Galen CEO Azrul Khalib said many Malaysians are being squeezed by unregulated hospital bills, repricing and unreasonable private health insurance applications.
Azrul said the regulator must be independently empowered to review, approve, cap, or roll back unjustified increases in hospital charges and premiums.
“We need a single, independent regulator with a clear consumer protection mandate to bring transparency, fairness and discipline to the private healthcare market,” he said in a statement.
Azrul also questioned the effectiveness of measures to cap insurance premium adjustments to less than 10% for three years announced by Bank Negara Malaysia last December, stating that many insurers and takaful operators (ITOs) continue to be non-compliant with the regulation.
“Many ITOs appear not to be in compliance with the 10% cap and protection for those above 60.
“Despite denials by the operators, their own agents report increasingly more people terminating their policies, having been priced out of affordability and left unable to access the promised financial protections and reimbursements,” he said.
He said the commission’s key functions would include regulating hospital rates beyond consultant and procedure fees, reviewing and deciding on proposed ITO rate increases and caps, harmonising regulation of ITOs with hospital pricing, and publishing an annual private healthcare affordability report.
He said the lack of these regulations risks creating the financial hardship many expect insurance to protect them from.
“With ITOs pricing premiums out of affordability, imposing unreasonable co-payments and deductibles and using tactics to limit, restrict and dodge payment and control treatment, policyholders could face large out-of-pocket payments beyond their means in the case of major illness,” he said.
Yesterday, CodeBlue reported that a survey among 855 specialists in private hospitals nationwide found almost all of them perceived health insurers violated their clinical autonomy.
Ninety-nine per cent of the respondents in the poll also reported that their patients experienced health insurance problems over the past year, with half saying that one to five of their patients faced insurance coverage issues every month on average, while 24% had six to 10 patients a month encountering such problems.