Many of the insurers they love to say ours has one million cover. You know. Yeah.

And it's increasing still

Yeah, yeah, yeah, yeah. To impress you. But I have been telling all my friends and doctors, if you claim more than 500,000, you're probably going to die anyway.

Hi everyone, and welcome to InsuredTruths. I'm Shankari. Co-Founder of InsuredSpeaks and your host today. Just a quick intro for our first time audience. InsuredSpeaks is a Malaysian startup where we aim to provide health insurance clarity and transparency to our review and rating platform. So if you have any claim experiences that you want to share with the community, please head to our website in the link below and share your story with us today. In this podcast series, we bring together experts across the healthcare and insurance industry to have real conversations about one thing that actually affects all of us health insurance. In our previous episode, The Next Chapter for Malaysia's Health Insurance, we had the privilege of having Ms Renu Butler as our guest speaker, where we talked about the current health insurance industry, shifting healthcare needs, and the importance of insurance education about health insurance, and policy clarity.

If you haven't checked it out, please do check us out on our YouTube channel. Now moving on with our today's show. Today we are going to talk about a very hot, buzzing topic that everyone has been talking about the past few weeks. The base medical Insurance Takaful plan, the white paper has been published, and we have a very special guest speaker that is here to talk about that with us today. In today's episode, the Case for a national based plan and health fund, we are honoured to be joined by Professor Dr John George. Professor Dr John George is a senior academician, musculoskeletal radiologist and healthcare policy contributor with decades of experience at the intersection of clinical medicine, sports health, and public health care systems. In addition to his medical expertise, he has formerly held several notable leadership roles, including chairman of the Government Doctors of the Malaysian Medical Association, Chief of Musculoskeletal Radiology at University Malaya, president of the Malaysian Association of Sports Medicine, currently a radiologist at the National Sports Institute and Beverley Wiltshire Medical Centre in Kuala Lumpur.

Professor, thank you so much for being here today.

Thank you.

Let's jump right in. You have been working closely with regulators and policymakers. How has your journey been so far?

Yes, it’s been quite an exciting journey for me because, as you know, this whole issue of having to come up with a solution for problems that just started about, maybe two years or one and a half years ago when you would have seen in the press, many of the public were complaining that their premiums had suddenly risen by even up to 30-40% and had not become affordable. And the Public Accounts Committee, you know, YB Sim and others started making it an issue. Raising it up, even bringing it to Parliament where we could go and voice it out. So at that time, I, as a seeing these issues, was thinking about potential solutions. So in February 2025, after several months of thinking and writing my thoughts on it, I actually put up a concept paper saying the tackling the issues.

First listing out the issues and then listing out the potential solutions. So at that time, I actually put one of the potential solutions as a national base plan, not under the the government sector. You know, like a social health insurance, but under the private insurance, that means the private insurers would offer a national base plan, which would be affordable, sustainable to old age and have many factors that would, currently, which the public are not happy about. Like, for instance, the denials, the approvals. So it had to look at all these areas as well. So I proposed that and interestingly, the BNM and the insurers announced that they had been also, I think, thinking about something like this and that they would be coming up with a national base plan insurance. So it was like, in tandem. You know, I don't take all credit for rewriting it.

That was happening at the right time.

It was happening at the right time, and everything was coming together. Yeah.

So what happened was, the MMA as a committee in which, so the, KKM decided that for this insurance, one of the problems is overcharging by the hospitals. So in this base plan, there must be fixed charges for the conditions under what they call disease related groups, or DRG. So with DRG, if you have appendix, there will be a fixed payment for the number of certain number of days of stay, whatever. And that's it. So that way there would be cost control. So the KKM had several workshops on this, and I was able to attend on behalf of MMA to contribute my thoughts on the DRG and how it should be implemented, and also, especially for the doctors, part of the fees, because, as you know, our fees are regulated by law under the 13th schedule and the Parliament. So we doctors want the fees in the DRG to be according to the stated fee schedule and not just randomly chosen by them. So my role there was more to, I suppose, in a way ensure that we the DRGs followed the regulations.

