MEDICAL HEALTH INSURANCE IN MALAYSIA, A CALL FOR REFORM

The NST 2nd Nov 2007, carried an article on the need to for a re-look at the present private healthcare system, especially the role and responsibilities of third party payers in healthcare. It is true that healthcare cost has increased over the years but it must also be said, in the same breath, that people are living longer and in better health. The rising cost is because treatment modalities are better and new treatment modalities cost money. I suppose, because of the "high" cost of healthcare, healthcare has become a business for some to make money.

In the good old days, the doctors treats the patient, charges for the cost of treatment, and the patient pays, usually from his own pocket. There are essentially two stakeholders, the patient and the doctor.

Nowadays, in the private healthcare system, there are three stakeholders. The owner of the healthcare facilities, the third party payers, and the doctor who treats the patient. Each of them has a role to play. Unfortunately, till today, two of them have responsibilities and laws to govern them. The owners of healthcare facilities is governed by the new "Private Healthcare Facilities and Services Act 1998, and Regulations 2006" and the doctors are governed by the Medical Act 1071. But, there is no code of conduct, or code of behaviour to govern the third party payers. Yes, I understand that they are are answerable to Bank Negara, but have no oversight from the Ministry of Health, although they are part of the healthcare system.

In the article on the 2nd Nov 2007, it is stated that the third party payers, in this case, ING insurance, feel that they do not need to talk to doctors about their charges. They only need to talk to the owners of the medical centers. How can this be? The doctors are stakeholders, and whatever is discuss about them must have their (the doctors) input, especially when offering discounts by hospitals to ING insurance may be okay with the hospitals (bring more business, whatever the cost) but certainly not okay with doctors. Hospitals may view their giving discounts to ING insurance (or any other third party payers) as a business decision to get more patients. But what they forget is that, when they make that decision on behalf of the doctors, they have put their doctors in breach of Medical Act 1971.

The Medical Act 1971, clearly spells out that giving discounts as an incentive to get patients is wrong and grossly un-ethical. The doctors could be jailed or struck off. In layman terms, giving incentives to get patients is called touting (maybe we should call it solicitation to invoke images of the worlds oldest profession), and that is clearly against the medical code of ethics. ING insurance claims, in the other national daily, that whatever discounts they get from doctors, is given back to their customers. Is this a joke or what. Have anyone of us seen insurance premiums going down, with rebates?

ING also claims that they are not denying anyone care. That patients can still go to delisted hospitals, get treatment, pay first and claim later from ING. Does this line sound fair to any of us buying health insurance. How often have we heard of "you pay first and claim later" go sour and your claims either fully or partly denied. Most buying insurance will want their healthcare to be cashless, and if possible hassle-free.

I hope that by reading this piece, the government will realise that we need laws, code of conduct and code of ethics for health insurance companies and third party payers of healthcare. I hope that doctors reading this will realise, that if you give discounts, for the purpose of getting more patients, it is in breach of the medical code of ethics, and I hope that patients, customers and corporate customers who have bought health insurance will know the right questions to ask of their health insurance companies.

Were you told that you may not be able to see the doctor of your choice, if they are not prepared to give discounts and break the law. Or else, pay first and hope to claim later.

Is this fair and right? Is this what the government wants? Is this what you patients want? Gamble with your life if you must to save a few dollars, perhaps enough angry customers will give ING cause to re-consider their ill advised methods.