupulous private hospitals who may be tempted to try “utilize” as much of the ample limits to maximize profit as they can later claim from the insurance companies? In such a scenario, aren't both parties guilty…?
Another fear is that some insurance companies may raise the premium excessively upon the insured person reaching a certain age, say 65, to “compel” those who cannot afford the revised premium to “surrender” the policy; perhaps, in this way they can cut potential loses arising from huge claims by certain high-risk groups. These are all just some of the alleged unfair practices that the authorities need to investigate, verify and clamp down on!
In fact, there may be other such underhand “business tactics” employed by some private hospitals and insurance industry players which the Madani government need to act on if they are found to be true; instead, choosing the easy way out by burdening the patients is blatantly unethical and cruel - and as such, can any government that calls itself caring and compassionate be complicit in carrying out such inhumane acts?
Information source: NST, Code Blue and Indeed.com
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