Okay. But of course, being there, you know, I didn't just stick to that. I gave my opinions on, for instance, how to do the costing. so it's been good, in that way that I've been able to contribute to this national base plan with some ideas. And currently the, the Bank Negara and others are asking my advice on how to roll it out. so yeah. So that is something, I have been doing in the last few months. Yeah.

That's amazing. Yeah, a lot of things has been done. And the white paper has just been published as well. okay. Maybe for some of us there might be confusion, like what is a national base plan? Who is it for? What problem is it meant to solve?

Yeah. So as I, I think I kind of illustrated just now a little bit about it. that, you know, it is meant to solve the, the problem of the rising premium load. In other words, when you have a national base plan, it must be affordable.

It must be sustainable till old age. and it must be able to give the necessary coverage for the majority of conditions that people suffer. Now, interestingly, if you look at the white paper, it says that majority of claims for the conditions that people go to hospitals are under hundred thousand. The claims are under hundred thousand. Okay. So you know, many of the insurers, they love to save our has got one million cover. You know.

Yeah. And it's increasing still.

Yeah, yeah, yeah, yeah. To impress you. But I have been telling all my friends and doctors, if you claim more than 500,000, you're probably going to die anyway. So, yeah, you know, I mean, honestly, because that is like, you know, it's a lot of money to pay. You probably be in ICU and things like that. So this is unnecessary, you know, and that's where the BNM, you know, I'm sorry to make a joke about it, but but this is where BNM is being practical.

They are saying the truth is, you know, for most of the conditions 100,000, 150, even 300,000 more than sufficient. So why give all these additional things and then include. So try to reduce the investment component. Reduce the life insurance component or keep it separate. And that's what the national based plan is doing. It's taking out the others unnecessary components going straight for what you need and I think this is the whole package is all about it being affordable to low age and also sustainable and giving you the necessary coverage. so which the current insurers also don't do, the current insurers also currently they have a lot of exclusions like for those with NCDs, you know, hypertension, diabetes and all that. So that also needs to be looked at. so those with stable NCDs, whether they can be covered because they are actually their blood pressure is normal for years under medication, so technically they are normal. Diabetes Control HBC1s is normal, a cholesterol normal for years. So why would you want to penalize them.

Because actually their NCDs are controlled. So they should be able to get the insurance at the same or maybe slightly more than the premiums in the plan. Yeah.

Yeah. That means even people that previously had pre-existing conditions will be actually able to afford this medical plan.

They will be. Well, at the moment I'm talking about the NCDs. Yeah. Because it's a bit more difficult when you talk about cancer. Stage four.

Yes.

Chemotherapy, stage four and all that. So I have a feeling that maybe they will start off the plan, maybe with things that they can cover like NCDs which are stable. And then they'd have to consider the other conditions. Maybe later.

That's amazing.

That depends on them. I have no idea at what level they will cover. You know.

It's still in the talks at the moment.

Yes. It depends on the base of the coverage as well. You know, the larger the base of people who join the premiums or pay the premiums, the more the coverage can be.

Okay. Because the risk pool will be bigger.

Risk pool will be bigger. So maybe they can't decide that too early for the moment to cover everything.

Okay. What do you see as the biggest challenge in implementing a sustainable health insurance plan in Malaysia?

Okay, so first thing, it's a voluntary participation by the hospital and also the public. So for the hospitals, when this came up, there was a town hall and they were actually very much against DRG. Yeah, because they said drugs implemented, like for instance in the USA and others, they didn't cover the costs. The actual cost of the hospital, they were they were determined by the group of people in charge of the health insurance. But the DRGs that they actually implemented did not pay the cost. So like Medicare in the US, it did not cover the cost. And so the rural hospitals actually found that they were running at a loss and they had to close some of their services, you know, and some of them, the entire hospitals had to close in the rural areas because the Medicare was not paying the sufficient amount.

