On May 29, 2025 some 200 people turned up for a public forum on Medical Inflation and Its Contributory Causes organized by the Medical and Health Science students at Universiti Malaya.
An earlier forum in April 2025 had focused on stakeholders’ ‘fire-fighting priorities’ in the immediate aftermath of steep hikes in health insurance premiums. This follow-up forum was an opportunity to address more systemic aspects of Malaysian healthcare and its financing.
The keynote address by Dr Aneil Moorthy, Head of Health IA (International Assistance}, - in my interpretation (and rearrangement) of its component parts - answered the crucial question:
Why Do We Need Private Health Insurance?
The answer I arrived at was chronic underfunding in public sector healthcare which has forced many Malaysians to prepare for contingencies when faced with congested public hospitals that results in long queues and delays when seeking urgent in-patient care.
For those without deep pockets, contingency plans mean looking at private hospitals and ensuring they have the necessary insurance coverage if and when the need arises.
That, sadly, is the backdrop to the recent public uproar over premium hikes for hospitalization insurance, if one is unfortunate enough to get entangled in a tug-of-war between profit-driven overtreatment (“the vendor tells the buyer what the buyer must buy”) and profit-driven insurers’ denial of coverage and treatment (“the high-risk cases who are most likely to need healthcare, will be the individuals least likely to get coverage or treatment when they need it”).
It's Not Us, Look Over There
Association of Private Hospitals of Malaysia (APHM) president, Dr Kuljit Singh, unfortunately declined the invitation as a much-needed panelist, but he was present, nonetheless, holding a watching brief on behalf of APHM’s member hospitals.
His occasional protagonist, Life Insurance Association of Malaysia CEO Mark O’Dell deftly explained why insurers were not the sole culprits deserving of brickbats and deflected blame from irate policy holders (and hospitals), for the steep hikes (40%-70%) in health insurance premiums for 2025.
Despite five and a half hours of animated exchanges (yes, audience engagement was that sustained), time constraint did not allow me to ask Mr O’Dell a second question from the floor:
Should profit-driven risk-rated healthcare insurers have any role in healthcare financing?
Should Bank Negara Malaysia, as insurance regulator, allow only uniform, community-rated health insurance which is non-discriminatory of risk sub-groups? (in effect, mandate cross-subsidies as an unavoidable feature of risk pooling and sustainable risk management in health insurance)
A Primary Care Detour
Malaysian Medical Association president-elect Dr Thirunavukarasu Rajoo rightly emphasized the key role of primary care in a comprehensive national response to on-going epidemics of noncommunicable diseases (NCDs). With the added involvement of other health-related personnel and civil society organizations, it could contribute importantly towards cost control by pre-emptively reducing the need for expensive referrals for higher levels of care and in-patient services.
Notably, he did not dwell at length on GPs’ discontent over medicines price labelling and its underlying complications in the stagnation of GP consultation fees, (compensated by increased & opaque mark-ups on dispensed medicines), patients upset with a prescribing fee on top of a consultation fee, pharmacists also wanting dispensing fee, etc (sympathies for YBMK Dr Dzul… I wonder if a meaningful solution for these problems is possible without considering [flexible] separation in prescribing and dispensing).
Healthcare Cost ≠ Medical Bills
Just as the primary care response to NCDs entails promotive, preventive (and in the near future, predictive?) care as well (i.e. much more than just prescriptions and medications), Prof Nirmala Bhoo Pathy made an important point, from a patient’s perspective, that health-seeking costs do not equate to medical bills.
She eloquently pointed out that a more meaningful listing would include “health-related costs beyond medical bills: transport, lost income, special diets, caregiving… real cost protection requires cross-sector solutions across social welfare, transport, labour, local governments, and NGOs.”
Sourcing for Increased KKM Allocations (Taxes vs. SHI?)
Did Special Guest Khairy Jamaluddin signal that KJ akan kembali, selepas Keluar Sekejap?
KJ was the first health minister who publicly acknowledged, during his short tenure, that Kementerian Kesihatan Malaysia was chronically underfunded and that he would seek a doubling of federal allocations to 5% of GDP within 5 years.
In his closing remarks at the Health Policy Summit 2022: Future of Our Healthcare – Health White Paper Development, KJ candidly remarked that he had pointedly avoided the “i” word (insurance) in the preceding two days because he didn’t want to get embroiled in a discussion on Social Health Insurance.
Unfortunately, he left the forum early and I missed the chance to ask if he still favored SHI labor taxes as a principal source for doubling KKM’s allocations, despite extensive, consistent evidence (Yazbeck et al, 2020; Wagstaff, 2009) that tax-funded healthcare systems outperformed SHI-funded healthcare systems.
During his articulate presentation, KJ did concede, as did former Deputy Health Minister Dr Lee Boon Chye, that the most urgent task was to upgrade, reinforce, and reform an (in)adequately funded public healthcare delivery system before asking the public to consider supplementary taxes for further system improvements, or increased patient co-payments at point of service.
Dr Lee Boon Chye further remarked that RakanKKM was in his opinion a band-aid stop gap that was unlikely to significantly improve affordable access, perhaps could even degrade the quality of care for regular KKM patients.
Emerging Leadership
By way of concluding, kudos are due for the excellent organizing abilities and attention to detail by the UM students who organized this event.
It is indeed encouraging that medical and biomedical undergraduates are going beyond their usual preoccupations with clinical and laboratory skills to also engage in urgent healthcare system and health policy priorities on the national agenda.
Syabas!
Please note that the views expressed in this article are those of the author and do not necessarily reflect the opinions or positions of Vital Signs
