KUALA LUMPUR: The government has been urged to look into regulating third-party administrators (TPA) in the private healthcare sector to curb unethical practices of fee-splitting and protect the healthcare system against commercialism.
Malaysian Medical Association (MMA) president Dr Azizan Abdul Aziz urged members of parliament to address the matter in the upcoming parliamentary session.
She said despite matters concerning TPAs being brought up for discussion since nine years ago, no regulatory action has been taken to address the issue.
She said issues concerning TPAs have an impact on healthcare delivery for the population.
TPAs are privately-owned managed care organisations hired by companies to manage their employee health benefits.
These middlemen in private healthcare earn from
providing managed care services to employers and from charges to private GP clinics to be listed as a panel clinic.
"Despite engagements with the ministry since 2015, there has been no regulatory action to address the issue.
"The absence of regulation and oversight of TPAs has been a lingering problem even though it has been highlighted in the Malaysian Productivity Council Report 2016.
"Even Bank Negara Malaysia (BNM), which regulates insurance providers, has remained passive concerning the regulation of TPAs, although they handle claims for insurance providers," she said in a statement, today.
Dr Azizan added that these TPAs would also charge private general practitioners through fee-splitting where they take a certain percentage from the bill charged to patients.
This, in turn, could lead to increased costs incurred among private general practitioners (GPs) and specialists.
According to her, a number of TPAs were also known to deduct 10 to 15 per cent of the bill.
"A majority of private GPs rely on TPAs for the network of clientele they provide and administrative services managing the various companies.
"Over time, this can affect the sustainability of the private clinic and quality of patient care being provided as the GPs involved might be forced to make cost-cutting decisions or even adjustments in charges to cover losses.
"If left unchecked, these unethical practices in our healthcare system will lead to a
further escalation in healthcare costs, in particular private primary care services.
"(And) since the ministry claims it does not regulate TPAs, we urge the government to take action against private medical practitioners involved in fee-splitting so that TPAs will be pressured to comply with ethical standards."