So that's the first thing. Will the DRG cover the cost and not only cover the cost? Don't forget that private hospitals need to make a profit. Right. So what is the profit that they are going to include. Will it be 20% or 30%. So you'd have the cost plus the profit as the tariff as the payment. So this factor will be very important for the participation of the hospitals, whether they agree to participate. Because if they feel no, it's not worth it, then they will not participate in that. And that won't be good.

But we need them, for them to participate to in order for this to work.

Yes, but for this to work, you must make sure that your DRG covers the cost, but gives the profit also. Yeah. So this is where the calculations have to come.

So the transparency in price also need to come come up.

Yes. So what happens is currently what they are doing is this is the first two DRG workshops that we had.

We are asking them for their costing.

Okay.

So let's say for appendix they come up with their costing. Right. So then you look at the bill, if you feel there is overcharging in components and all that, you negotiate with them. So at the end of the day, this DRG actually needs to be a negotiation, not a one sided thing.

okay, understand.

So now the insurer and the hospital will say, look, let's work out the DRG. So do you agree now to this pricing for an appendix. And then we add the profit margin. So now you've got them on board because they are the ones giving you the costing. And then you're looking at the costing and then seeing this one I think there's too much overcharging of this consumable. Let's say the real pricing of that consumable or particular needle or something is only, 300, but you are putting 1500. You see. So there'll be some negotiation. They'll say, okay, look, you know, we have to reduce that component.

So they look at the total bill, reduce the overcharging. So this is what is currently happening. The insurers are complaining that the hospitals are overcharging. Yes. And at the public Accounts Committee meeting, you know, in the Parliament, one person said, you know, in one hospital, the appendix can be 19,000. In another hospital, 23. In other hospital 30 and other hospital 37.

Yes, that’s the reality actually.

So why is it so different? You know. So it has to be. So the idea here is to standardize the charges with working with the hospitals. Now if they do that, then there will be success. The hospitals will accept it because it's a negotiation, not a one sided telling you this is how much we are paying you.

And if they agree, they'll go into the network of hospital, the network hospitals.

So each hospital, you know. So don't forget that there is something called an adjustment factor. So after the mean DRG is worked out, if your hospital happens to be a five star hospital with a lot of overhead, an adjustment factor can be added to the mean DRG for your hospital to make sure that you have a profit.

Okay.

Because at the end of the day, this is not a free service. It is a Service with a profit. Because these hospitals are private hospitals, they have shareholders and they expect a certain amount of profit, but the profit will be controlled. Yeah.

Okay. That's actually one of the things that we have to think about on how they're going to successfully make this work.

Yeah. Now from the public side, you are seeing the challenges. The public side is what will be the inclusions and exclusions.

Okay.

Yes. And the premium.

And the premium price. How will this affect in taking into account the exclusions as well. If they have.

Okay. So it depends on what they offer as well whether it's attractive to them to join the scheme. Yeah okay.

Okay. There's also some talk about the National Health Fund. Tabung Kesihatan Negara. What is this about? And how is this different from the national MHIT plan?

Okay, so the national MHIT, it is all about a person who wants to take up a private insurance, go to a private hospital.

Okay.

Now, the tabung has been announced, but actually, what it will cover has not really been announced. You know what I mean? So in my concept paper, what I've written about the tabung is the coverage of consumables and things provided by KKM, where the public have to pay for it. For instance, there are certain stents, or maybe a renal stent or a heart stent, where the government sometimes says, look, we will do the procedure, but you need to purchase this thing, or you need to purchase the consumables so we can cover that. So what happens is, if you are a let's say the stent cost 8000 to 10,000, that's a lot of money. Yes. So what is happening currently is the individual starts looking around for the welfare funds to see whether they can cover. Or they go to friends. I mean, I've had many people also approached me to contribute towards, you know, prostheses or things like that. or the groups that we are in asking to help an individual to come up with a certain amount of money to pay for the consumables.

