Long, winding road towards DRG payment model rollout

KUALA LUMPUR: A proper rollout of the diagnosis-related group (DRG) payment model could take more than six months, given the complexities in data gathering and analysis, said Association of Private Hospitals Malaysia (APHM) president Datuk Dr Kuljit Singh.
He said that for any DRG or any DRG-type mechanism to work, accurate clinical data and a national electronic health record system are needed.
Presently, this foundational data is not yet available, which presents significant challenges for timely and effective DRG implementation, he added.
'As the process of gathering and analysing such data is complex and time-consuming, APHM anticipates that a proper rollout will require considerably more than six months,' said Dr Kuljit.
He also said the APHM is heartened to hear Health Minister Datuk Seri Dr Dzulkefly Ahmad's announcement at the APHM International Healthcare Conference and Exhibition 2025 that a basic medical and health insurance/takaful (MHIT) product will be introduced later this year, while the DRG will be rolled out in phases.
To support this national initiative, Dr Kuljit said APHM member hospitals have offered to share relevant clinical data required for the set-up of a DRG system with the Health Ministry and the Finance Ministry.
'APHM strongly advocates that adequate time and resources be allocated to ensure that the DRG initiative is thoroughly conceptualised, piloted and implemented to ultimately deliver sustainable improvements for all Malaysians,' added Dr Kuljit.
Earlier, Dzulkefly said introducing DRGs to pay for healthcare services, in phases, beginning with MHIT products, will be a key driver for value-based healthcare.

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Malay Mail

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Philippines — 2013 The Philippine Health Insurance Corporation (PhilHealth) began shifting from FFS to case-based payments in 2014 with the All Case Rates (ACR) system. The 2019 Universal Health Care Law reinforced this approach, mandating PhilHealth to strengthen financial risk protection and further refine DRG-based mechanisms. Indonesia — 2014 Indonesia launched its national health insurance programme, Jaminan Kesehatan Nasional (JKN), in 2014 alongside its DRG system, INA-CBGs. Both inpatient and outpatient services are reimbursed using standard tariffs set by the Ministry of Health. This model has helped keep JKN financially sustainable and scalable.

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New Straits Times

15 hours ago

• New Straits Times

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