KUALA LUMPUR: New pricing structures are needed to control rising costs in private hospitals, said Health Minister Datuk Seri Dr Dzulkefly Ahmad.
Speaking at the launch of the Association of Private Hospitals of Malaysia (APHM) Factbook today, he said out-of-pocket expenses could lead to financial shocks, especially for those without insurance coverage.
"Out-of-pocket expenditure itself is already inflationary. The ministry would like to encourage upper-middle and T20 groups to subscribe to insurance to avoid sudden financial shock," he said.
Dzulkefly said the Diagnostic-Related Group (DRG) based payment scheme as a promising approach to help mitigate medical inflation.
DRG is a method of pricing based on the patients' diagnoses and takes into account other factors (such as age, sex and comorbidities) to ensure they get the care the need without unnecessary charges.
It is adopted in the United States' Medicare scheme.
"Although it has not been put in place, I will want to believe that this DRG is the way forward.
"It is still a work in progress. Whether it's DRG or later on Case-Mix Group (CRG), we would be in a better position to mitigate this medical inflation," he said.
A CRG categorises patients with similar characteristics together so the healthcare facility can pool it resources.
Dzulkefly said rather than adopting a pay-for-service model, where hospitals bill patients on a per-service or per-procedure basis, a pay-for-health-outcomes payment model could help reduce medical costs while providing a more positive experience for patients.
The Association of Private Hospitals of Malaysia (APHM) launched a factbook today at The Majestic Hotel, aimed at providing solutions and clarifications on challenges faced by private hospitals.
The factbook highlights three key areas within the private hospital sector, which are contributions to healthcare, challenges faced by private hospitals, and ways to move forward.