PETALING JAYA: The co-payment feature may deter patients from seeking necessary treatments as the out-of-pocket expenses might be too high, says the Federation of Malaysian Consumers Associations (Fomca) secretary-general Dr Saravanan Thambirajah.
This is especially for major medical procedures as the co-payment amount can be substantial, he said.
“This could push more people toward public healthcare facilities, potentially increasing congestion at government hospitals.
“Medicine prices, consultation fees and hospital charges must be scrutinised to prevent unjustified price hikes,” he said, while expressing concern that there might be a need to correspondingly address the rising costs of private healthcare.
To manage costs, he suggested that the government could establish a health fund to help cover co-payment expenses for vulnerable groups.
The fund could be supported by public-private partnerships, corporate social responsibility (CSR) contributions or targeted government allocations, he said.
In July 2024, Bank Negara clarified that co-payment policies are needed to promote more sustainable and affordable medical and health insurance and takaful (MHIT) offerings, amid the continued rise in medical cost inflation.
It said that with the co-payment option, lower-cost MHIT products could be available based on consumers’ financial circumstances and needs.
It added that co-payments are not applicable for emergency treatment, outpatient treatment for follow-up treatments arising from critical illnesses and treatment at a government facility.
Recently, some insurance companies start implementing a co-insurance feature of between 5% and 15% for newly purchased medical cards.
A banker, who wishes to be known only as Goh, said that having co-payment of up to 15% of the medical fees is a significant increase.
“This will adversely impact those from lower-income groups, and they would need to seek help from NGOs and government agencies,” he said.
Yasmin Muhaiddin, from Ulu Kelang, said that she will continue with her medical insurance despite the co-payment, as it can offset high charges at private hospitals.
On the positive side, she added that co-payment may allow for better pricing at hospitals.
She said that this depends on whether the co-payment is a fixed amount or based on a percentage.
An Ampang hawker stall owner who is known as Ah Beng said he would rather go to a government hospital for treatment when faced with these kind of co-payment arrangements.
“This will only cause the government hospital patient-to-doctor ratio to get even higher,” he said.
Another 24-year-old who wishes to be known as Tan, said co-payment discouraged him from buying medical insurance, especially if he needs to pay more than 10% out of pocket even with insurance.
“I am scared of the high cost of healthcare, and now with this feature, I don’t see how buying insurance will help,” he said, while hoping the government can intervene to cap co-payment at a fixed rate.
Malaysian Coalition on Ageing chairman Cheah Tuck Wing said co-payment is a good move as people will be more aware of medical costs.
“When people have to pay out of their own pockets, they will be more responsible for their well-being,” he said, though he added that the weak regulation of medical insurance here has caused many seniors to cancel their medical policies, and then overload public hospitals.
“We need to introduce a national insurance programme funded by both workers and the government like what is being done in Singapore,” he said.
Meanwhile, Malaysian Pharmacists Society (MPS) president Prof Amrahi Buang said co-payment is a feature that has been approved by Bank Negara, and advised the public to go through the details of the agreement, and query the risks and benefits from providers.
He also said that pharmacists are concerned about the financial strain on Malaysians amidst the sharp increases in insurance premiums and private hospital charges.
“We urge the government to implement a transparent pricing framework that ensures accountability from all stakeholders,” he said, adding that any unilateral increase in insurance premiums or hospital charges must be justified and transparent.
He said that the increasing cost of private healthcare has resulted in higher dependency on public hospitals, stretching government resources further.
“To alleviate this pressure, MPS strongly supports the implementation of a National Health Insurance that integrates public and private healthcare services,” he said.
