Two steps away to reducing medical costs

I REFER to the letter “Medical insurance industry in need of care” ( The Star, June 1) in which concerns were raised over the rising cost of medical care in the absence of unregulated fees in private hospitals and the consequential burden posed on patients.

I would, however, like to clarify that not all private medical facilities impose surcharges on their insured patients. The issue at hand extends to beyond just this.

To really reduce the burden of rising healthcare costs, there are two “easy” steps that could be implemented:

1. Allow all licensed healthcare facilities to get credentialed to be on the insurance panel, thereby creating healthy competition which will translate to lower medical costs for patients; and

2. Abolish the outdated clause in older policies which mandates that claims can only be approved with hospital admission.

Currently, insured patients who go to the panel hospital associated with their insurance provider have access to medical treatment that will be borne fully or partially by their insurer via a cashless medical card. Patients visiting nonpanel clinics will have to seek reimbursement via the file and claim method.

Most patients have expressed reservations over the system of paying out of their own pocket first. They are unwilling to go through the hassle of paying upfront, fearing that their claims may not be approved.

Some of our patients have remarked that some insurance agents have steered them to private hospitals to take advantage of the cashless payment system (which may cost insurance companies more than the 20% stated in the said letter) that requires less “work” for the agent rather than allow them to seek the same treatment elsewhere at a lower cost via the file and claim practice, which the agent has to help with.

The other step is to abolish the requirement of older policies that necessitate patients going for outpatient surgery to be admitted first to be eligible for claims and reimbursements. As such, many patients are “forced” to be admitted in hospitals even though it is not necessary (such as for modern cataract surgery), significantly raising the cost.

We believe that competition by widening insurance panels to all healthcare facilities and hospitals and abolishing outdated policies that require unnecessary admission are just two steps away to reducing medical cost.

As mentioned by the writer, we too are open to a dialogue with the health insurance industry, government officials or relevant parties to seek a solution to lower medical costs that would ultimately benefit all Malaysians.