But I feel that if you have a, you know, this tabung, what will happen is that the tabung will enable each person, to, under your IC have a set allocation of money. So you know like petrol we have 300 right, yeah. So like my Budi, you will have Tabung Kesihatan you know, where you will have access to, let's say, I'm just giving a ballpark figure 20,000 or 30,000 because currently the states, many of the states, they're having their own healthcare schemes for the B-40 like Peka 40 and all that they provide. Turn up to 20,000. Whatever. But this one, my idea is that it will be for everyone. You know, you will be able to. Even if you're M40, you can also still claim, because the lower M40 are the ones the real trouble. The B-40 have a lot of coverage. The upper M40 are okay, but the low M40 just above the B-40, they actually can’t afford a lot of things as well, but they're not covered.

So this will help to cover that group and anyone because even the petrol after all. Actually many people asked about the petrol coverage initially. Remember. They said that the richer people would have to pay the full amount. Yes, and all that. But you look, the government I think is very smart, very smart in the sense that they they realise how difficult it would be to separate your income group and all that at a petrol pump. Right. So to decide whether you can afford it or not afford it. So what did they do? They just said all Malaysians. Regardless of whether you're the richest Malaysian. You will still get the subsidy, right? So if you look at that, that's a very beautiful concept that as long as you are Malaysian, you will get the the allocated sum of money. So my idea is that the table will give you 20, 30,000. So if you have a stent ten thousand, you have an IC number right. So the public hospital will apply to the tabung and say John George has got 10,000 allocated. I mean 30,000.

We like to use 10,000 to buy stent. So the public hospital will claim the fund. It won't go to you. It'll go straight to HKL or whatever. They will take the ten, they'll buy this stent for you and they'll provide it. So like this. That's the beginning. Starting with the consumables. Because that is not covered. That's not under National Insurance. Then if there is surplus, then the government is talking about Infrastructure. Yes, new hospitals, emergency maintenance. Because it's one thing to buy an MRI. It's another thing to keep it running. So what happened when I was in UM we, we would have a CT scan tube that burnt out, and suddenly you need 150,000 to replace it. So where's the fund going to come? I know in KKM hospitals, like my daughter was working in dentistry in KKM. If uh one of the equipment went down X-ray machine to get it replaced or repaired, even though it's only 50K, there was a long process and then they had to wait for the budget.

And the X-ray machine in this major district hospital is down for one year.

One year.

One year.

So where do people go for X-rays?

So they have to go to outside other places or other clinics and all that. So where is that 50,000 if you have this tabung immediately IC or the hospital account number applied for the 50,000. Straight from the tabung. Get it repaired.

Amazing. So it has a lot of potential.

A lot of potential if it's used. But it has to be ring fence. That's what they say. Ring fence means protected from abuse.

Yes. That's all. But to ensure that the base plan actually succeeds. Having this tabung also will together will help with the execution. I mean parallel.

Well, you see, that is a different question. Whether you will be then allowed to use the tabung. Once someone said a lot of people in EPF, when they retire will only have 20,000 or less in their savings. That's what is mentioned currently, 50 or over percent of people.

So maybe for that group of people with less than 20, maybe the stent or something else could be paid by the tabung to make sure that their co-payments are less. Or I think you mentioned about paying the co-payment.

Yes.

So, you know, in that group of people, if you claim and the copayment is, is 3000 or 4000. You allow the co-payment to, when you are admitted to be paid by the tabung. So not a bad idea.

Not a bad idea.

Not a bad idea.

Let's see how it goes. Now the talks has just started actually.

So I think with everything you start with what needs to be covered, and then you move on to think about other things to be fair to others.

Okay. Talking about EPF, so the base plan allows us to take the money from EPF to pay for the premium.

Well, they’re are talking about it.

Oh they're talking about it, but some people are worried about dipping into their retirement funds.

Well, a lot of people, there's not some either.

The politicians. There are so many say these are retirement funds.

Yes.

