Lim said this was based on an analysis of private hospital billing claims submitted to insurance companies and takaful operators (ITO), Bernama reported.
“Since the treatment charges imposed are less transparent, a more detailed study is required to better understand this issue and determine the appropriate follow-up measures,” she was quoted as saying during a question-and-answer session in the Dewan Rakyat today.
She was responding to Sim Tze Tzin (PH-Bayan Baru), who had asked the finance ministry to explain the price differences between the two payment methods.
A guarantee letter is a document issued by an insurance company or employer to a hospital or medical provider, guaranteeing payment for a patient’s treatment.
Lim said the government was aware of the concerns, which were also raised during recent public hearing sessions by the Public Accounts Committee (PAC).
She said the health ministry, in collaboration with the finance ministry, private hospitals, and ITOs, was working to find a long-term solution to the issue of rising medical costs and private hospital charges.
“This includes enhancing the transparency of medication costs and facilitating comparisons of common medical expenses. This integrated action plan was presented to PAC yesterday,” she said.
Lim also revealed that initial findings from the integrated claims database of the ITO industry showed high claim rates for certain illnesses in 2023 under medical and health insurance and takaful.
Among the most commonly claimed illnesses were pneumonia, spinal issues, digestive system disorders, and heart disease.
Bernama also reported Lim as saying that the government would conduct an in-depth study to assess the feasibility of detailed profit and loss reporting for each medical insurance policy.
ITOs currently only disclose overall financial statements under Malaysian Financial Reporting Standard 17, with premium adjustments based on claim costs.
Lim said ITOs must balance policyholder affordability and product sustainability when determining premium changes, ensuring that adjustments are based on the cost of claims and not solely for profit.
“For example, ITOs must monitor the cost experience of MHIT claims objectively, and may only adjust premiums when the actual claims costs consistently decline and exceed the threshold value previously set in the ITO’s internal practices.
“ITOs are also prohibited from resetting premiums solely to increase their profits,” she said in response to Teresa Kok (PH-Seputeh), who asked if companies would be required to provide detailed financial listings.
