Value-based healthcare
KUALA LUMPUR: The introduction of basic medical and health insurance/takaful (MHIT) products will mark the first step in the implementation of the diagnosis-related group (DRG) payment model, says Health Minister Datuk Seri Dr Dzulkefly Ahmad.
He said MHIT products would steer private healthcare towards a value-based healthcare model with fairer rules for those with pre-existing conditions.
'Introducing DRGs to pay for healthcare services in phases, beginning with this base MHIT product, will be a key driver for value-based healthcare.
'DRGs incentivise efficiency and we expect this will drive innovations in ambulatory and day case surgery, and expand the use of health technologies, which will demonstrate strong cost effectiveness in improving health outcomes while reducing costs,' said Dzulkefly.
He added that the Health Ministry is working with the Finance Ministry, Bank Negara and the Employees Provident Fund (EPF) to transform private health insurance and takafuls by developing a base MHIT product.
Speaking during the launch of the Association of Private Hospitals Malaysia's (APHM) International Healthcare Conference and Exhibition 2025, he said the Health Ministry has made healthcare financing reform and digitalisation of healthcare services its priority.
'We are also exploring a more diversified health financing ecosystem that combines tax-based allocations, social contributions, employer-based schemes and targeted subsidies, all under a progressive and equitable framework,' he added.
Speaking to reporters after the launch, Dzulkefly said the Health Ministry is hoping to introduce the DRG payment model by the end of the year.
He said the proposed DRG scheme can start with a simple mechanism in its initial stage.
'Start simple first and after the momentum is developed, go for a complex one,' he added.
He also said that Malaysia, especially the APHM and Finance Ministry, have experience in implementing the DRG model.
DRG is a payment system that involves paying an amount predetermined by the DRG, instead of paying for each service received.
Other countries that have implemented this system include Sweden, Canada and Australia.
Dzulkefly was responding to news reports claiming that the government's plans to introduce the DRG system at private hospitals are being put on hold.
Commenting on a separate issue, he said the review of consultation fees for private general practitioners (GPs) has been raised to an executive task force chaired by Deputy Prime Minister Datuk Seri Dr Ahmad Zahid Hamidi.
Dzulkefly said that after a meeting between the Health Ministry and the National Action Council on Cost of Living (Naccol), it was decided that this issue should be raised to the task force led by Ahmad Zahid. Dzulkefly added that there are no deadlines for finalising the review of consultation fees for private GPs.
'No, but we will tackle this issue at the soonest time possible.
'The Deputy Prime Minister, who chairs the executive task force, will look into the final touches of this,' said Dr Dzulkefly.
On May 3, he had said the review of consultation fees for private GPs would be finalised within a month.
Yesterday, the Medical Practitioners Coalition Association of Malaysia (MPCAM) had proposed raising private GP fees to a minimum of RM50 and a maximum of RM80.
MPCAM had said GP consultation fees have stagnated between RM10 and RM35 for more than three decades since 1992.
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