Private hospitals propose joint committee for fair healthcare pricing

PUTRAJAYA: The Association of Private Hospitals Malaysia (APHM) has proposed the establishment of a joint working committee between the association and Insurance and Takaful Operators (ITOs) to review billing structures and ensure fair pricing of healthcare services.

In a statement today, the association said the proposal, among other matters, was presented during a meeting with Finance Minister II Datuk Seri Amir Hamzah Azizan, Health Minister Datuk Seri Dr Dzulkefly Ahmad, and representatives from Bank Negara Malaysia (BNM) and ITOs, held today at the Finance Ministry.

"The primary objective is to review the current billing structure and address the issue of cross-subsidisation, ensuring that charges more accurately reflect the true cost of delivering healthcare services, including drugs and medical supplies. This initiative aims to improve transparency in hospital pricing while maintaining affordability for patients.

"The committee will also work towards developing a fair pricing model for drugs and consumables, balancing cost sustainability for hospitals with reasonable reimbursement structures. By aligning reimbursement rates with market realities, the initiative seeks to prevent selective coverage and cost-shifting, fostering a more equitable and financially sustainable healthcare system," it stated.

APHM also reaffirmed its commitment to actively addressing the ongoing challenge of medical cost inflation.

The association also proposed the creation of an independent healthcare cost and reimbursement review committee to oversee fair pricing and reimbursement practices, as well as conduct regular reviews of premium pricing and reimbursement structures.

"This is to ensure they align with actual healthcare costs and prevailing market conditions. The committee would promote structured, data-driven negotiations between hospitals and ITOs, fostering transparency and ensuring the long-term sustainability of the healthcare system," it added.

Other proposals presented include the expansion and inclusion of primary care in the patient care pathway, enhancing transparency in health claims volume and costs, pre-policy medical screening for insurance seekers, the establishment of a national medico-legal committee, reviewing and implementing recommendations to reduce regulatory burdens, and the creation of an industry-wide joint communication working group between APHM and ITOs.

"APHM is encouraged by the joint leadership of the ministers (of Finance and Health) in spearheading the establishment of collaborative industry efforts as outlined in the proposal. These collaborative efforts, through joint committees, are expected to take place in the coming month.

"APHM remains steadfast in its commitment to fostering a sustainable and transparent healthcare system. In partnership with the government and all stakeholders, we are determined to work together to identify innovative, evidence-based, and effective solutions to strengthen Malaysia's healthcare system," it said.

The association also expressed support for the insurance sector's proposed recommendations, published by the Life Insurance Association of Malaysia (LIAM), the Malaysian Takaful Association (MTA), and the General Insurance Association of Malaysia (PIAM) on March 7.

APHM also said it was committed to actively contributing to these recommendations and working collaboratively with ITOs.

"While APHM is broadly aligned with these recommendations, there are specific points raised by ITOs that will require further input and consideration from APHM to ensure alignment and cohesion."