So, there is an agreement that we should not take lump sums. you know, so you see, the whole idea of the the premiums when you pay is that you have agreed to pay the premiums yourself from your salary or income or whatever, and that that is the idea of private insurance. The government shouldn't be paying your private insurance, right?

Yes.

And the retirement fund. This is a retirement fund. Now, if you look at the current retirement fund, they are talking about savings, basic savings. They want you to have a new retire of 650. And if you want to live comfortably 1.3 million. That's the figures that they are talking about that you need to save to have a good retirement. So if you want to get people up to that mark, you have to preserve as much money and not allow them to take it out of the funds. Do you understand? It must be a savings where you get 6.3 dividend or 6% dividend a year.

So the whole idea of is don't allow people to take money out, you know, they must use the money from their other savings, FDs, whatever and pay for it, not from the EPF.

But I think a lot of people again, the base medical plan is to afford private healthcare, private to go for private hospitals and all. If you don't have insurance, you go to the government hospital. That's, fundamentally, the reason why this came up with.

But you must realize that all the insurance that people are paying today, up to now, including the 10% increase, 20% is paid by themselves. Yeah. They've never talked about using EPF up to now. Right.

Yes. Yeah. But when you look at the payment like this is a one way you can afford it. Now what's thinking with this.

No no no I think you got the concept wrong because the whole idea is that people have the 12 million people who are paying the private insurance have been paying all along without the EPF help.

Okay, so why? Why? Well, the national plan you need to pay with the. Because even less.

Yes.

So you just pay.

This shouldn't be an option there, right?

That's what people are saying that, you know don't tap into allowing them to use the EPF for 4 or 5000 because that 4 or 5000 compounds. Yes. So don't don't allow it. That's what they're saying.

So yeah, we have yet to see whether because this has not been rolled out. It's just in the talks.

You're right. It's in the talk. So that is why there are many who are saying please don't allow. You know, try to protect the funds for retirement. Okay. Now the next is how do you get the contribution for the tabung. Right.

So now the tabung? The YB Minister of Health mentioned was that you have this another employer employee deduction. Whoa. Now, that is not very popular with a lot of people as it is. You already have got your EPF you know and then you've got Socso and everything.

So I feel that that is the wrong way to go. I don't think you want to have another employer employee. I don't think he's speaking to everyone about it yet. I think it's just something he mentioned, but he said, I'm not sure yet. So, in my concept paper, I actually wrote it. Should see we have already contributed to the EPF 16 million people. Okay, so you have the people 16 million out of 33 million people in Malaysia. I'm not sure the current population, but nearly half are already in EPF. Okay. So let's talk about them first. You have a contribution and you have a different accounts including account three. So in my concept I say take ten ringgit from your account three because it's already there in account three monthly ten ringgit goes into the tabung. Okay. Now 16 million people is 160 million ringgit per month. Okay.

Yes.

How many MRIs that can buy? How many stents? It can buy everything because not everybody is claiming every year, right?

Yes.

So thats a lot of money. Now in one year, is over 3 billion into the account. Now for the rest he mentioned sin tax, you know, like tobacco tax and all that to add funds into the tabung healthcare. So that is for the people who are not having EPF to get their their coverage. So you have to add in funds from other sources into the fund. So it has about 6 billion per year. That's what they are estimating. You need about 6 billion less or more. So that would be much better than an employee employer another employer deduction because you've already contributed. Yes. The employer has contributed. You have contributed. Now, just take that.

It's going to be more expensive for the employers to hire people as well.

Yes. And what will happen.

To the unemployment rates?

And no, not just that. What happened in the US. They started employing them on part time contracts are. yeah. So they're actually working full time, but they are given only part-time contracts, part-time, full time job

And that's the reality we'll face.

Yeah. So that they don't have to pay EPF. They don't have to pay minimum wage. They don't have to whatever. You know they are trying to get away from the contributions. So in America because you have to pay the health care right. So if you put them as part time, you don't have to pay for the health insurance.

Okay.

