Health Ministry admits trust deficit with private sector amid limited cost data

KUALA LUMPUR, August 15 – As non-communicable diseases (NCDs) become a growing crisis in Malaysia, experts are concerned about the lack of data, especially from the private healthcare sector, that could help with planning, fill the deficit and inform political decisions.

A report released last Tuesday by the Ministry of Health (MOH) and the World Health Organization (WHO) on the direct healthcare cost of NCDs in Malaysia – focusing on diabetes, cardiovascular disease (CVD) and cancer – relied heavily on data from Ministry of Health facilities which was then extrapolated to estimate spending in private facilities.

Data from private health insurance was made available for the study, after regulatory approval, although information from private insurers was not “thorough enough” to work with, said the deputy director of the Ministry of Health. Health for National Health Financing, Dr. Muhammed Anis Abd Wahab.

“I remember – it’s a sharing of some trade secrets I guess – that before we even went to private hospitals, we went to private health insurers hoping that some of that [sic] the data they had would help us,” Dr Muhammed Anis said during a panel discussion at the launch of the report titled “The Direct Cost of Non-Communicable Disease Healthcare in Malaysiaby the Ministry of Health and WHO offices in Malaysia, Brunei Darussalam and Singapore.

“The reality was that the data was not deep enough for us to work with.

“The fact is that some insurers are still working with manual data. And of course that makes the whole process difficult because we would need to go through all these simple manual forms to find meaningful data to analyze,” said Dr Muhammed Anis.

He added that “trust” issues between public and private health care providers were further impeding access to useful data.

“Of course, there is also the problem that when we go to private hospitals, it is always a question of a lack of trust between the two parties (the Ministry of Health and the private sector).

“On the Ministry of Health itself, I agree there needs to be more transparency with the data from the Ministry of Health that we can share with all sectors, including NGOs. But as long as we don’t If we have not overcome this trust deficit with the private sector, they will not be willing to share,” said Dr Muhammed Anis.

According to the cost analysis study by the Ministry of Health and WHO, the annual direct health care costs related to diabetes (RM4.38 billion), cardiovascular disease (RM3.93 billion ) and cancer (RM1.34 billion) exceeded RM9.65 billion, accounting for 16.8% of total health expenditure in 2017.

The largest components of the total annual direct health care costs for diabetes, cardiovascular disease and cancer were primary care and outpatient consultations which accounted for RM4.2 billion or 43.5% of the total, and medicines at RM1.72 billion (17.9 percent). percent of total costs), closely followed by medical tests at RM1.67 billion (17.3% of total costs).

The private sector accounted for RM3.49 billion or 83.6% of total outpatient and primary care costs. Outpatient and primary care refer to all medical consultations performed outside of the inpatient inpatient system.

By NCD category, primary care and outpatient expenditure for diabetes was highest at RM3.1 billion, 204% higher than for cardiovascular disease at RM1 billion and 3,408% higher than those for cancer at RM88.1 million.

The private sector also accounted for nearly two-thirds (61%) of drug expenditure for the three selected NCDs, which amounted to RM1.72 billion in 2017.

The private sector accounted for RM1.06 billion in medicines, with the largest proportion dispensed through pharmacies, followed by private hospitals and private clinics.

The public sector accounted for RM667.67 million (38.7%) of medicines for the three categories of NCDs, with public hospitals making up the largest proportion.

Nearly half (46%) of total drug expenditure was incurred for drugs for patients with cardiovascular disease, while the remainder was split reasonably evenly between drugs for diabetes (30.3%) and cancer (23.7%).

Malaysia has a dual health care system consisting of public hospitals run by the Ministry of Health, teaching hospitals and military hospitals, as well as tax-funded primary health care centers and of a paying private sector.

There were 200 private hospitals and over 7,000 private medical clinics in 2017. Consultation fees at private facilities are governed by the Private Health Facilities and Services Act 1998 (Act 586), although private providers retain their autonomy to set the prices of the other components of medical bills. , such as room fees and medication.

Mark O’Dell, CEO of Life Insurance Association of Malaysia (LIAM), in June spoke about inflation in medical claims which he partly attributed to unregulated private hospital charges.

He said that while doctors’ fees and related expenses are regulated by scheduled benefits, about 60-70% of a hospital bill consists of charges that are not regulated.

An industry report commissioned by LIAM, the Malaysian Takaful Association (MTA) and the General Insurance Association of Malaysia (PIAM) found that medical costs in Malaysia increased by an average of 8-9% per year between 2013 and 2018.

Five key factors identified as contributing to the annual increase in private medical costs and claims in Malaysia were advances in medical treatment, importation of equipment and medicines, high prevalence of non-communicable diseases, aging population and increasing benefits and policy design.

The report’s recommendations include engagement with stakeholders – doctors, private hospitals, insurers and regulators – to explore ways to reduce unnecessary spending, while greater transparency in publishing average costs for common procedures and treatments. (detailed billing and explanation of the availability of treatment alternatives) are required.

About John Tuttle

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