APHM president Dr Kuljit Singh said there were some potential drawbacks, depending on the mechanism, in the proposal for value-based healthcare fees, charged based on the outcomes of treatment.
Outcome-based pricing is a model in which the cost of a service is based on the results it delivers to the patient, rather than a fixed agreed cost. Instead of the pricing being directly linked to the cost of the service, it is tied to the performance or outcome achieved.
This pricing approach represents a shift from traditional models, where pricing is typically based on fixed fees.
Kuljit said private healthcare facilities could struggle in transitioning from a fee-for-service model to one that was value-based, and that setting criteria on the quality or outcomes of treatment could be “problematic”.
“High-risk patients may be overlooked by doctors due to performance expectations, potentially leading to under-treatment or rejection.
“New payment mechanisms that shift financial risks can also dissuade providers and payers. Patients may be opposed to changes in therapy availability and delivery.
“Value-based healthcare payment systems offer some potential but they necessitate careful planning, stakeholder engagement, and the resolution of technological, organisational and cultural challenges.
“We expect the health ministry to conduct a comprehensive study to review the public healthcare delivery system, utilising value-based healthcare principles that are tax-funded. This will encourage private organisations to replicate them,” he said in a statement.
In the Dewan Rakyat earlier today, health minister Dzulkefly Ahmad urged private hospitals to introduce “pay-for-outcome” fees to curb medical inflation and improve the outcome of healthcare treatments.
He said Malaysia’s inflation in medical costs had reached 12.6%, more than double the global average of 5.6%.
Kuljit said another issue that might surface was incompatible electronic health records, which would hinder data sharing and interoperability.
Nonetheless, he acknowledged that other countries had employed the same model with some success.
“In the UK’s National Health Service, pay-for-performance initiatives have increased quality to some extent, while bundled payments encourage clinicians to plan ahead of time to avoid complications.
“Capitation regimes in Japan and the Netherlands have prioritised population health by pushing providers to engage in preventive care and integrated care systems to enhance chronic illness treatment.”