So we don't want that to happen here. As it is there things are okay, now. Most people are getting the EPF. Don't add additional burdens. And then imagine the paperwork. The paperwork for this other contribution, you know, getting people to the employer to pay it and to contribute it. That's another thing to get the employers to pay for it. So make it less complicated by just taking what is already available. Yes. It doesn't have because you don't see it because it's already in the fund.

Yes.

Right. So every month they’ll take 10 ringgit. What is 10 ringgit? One nasi kandar meal.

That's all right. And you don't even notice it because it's already just taken directly from your funds and into. But what happens is for that ten ringgit, you're getting 30,000 allocation under your IC to buy, the stent to buy the various things, the consumables.

So they are covered actually, the money's being put into protection.

So would you complain if I said I'm taking ten but I'll give you 30. Nobody will complain. You'll be the first to join. Right? All of us will be straight away joining. They're saying, oh, I've got many people commenting. Oh, everybody will be unhappy. I said, I don't know, I'll be the first in the queue to join. I said, I said ten ringgit, I get 30,000, you know. So this is why I don't understand the health economist trying to speak for the public, because the public will have no problem with it. But the health economist says there's a problem. You know, I don't understand that, I really don't.

Okay. okay. some people worry that base plan may lead to lower quality coverage or longer waiting times from your experience. Is this a fair concern?

that's an interesting question, because I just had a patient who wanted an appointment to see an orthopedic surgeon in the private hospital. Appointment was two weeks to see the private doctor.

To just see the doctor.

To see the doctor. So, you know, obviously must be a popular doctor or something like that, but. So I think this, the waiting time will. Well, no, you see, the first question is which hospitals will actually take up the plan, and then the waiting time will depend. For instance, now, one of the good things is that many of the private hospitals, private hospital chains are opening new hospitals in small towns. Other places?

Yes.

When you go past these hospitals, the carparks are empty. They're not full yet. Yeah, they've got plenty of capacity. So, actually, I don't see much waiting time lost.

Because if the patients are going and let's say these private hospitals, because they are, they haven't got the capacity yet. This happened in Indonesia as well. They immediately take up the National Insurance plan because they want all these patients to come to the hospital.

Okay. So this this private hospital will directly go into the network hospitals, right?

Yeah. Because they are looking for business. So taking on the National Health Insurance gives them these additional patients, and there's no waiting list because currently there are only 30%, 20% occupied. Yes, there's 80% capacity. So it'll help actually to take. And these patients would otherwise go to public hospitals.

Yes.

So now the public hospital is overloaded. Cannot cope. So at least these patients will be taken care of by this under capacity private hospitals and then the public hospitals can look after the more complex, difficult cases and the B40. Yeah, that's that's the concern.

So it's actually we'll reduce the burden on the government hospitals right now, they are taking.

Yes. Because what has happened since the premiums have increased, some people have stopped paying and gone to the public side. And the public side is finding the doctors, especially because they are understaffed, are finding it very difficult because the number of patients coming across is a lot. And in fact, the government in some cases has even started outsourcing, okay, patients to private hospitals to do certain operations. So it makes more sense to actually keep people in with a private insurance going to private, rather than to pay lump sums or money to private for the operations. Let's say one cardiac operation 50,000. Right? But instead of that 50,000, if you can help people to to keep their national insurance in a national MHIT, in which the co-payments may be, let's say 2000. That's how many patients. 50,000 is a lot. 25 patients who can be kept in the private side to go to a private hospital rather than paying one patient 50.

Yeah. That's true. Yeah. So there is a lot of potential.

Yeah.

And actually, it can address so many pain points that we are currently immediately with this.

I love your point because the point is immediately the the problem today is the poor patient doesn't have that immediate fund for the stent.

Yes.

The and these are the real issues on the ground. The doctors want to get things done and they have got denial of the claim. Whereas the national MHIT once you have the criteria you cannot be denied and then there'll be appeals. We didn't talk about appeals like appeal. You know, I've been advising that you need to have a better appeal system, you see, because if your claim is rejected now, if you go to the current system, you know, and you are mentioning, maybe you can tell us a bit about what is happening currently.

