Insurance companies, takaful operators (ITOs), and Third Party Administrators (TPAs) have no authority to determine or influence the type of medical treatment patients receive in Malaysia, the Ministry of Finance (MoF) has confirmed.
Deputy Finance Minister, Lim Hui Ying, stressed that medical decisions remain solely under the professional discretion of doctors. “In all circumstances, the decision regarding a patient’s treatment must be made by the doctor, not by insurers or takaful operators,” she said during the oral question session in Parliament today.
Lim explained that when a treatment does not adhere to standard medical protocols, ITOs are allowed to conduct further reviews to understand the clinical justification. If the treatment is deemed medically necessary, the insurance claim must be honoured and paid.
“This process is crucial to manage medical cost inflation caused by wastage and abuse. If left unchecked, it may lead to unreasonable increases in insurance premiums, which will ultimately affect policyholders,” she said, responding to Sim Tze Tzin (PH–Bayan Baru).
At the same time, Lim noted that treatments not covered under a policy would need to be settled directly by patients.
She added that industry data shows the average claim approval rate among ITOs exceeds 90% nationwide.
The government, together with Bank Negara Malaysia (BNM) and medical industry stakeholders, is also reactivating the Health Complaints Mechanism Committee, which serves as a platform to address operational issues — including delays in guarantee letters and disputes over claims.
“The committee will function as a coordination mechanism to streamline claim processes and promote transparency across the healthcare and insurance sectors,” she said.
In response to Roslan Hashim (PN–Kulim Bandar Baharu), Lim said that BNM will continue monitoring interim measures for the next three years to limit healthcare insurance premium increases.
She also revealed that a basic health insurance product is being developed and expected to launch by early 2027, offering sustainable and affordable protection options for Malaysians.
“The interim measures are only temporary solutions. Extending them beyond three years may affect the long-term resilience of health insurance products,” Lim cautioned.
She concluded by emphasising that medical cost inflation is a complex challenge requiring a holistic approach involving government, industry, and healthcare providers.
Source: Berita Harian.
