Latest news with #DRGs
The Star
10-06-2025
- Health
- The Star
Value-based healthcare
Medical advances: Dzulkefly (third from right) attending the APHM International Healthcare Conference and Exhibition at the Kuala Lumpur Convention Centre. — YAP CHEE HONG/The Star KUALA LUMPUR: The introduction of basic medical and health insurance/takaful (MHIT) products will mark the first step in the implementation of the diagnosis-related group (DRG) payment model, says Health Minister Datuk Seri Dr Dzulkefly Ahmad. He said MHIT products would steer private healthcare towards a value-based healthcare model with fairer rules for those with pre-existing conditions. 'Introducing DRGs to pay for healthcare services in phases, beginning with this base MHIT product, will be a key driver for value-based healthcare. 'DRGs incentivise efficiency and we expect this will drive innovations in ambulatory and day case surgery, and expand the use of health technologies, which will demonstrate strong cost effectiveness in improving health outcomes while reducing costs,' said Dzulkefly. He added that the Health Ministry is working with the Finance Ministry, Bank Negara and the Employees Provident Fund (EPF) to transform private health insurance and takafuls by developing a base MHIT product. Speaking during the launch of the Association of Private Hospitals Malaysia's (APHM) International Healthcare Conference and Exhibition 2025, he said the Health Ministry has made healthcare financing reform and digitalisation of healthcare services its priority. 'We are also exploring a more diversified health financing ecosystem that combines tax-based allocations, social contributions, employer-based schemes and targeted subsidies, all under a progressive and equitable framework,' he added. Speaking to reporters after the launch, Dzulkefly said the Health Ministry is hoping to introduce the DRG payment model by the end of the year. He said the proposed DRG scheme can start with a simple mechanism in its initial stage. 'Start simple first and after the momentum is developed, go for a complex one,' he added. He also said that Malaysia, especially the APHM and Finance Ministry, have experience in implementing the DRG model. DRG is a payment system that involves paying an amount predetermined by the DRG, instead of paying for each service received. Other countries that have implemented this system include Sweden, Canada and Australia. Dzulkefly was responding to news reports claiming that the government's plans to introduce the DRG system at private hospitals are being put on hold. Commenting on a separate issue, he said the review of consultation fees for private general practitioners (GPs) has been raised to an executive task force chaired by Deputy Prime Minister Datuk Seri Dr Ahmad Zahid Hamidi. Dzulkefly said that after a meeting between the Health Ministry and the National Action Council on Cost of Living (Naccol), it was decided that this issue should be raised to the task force led by Ahmad Zahid. Dzulkefly added that there are no deadlines for finalising the review of consultation fees for private GPs. 'No, but we will tackle this issue at the soonest time possible. 'The Deputy Prime Minister, who chairs the executive task force, will look into the final touches of this,' said Dr Dzulkefly. On May 3, he had said the review of consultation fees for private GPs would be finalised within a month. Yesterday, the Medical Practitioners Coalition Association of Malaysia (MPCAM) had proposed raising private GP fees to a minimum of RM50 and a maximum of RM80. MPCAM had said GP consultation fees have stagnated between RM10 and RM35 for more than three decades since 1992.
The Star
10-06-2025
- Health
- The Star
‘DRG grouper that can be used by all hospitals needed'
PETALING JAYA: The Health Ministry should develop a national grouper on diagnosis-related groups (DRG) that will work for all hospitals. DRG groupers are used to categorise patients into DRGs, which are groups of cases with similar diagnoses, procedures and other characteristics. Prof Dr Maznah Dahlui, a health economist at Universiti Malaya and chairperson of the technical advisory committee for the DRG under the Health Ministry, said currently, there are different groupers based on hospital type. 'The ministry needs to come up with a DRG grouper that can be used by all types of hospitals. Currently, public hospitals use the grouper that they developed and teaching hospitals use the grouper developed by Universiti Kebangsaan Malaysia, while some private hospitals adopt (the model) from Australia,' she said when contacted. The main purpose of the DRG grouper is to assign DRGs, which are then used to determine payment for the hospital stay under the inpatient prospective payment system (IPPS). Prof Maznah said DRGs work as a costing model to improve hospital efficiency and as a payment model, but may not necessarily be applied for health insurance reimbursement. 'At the end of June, representatives from hospitals will have a workshop to discuss the development of the national grouper. 'Most likely, we will adopt the available grouper in public hospitals but modify it to consider patient characteristics (diagnosis and procedure) in private hospitals. So it's still under discussion,' she said. 'There is another group under the Health Ministry that looks at developing the health benefits package and the healthcare payment model for Malaysia, in preparation towards National Health Insurance (NHI). So, DRG is only part of and not necessarily only for NHI,' she said. The DRG, she added, is the bundling of treatment costs, which is equivalent to treating a certain DRG. 'We want to standardise how we group the patients for diagnosis plus procedure. It gives transparency of treatment cost,' she said. Dr Khor Swee Kheng, health systems specialist and CEO of Angsana Health, said implementation of DRG could take up to a decade if done in phases. 'Any DRG implementation should take five to 10 years, and it happens in phases. This has been the experience in other countries that have launched their DRGs, which started in 1983 in the United States,' he said. Dr Ginsky Chan, co-founder and access director at Angsana Health, said the phased introduction of DRGs, starting with minor illnesses, is a positive move towards value-based healthcare. 'Implementing it by the end of 2025 is ambitious but feasible with strong coordination. 'While it does not require a national insurance system immediately, it does highlight the need for integrated financing across the public and private sectors. A phased, collaborative approach will be key to its success,' he said. The DRG-based model has been implemented in a number of countries, including Indonesia and South Korea. However, there appears to be some resistance in the private sector towards its implementation. IHH Healthcare Bhd said last month that the payment model is not suitable to be implemented in local private hospitals, and feels that further studies are needed before considering its adoption. Its group chief executive officer, Dr Prem Kumar Nair, said DRGs are very difficult to implement in private hospitals, adding that it was originally designed to fund public healthcare through a single-payer model. Under the framework, inpatient cases are grouped into categories based on clinical similarity and expected resource use, allowing payers to reimburse hospitals with a fixed rate per case rather than through itemised billing.