So right now, if, if you got your claim rejected or you're unhappy with the insurance decision, you can, go to Ombudsman Financial Services. But there are cases where when you do submit, the response is not as expected.

It takes time for them to get back to you. And sometimes even the feedback receive is not the solution that we are seeking for. And it takes months. It's not an immediate solution. I think we all have faced that.

Yeah. So the so in my suggestion is that you should have a portal in this portal if there is a rejection. Well, I mean, first of all the criteria for denial. If you have the criteria for inclusion, first let's say for an appendix, a CT scan shows that you have appendicitis. Then there is no question about denial. You understand because you have the condition. So the criteria for inclusion must be if it is fulfilled, there is no denial. That's the first one. Next there's some reason for denial. First thing is there must be a portal. The portal allows the doctor and the patient to appeal to the insurance doctor first, not the staff.

Okay.

Because many of the denials in the insurers are done by staff, not by doctors. They.

They decide, random staff will decide, deny or not deny. So it goes to the doctor. The doctor has one week to reply whether the the claim can be approved or not. Now, if the doctor still denies, then it has to go to a third party. I am recommending a three man party. Okay. A retired doctor in that specialty. An insured retired person and maybe a lay person. Okay. And they make a decision within another two weeks and say, okay, we agree with the rejection or we don't agree with the rejection. And two out of three. If you get the decision, then within three weeks you have a decision.

That that would be amazing that that happens.

So that's what I have suggested because what they are suggesting now is the grievance committee. But the grievance committee, the doctors and the people are busy working people.

Already busy enough with what they have.

They cannot cope with the amount of denials it needs to be given out to small subcommittees and with specialists in that subcommittee.

So it's a problem. It goes to a retired ENT specialist who can then make a proper decision.

They will have time to look into this case.

Because they are retired. Yeah. And maybe they get a small payment for each case. They do something like that. Yeah, that's my recommendation to make it faster. Yeah. Because at the moment it's not being.

So not efficient.

It's not efficient. The Financial Ombudsman is not the answer.

Yeah. Okay. We hope that suggestion will be taken into consideration. Yeah. Okay. okay, let's, I'm going to steer this conversation slightly in a different direction. If Malaysia does nothing. There's no base plan, no health fund. How would our health health care looks like in ten years?

It's already happening. So what happens? All those who can't afford the premiums currently, or are getting denial of their claims or moving to the public side? The public side. The government is not putting in the funds required to increase the infrastructure and the staffing.

They are not able to get more staffing, for various reasons. As you know, the pay in private versus the pay in the public sector. So what happens is you're going to have this problem of, the all the, the, these patients from the private insurance going to the public, which cannot cope. Okay. And so that's going to be a major, major issue.

And then the government doctors is going to overburden. They are going to burnout.

Already. They already burnt out because their clinics you know have got 200 people or more, you know, they have to see in one morning.

One morning, one morning.

So, you know, you can imagine they're literally really tired. And so we need to.

Get the talent also will move out from.

Yeah. So they are talking about other schemes. But that's another topic altogether rakan KKM you would have heard about it right, you heard about it? Also we will talk about it later. That's a different topic okay okay.

so if we don't do anything, it's just going to overwhelm the health.

The healthcare system will collapse if,

Yeah, because it'll overwhelm the public sector.

Okay. how? Okay. Right now, the base plan. We need the cooperation of the private insurers to support this initiative. What's their role and how is it going so far in that sense? Are they supportive because they need to cooperate to provide this base plan in their one of their packages?

Yeah. So interesting is that these workshops where the insurers are there, the hospitals and the doctors, and KKM is there, the support is very good.

Okay.

Yeah, yeah. They they have agreed to give their hospital billing, send in their current billing for the various procedures. Yeah. Yeah. They're actually working very well to to because they want, you know why? Because they have a self-interest to make sure that the costing is correct.

