Ministry to increase checks on hospitals against excessive insurance claims

By Isabelle Lai, The Star

PETALING JAYA: Health Ministry will enhance its mechanism to monitor private health care providers and hospitals to prevent misuse of medical benefits provided under insurance policies by carrying out needless procedures and examinations on patients.

Health director-general Tan Sri Dr Mohd Ismail Merican said the ministry would also look for ways to address the discrepancies between charges for self-paying patients and those with insurance, as this problem had also contributed to overall health care costs.

He said the problem was also compounded by some private hospitals being pressured by its shareholders to charge more in order to fulfil their key performance index.

“The ministry will continuously direct private hospitals, managed care organisations (MCO), insurance companies and other interested parties to ensure that the cost of health care are reasonable, detailed and transparent.

“This will help patients make informed decisions on getting treatment at any health care facility as they will be more aware of the charges that will be incurred,” he said in a statement Tuesday.

His statement came after a meeting last Friday with the Association of Private Hospitals of Malaysia, Malaysian Medical Association, Malaysian Medical Council, hospital chief executive officers and persons-in-charge of private hospitals, representatives from MC0s, insurance companies and several healthcare professional groups and independent professionals.

“The purpose of the meeting was to explore ways of curbing increasing private health care costs,” he said, adding that several points were agreed upon during the meeting.

Among them, he said, policy holders must be made aware of what was covered in their medical insurance policy and so that they would know that not all medical conditions or treatment were covered in one policy.

Hospitals, he said, must also fully informed patients about all professional and potential charges before they were admitted or treated.

He said it was also agreed that MCOs must not interfere with the clinical judgement management of patients by medical practitioners, including by general medical practitioners.

“The ambiguity in doctors’ charges that may lead to inflation in healthcare costs is being addressed through the amendments to the Private Healthcare Facilities and Services Regulations 2006.