![[UPDATED] Malaysia's health spending jumps 4 times in 20 years](/_next/image?url=https%3A%2F%2Fassets.nst.com.my%2Fimages%2Farticles%2FDzulkefly_Ahmadwe_1749435876.jpg&w=3840&q=100)
![[UPDATED] Malaysia's health spending jumps 4 times in 20 years](/_next/image?url=https%3A%2F%2Fassets.nst.com.my%2Fassets%2FNST-Logo%402x.png%3Fid%3Db37a17055cb1ffea01f5&w=48&q=75){kind=small}
New Straits Times
09-06-2025
- Health
- New Straits Times
[UPDATED] Malaysia's health spending jumps 4 times in 20 years
KUALA LUMPUR: Malaysia's per capita health expenditure nearly quadrupled between 2000 and 2020. Health Minister Datuk Seri Dr Dzulkefly Ahmad said the figure surged from RM600 in 2000 to RM1,600 in 2020, driven by rising demand for healthcare and advances in medical technology. "Private sources accounted for RM40 billion, or 47 per cent, of total health expenditure in 2024. "Out-of-pocket spending remains high, at around 36 per cent of total health expenditure. "Our vision is to sustainably expand fiscal space while ensuring healthcare remains accessible, high-quality, and equitable," he said at the launch of the 31st Association of Private Hospitals Malaysia (APHM) International Healthcare Conference & Exhibition 2025, here, today. Dzulkefly said the Health Ministry was working with the Finance Ministry, Bank Negara Malaysia (BNM), and the Employees Provident Fund (EPF) to develop a health insurance and takaful product. This product will support the rollout of the new Diagnosis-Related Groups (DRGs) system, which aims to transform the way healthcare services are paid for. He also dismissed speculation of a delay in the DRG implementation, adding that the initiative remained on track to be introduced in phases by the end of this year, starting with the "Rakan KKM" project. "This is not privatisation. It is publicly owned and developed for public benefit, offering optional value-added services within the Health Ministry's hospitals. "We are already seeing proof-of-concept through the Hospital Service Outsourcing Programme (HSOP), which applies bundled payment principles. "For example, waiting times for arteriovenous (AV) fistula creation for haemodialysis patients have been reduced by over 75 per cent," he added. Turnaround times for Magnetic Resonance Imaging and Angiography (MRI/MRA) services have also improved by more than 20 per cent, Dzulkefly said, saying these value-based models demonstrated that system efficiency and clinical outcomes could be enhanced. Meanwhile, APHM president Datuk Dr Kuljit Singh highlighted the lack of a national electronic health record system, which he said was a critical gap in the DRG implementation process. "The absence of such a system makes DRG implementation more complex," he said. Nevertheless, he expressed appreciation for the ministry's commitment to collaboration and its data-driven, evidence-based approach to the DRG rollout.
The Star
09-06-2025
- Health
- The Star
Health Ministry aims to introduce DRG by end of 2025
KUALA LUMPUR: The Health Ministry hopes to implement the diagnosis-related group (DRG) payment model by the end of the year, says Minister Datuk Seri Dr Dzulkefly Ahmad. Dr Dzulkefly stated that the proposed DRG scheme could start with a simple mechanism in its initial phase. "Start with something simple, and after momentum is developed, move to a more complex system. "I am confident we can start this," said Dr Dzulkefly after attending the opening ceremony of the 31st Association of Private Hospitals Malaysia (APHM) conference at the KL Convention Centre on Monday (June 9). Dr Dzulkefly noted that Malaysia, particularly the APHM and the Finance Ministry, has experience in implementing the DRG. "I am confident we will implement this by year's end," he added. Dr Dzulkefly was responding to reports that the government postponed the DRG systems for private hospitals. DRG is a payment system involving a predetermined amount decided by the group's payment model rather than paying for each service received. Countries like Sweden, Canada, and Australia have implemented this system. He responded to reports claiming the government's plans for the DRG system at private hospitals are on hold. It was reported that the DRG would focus on simpler medical cases initially. Earlier, during his opening speech, Dr Dzulkefly said introducing DRGs to pay for healthcare services, starting with base medical and health insurance/takaful (MHIT) products, will drive value-based healthcare. "DRGs incentivise efficiency, which we expect will drive innovation in ambulatory and day-case surgery, and expand the use of health technologies that demonstrate strong cost-effectiveness in improving health outcomes while reducing total costs." Meanwhile, Dr Dzulkefly said the Finance Ministry's GEAR-uP initiative will drive further investments in the health sector. "These initiatives will be coordinated by a Joint Ministerial Committee, which will be announced shortly. "I believe many in this room are well aware of this upcoming initiative," added Dr Dzulkefly.
