kuala lumpur: The Malaysian Medical Association (MMA) is calling for regulation of third party administrators (TPAs) to curb unethical practices such as fee-sharing and protect the healthcare system from commercialism.
The association's president, Dr Azizan Abdul Aziz, said the current lack of regulation of TPAs could lead to rising healthcare costs, especially in private primary care services.
“I urge lawmakers to address this issue in the next parliamentary session as it has significant implications for healthcare delivery to our citizens,” she said in a statement today.
Dr Azizan explained that TPAs are private managed care organisations that companies hire to manage their employees' health insurance, and these intermediaries also make a profit from the fees they charge private general practitioner (GP) clinics to join their network.
She said the majority of private GP practices rely on TPAs for management services to manage their client base (businesses) and various employers.
Dr Azizan said one of the concerns raised was the practice of fee-sharing, whereby TPAs deduct a percentage from the total bill charged to patients, resulting in increased costs for the private GPs and specialists involved.
She said TPAs, which typically deduct 10-15% of total bills, could impact the sustainability of private clinics and the quality of patient care, forcing GPs to consider cost-cutting measures or adjust fees to make up for losses.
“We would like to remind all private medical practitioners that fee sharing is considered unethical under the guidelines set out by the Malaysian Medical Council (MMC),” she stressed.
Dr Azizan also pointed out other issues, including high registration fees of up to RM5,000 just to be registered as a panel clinic, late payments and rejected claims, operational inefficiencies, lack of transparency and concerns over pricing and fee caps.
To resolve these issues, the MMA has proposed several measures, including calling on the government to address fee splitting within contracts, establish a regulatory body to oversee TPAs, enforce ethical standards and standardize processes to create a uniform clinic registration system, she said.
