Dr Lee Boon Chye said the creation of such an authority could effectively resolve arbitration disputes and ensure that companies conduct themselves properly.
“There should ideally be a regulatory authority to oversee the conduct of managed care organisations (MCO) so that if there are any grievances, that authority can act as an arbitrator to mediate payment disputes,” he told FMT.
“This authority should also play a role in ensuring that the MCOs’ conduct is ethical and transparent, and not arbitrary.”
This comes after the Association of Private Hospitals Malaysia (APHM) president Dr Kuljit Singh called for the creation of such an authority to govern reimbursements by health insurance companies.
Presently, insurance companies are under the purview of Bank Negara Malaysia (BNM).
Lee said that establishing a dedicated authority would be more advantageous given its specialised knowledge in the medical field.
“Under BNM, it is a bit difficult because they are not conversant in the medical field. I don’t think they are able to do the vetting as to whether claims are legitimate or whether the rejection of guarantee letters is legitimate,” he said.
“I think it will be better for the health ministry to monitor as a regulatory body.”
Lee suggested that the body comprise two distinct authorities, each capable of contributing their expertise in their respective fields.
He said BNM could oversee the financial aspects while the health ministry could monitor the medical side of things.
Meanwhile, Kuljit said establishing such a body would take time as the government would have to enact a law in Parliament.
In the meantime, a potential solution could involve seeking a middle ground between the government and the insurance companies.
“We believe that some regulation is required so that both hospitals and patients are also protected and they get the coverage they have been promised,” he told FMT.
“But if we can also work something out without having regulations and work as partners, I think that will be a better way for the time being.”