Medical insurance first product under diagnosis pricing system, says Dzulkefly

Medical insurance first product under diagnosis pricing system, says Dzulkefly

The health minister says the product will broaden private sector financing options and steer private healthcare towards a value-based healthcare model.

Health minister Dzulkefly Ahmad said 78 health clinics have adopted the cloud-based clinic management system, with another 90 set to come on board later this year. (Bernama pic)
KUALA LUMPUR:
Health minister Dzulkefly Ahmad says the government’s introduction of a basic medical and health insurance and takaful (MHIT) product marks the first step in the phased implementation of a diagnosis-related group (DRG) pricing system.

Speaking at the launch of the APHM International Healthcare Conference & Exhibition 2025 here today, he said the product would broaden private sector financing options and steer private healthcare towards a value-based healthcare model.

“We are also exploring a more diversified health financing ecosystem that will combine tax-based allocations, social contributions, employer-based schemes, and targeted subsidies under a progressive and equitable framework,” he said.

In March, deputy prime minister Ahmad Zahid Hamidi said the finance ministry, Bank Negara Malaysia, and the EPF would develop MHIT products in view of the rising medical costs.

He said the initiative was part of the national health sector reform effort to ensure access to more sustainable medical treatment.

Dzulkefly said the DRG pricing system – which standardises the costs for certain groups of patients according to their ailments and encourages cost containment initiatives – would be a key driver for value-based healthcare, with fairer rules for those with pre-existing conditions in the context of an ageing nation where the prevalence of non-communicable diseases is high.

“Diagnosis-related groups incentivise efficiency.

“We expect this to drive innovation in ambulatory and day-case surgery, and expand the use of health technologies that demonstrate strong cost-effectiveness in improving health outcomes and reducing total costs,” he said.

Dzulkefly said the system is expected to be rolled out before the end of 2025.

“We will start with simpler groups under DRG that are easier to manage. From there, we will build momentum and move on to more complex groups.

“With the cooperation of APHM, the finance ministry and other stakeholders, I am confident we can implement the initial phase by the end of this year and continue building from there,” he told reporters later.

Separately, he said a joint ministerial committee would coordinate health-focused initiatives under GEAR-uP, which will see six GLICs invest RM120 billion in “high growth, high value” industries over five years to stimulate domestic economic growth.

“This is expected to drive further investments into the health sector, particularly in the spectrum of healthcare providers, not limited to large multi-speciality tertiary hospitals,” he said.

Dzulkefly also said that 78 health clinics had adopted the cloud-based clinic management system, with another 90 set to come on board later this year.

He said the clinics saw more than 70% of patients receiving treatment in under 30 minutes, 20% attended to within 30 to 60 minutes, and 10% attended to within 90 minutes.

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