KUALA LUMPUR: Comprehensive engagement with stakeholders is needed in the development of the Diagnosis-Related Group (DRG) system so that public and private healthcare sectors are adequately supported without compromising patient outcomes.
Malaysian Medical Association (MMA) president Datuk Dr Kalwinder Singh Kaira said a collaborative approach is essential to developing a context-specific framework that is fair, incentivizes quality care, and addresses the realities of modern medical practice.
The DRG systems - originally developed in the US, have been implemented to address rising healthcare costs.
Under DRG, hospital care is reimbursed based on specific procedures or diagnoses rather than the length of stay in the hospital.
He said in the country, healthcare is provided by facilities under the Health Ministry, Higher Education Ministry, Defence Ministry and private facilities where each plays a unique role in the delivery of care, with varying levels of resources and capabilities.
"While these systems offer potential benefits, other countries have experienced challenges, including inadequate compensation models for high-risk cases and the avoidance of complex patients.
"These unintended consequences must be carefully considered in developing a Malaysian-specific DRG to avoid similar pitfalls.
"Developing an effective DRG system requires robust data collection and analysis, including accurate cost data from public and private healthcare facilities, classification of resources and capabilities, patient demographics, and risk profiles to address case complexities.
"This will ensure the framework reflects the unique needs of Malaysia's healthcare system while maintaining quality care standards," he said in a statement.
Though more details of the DRG are yet to be released, Dr Kalwinder said the association has concerns regarding the possible impact of its implementation.
"For patients, there is a concern that specialists may avoid taking on complex or high-risk cases if the DRG framework does not adequately account for the resources and expertise required.
"This could lead to a shift of such patients to public healthcare facilities, straining an already overburdened system.
"For healthcare professionals, the current professional fee schedule poses a significant challenge in fixing rates.
"The 13th Fee Schedule, enforced since 2006 and last revised in 2013, and which covers specialist charges in hospitals, does not account for many modern procedures introduced in recent years.
"Without adjustments and additions to this schedule, DRG implementation may be a challenge as private healthcare facilities also vary widely in their resources and capabilities.
"Hence a one-size-fits-all DRG system may not be the best solution."
He said the DRG system must include provisions for managing unexpected complications and the treatment of patients with underlying conditions, which often require additional resources.