Mark Cheong, a senior lecturer at Monash University’s school of pharmacy, said fee increases may cause life-saving treatments to be unaffordable for some low-income patients, while other patients may choose to delay or avoid necessary treatments.

Higher out-of-pocket payments should not become a barrier to receiving care, said Cheong, who is a researcher in health services and systems.

“Many patients have no other alternative than to be treated at IJN,” he said.

He added that the large number of patients referred to IJN from the health ministry suggests that some services remained unavailable or not easily accessible at government hospitals.

IJN chief executive Dr Ezani Taib was reported to have said last week that costs had gone up since the fee structure was set over 20 years ago.

“We still charge the government the original costs. So, we are seeking an increase of 10% to 40%, depending on the procedure,” he said, according to the Edge financial weekly.

“However, it will not reach what private hospitals charge.”

Ezani said IJN charges less than half of the RM110,000 to RM120,000 that a simple bypass surgery will cost at private hospitals.

Galen Centre CEO Azrul Khalib said the proposed IJN fee increase was overdue. However, he said it might result in a higher number of eligible low-income patients needing subsidies.

As IJN is set up as a private limited company, it must earn revenue and manage its operations without depending on public funds, he said.