The Malaysian medical community is continuing its efforts to ensure that insurers, takaful operators (ITOs) and third-party administrators (TPAs) are prevented from interfering in doctors' clinical decision-making.
Malaysian Medical Association (MMA) president Datuk Dr R. Thirunavukarasu had recently said that "There are a lot of things that have been highlighted, especially about ITOs and TPAs interfering in the clinical decision making of physicians. General Practitioners also have a lot of issues with TPAs.
According to media reports the MMA in the recent past had asked the health ministry to regulate TPAs, following reports that a TPA had issued a circular mandating that prescriptions for long-term medications be written using only the active ingredient, which meddled with doctor's decision-making.
In a related development in an exclusive interview with https://codeblue.galencentre.org Beacon hospital medical director and consultant clinical oncologist Dr Mohamed Ibrahim A Wahid said that such practices, if left unchecked, are putting patients’ lives at risk.
He said ITOs and TPAs have begun overstepping their roles by questioning clinical decisions and denying coverage for essential cancer drugs. “Insurance companies are crossing the line by interfering with patient care,” said Dr Ibrahim.
In his interview Dr Ibrahim said, “They are not acting in the best interest of patients, who are their customers, and, in many cases, are harming patient clinical treatment outcomes.”
Dr Ibrahim did not name any hospital or insurance player, but he revealed that one insurer demanded discounts as high as 30% from private hospitals.
He told CodeBlue that “Many hospitals cannot give that kind of discount because that essentially wipes out their entire profit margins. In some cases, that might even result in hospitals making net losses.”
He explained that some hospitals are circumventing the situation by marking up prices to meet such demands, ultimately burdening other payers, particularly patients paying out-of-pocket.
Dr Ibrahim explained that the cost of running a hospital in Malaysia has increased substantially due to inflation, rising energy tariffs, and surging prices of medical technology and drugs, besides health worker remuneration.