Don't rush into new payment system, MMA urges govt

Summary

• The Malaysia Medical Association urges the government not to rush into implementing the diagnosis-related groups (DRG) system without stakeholder engagement.

• Its president Kalwinder Singh Khaira says the government must consider Malaysia’s unique healthcare ecosystem before making any changes.

• He also points out that the fee for medical healthcare professionals has not been revised since 2013.

The Malaysian Medical Association has urged the government not to rush into implementing a diagnosis-related groups (DRG) payment system to regulate private hospital bills.

“This process should not be rushed, and all views should be considered.

“Ultimately, all cost-containment measures being considered must align with goals of quality and accessibility in healthcare,” its president Kalwinder Singh Khaira (above) said in a statement today.

On Nov 14, Health Minister Dzulkefly Ahmad said the government is considering implementing a DRG payment system to regulate private hospital bills.

Dzulkefly also said while the system is still under consideration, it represents a potential path forward for more standardised and predictable billing.

“Although it has not been put in place, I will want to believe that this (DRG) is the way forward. Whether through DRG or, in fact, people are now moving towards case-related groups (CRG) - that would be really value-based.

“It is still a work in progress. I’ve spoken to my medical adviser, Abu Bakar Suleiman, and we are really looking into this. This is the way forward for us. For now, I wouldn’t say it’s laissez faire but it’s almost like that.

“So that would be a better way to get to understand how you are charging…whether it’s DRG and later on CRG, we would be in a better position to mitigate this medical inflation,” CodeBlue reported the minister as saying.

‘Fixed amount for care’

For context, the DRG payment system involves paying a fixed amount based on the complexity of a case, rather than itemising each charge.

This means hospitals receive a set amount for a patient’s treatment and must manage resources within that budget. This fixed payment model may help regulate medical costs by limiting excessive charges while maintaining quality of care.

As for CRG, it is a payment method used in healthcare financing that classifies patients based on the type and complexity of the medical case they present.

Under this system, payments to healthcare providers are made based on the type of medical case, rather than on individual procedures or services provided. This system is aimed at standardising payments and improving the efficiency of healthcare delivery.

Consider M’sia’s healthcare ecosystem

While he acknowledges the pressing need to address escalating healthcare costs and support efforts to establish effective cost-containment systems, Kalwinder said the DRG system must be looked into within the scope of Malaysia’s healthcare ecosystem.

For example, he mentioned that in Malaysia, apart from the Health Ministry - the Higher Education Ministry, the Defence Ministry and the private sector also provide healthcare services to the people.

“Each plays a unique role in the delivery of care, with varying levels of resources and capabilities.

“A standardised DRG framework must consider these variations to ensure that both public and private sectors are adequately supported without compromising patient outcomes,” he noted.

Kalwinder also pointed out that private healthcare facilities vary widely in their resources and capabilities, which means a one-size-fits-all DRG system may not be the best solution.

“Additionally, the DRG system must include provisions for managing unexpected complications and the treatment of patients with underlying conditions, which often require additional resources,” he added.

Fee revision

Kalwinder also mentioned that the current fee schedule for professional healthcare professionals, under the 13th Fee Schedule, was only last revised in 2013 and would pose a significant challenge in fixing rates for the implementation of DRG.

“The current scheme does not account for many modern procedures introduced in recent years.

“Without adjustments and additions to this schedule, DRG implementation may be a challenge.

“And this is why we need stakeholder engagement to ensure uncompromised patient care and a system that is equitable and sustainable,” he said.

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