Yes.

So by giving this, they are hoping that the costing will be correct and the profit margin will be there.

Yes. So there won't be cases of overcharging and all the issues that.

No, no, no, we're charging part is by the KKM,

By the private hospitals?

No, the private hospitals. I won't say that they are looking into being supportive to stop them getting more. The private hospitals are supportive because DRG is coming in regardless.

Okay.

The DRG shouldn't underpay them.

Okay.

So they are being supportive to ensure that the DRG doesn't underpay them the costs. so that's why they're being supportive. Okay. Yeah. But in that they will have to the KKM will definitely start looking at the itemized billing, you understand, and look at what is being overcharged in the itemized billing and make it more standardized. Yeah. So that's when but the cooperation is there. The nice thing is that the APHM, the Association of Private Hospitals, the insurers, everybody is really collaborating for this national base plan. But like I said, there are many things to discuss in inclusion criteria. The portals for applying for the insurance for the, you know, so many things. Who are the patients that can be included excluded, all that.

The minor details still need to be ironed out.

There are actually quite major details for minor details. Yeah, yeah. So that is where we come in with you know everybody is brainstorming.

And we have the best experts at hand discuss.

Yeah. And then you have all the actuaries from BNM from insurers who will also look at the proposals and see what can be included, what can’t be included in the beginning. I think the safest bet is to make it look at the safe proposals for what can be included. And that's why I mentioned about stable NCDs. Because stable NCDs, you don't have to think about it. The person has been normal for ten years.

Yes.

So why shouldn't they be included? They're not. You understand because the blood pressure technically is normal for ten years. Just because they got, they were diagnosed BP ten years ago, it doesn't mean that they are having a high BP now.

But the reason comes up in the denial in some cases.

No, no, no, that's why I'm trying to say so.

With the new national insurance system, they will say it doesn't matter if you had, as long as you have it controlled.

Yes.

So if you can show evidence of control over a certain number of years, you are included. so like that, you know, you have to look at different aspects and see what, how you can help to include more people. The idea is everyone is looking is how can we include more people that are excluded currently. That's the nice summary of it. How to include more people that are excluded currently.

That's that's amazing. Yes. Yeah. Okay. okay. I think we are at the end of the session already. So as we wrap up, what message you would like to share to our fellow Malaysians, what should they be doing right now to prepare for their future?

Yeah, I think that's a very important question. sensitive question also. And I think if you look at it, I think the most important thing is, you need to first take care of your own health.

Yeah. Yeah, I think so. When I look at the problem of obesity, for instance, you know, the obesity in Malaysia, as you know, it's one of the highest in Southeast Asia, diabetes, one of the highest in Southeast Asia. I think the prevention role in in by the primary care is not being emphasized. Now I'll tell you why. Because you see, at some stage, most of us will go to a GP for your coughing call or some some reason. right? There's a very nice time where if you are going to a regular doctor and they bother to take your weight or ask you about your lifestyle, that they can intervene. because nobody gets obese overnight.

Yes. Yeah.

Right. Nobody gets obese overnight. So if you see a GP and then let's say you are only, your normal weight is, 70 or let's say male 70. The next time you see the GP you are 80, you know. So then the GP immediately alerts hey Shankar your weight is now 80.

You know you've gone up or let's say even 75. let's do something about that. Let's see whether we can get you back to the normal weight, give you advice on, you know, how to reduce weight or send you to a dietician or things like that. I think the prevention aspect, you know, is very, very important. I think the national base plan is talking about giving some discounts or concessions towards prevention, including vaccinations, other things. I don't know exactly how, but I feel that leading people to try to be more healthy in their lifestyle and, prevent obesity and all this is what we should be concentrating off to so that we will live healthier and more productive lives. and and then if the insurance for any reason is needed, like you get appendicitis or some other issues.

Something beyond our control.

Beyond your control, then you know it's there.

Yes.

It's there to help you at affordable and most important thing. The in the concept paper I wrote, it must be available till your 80.

So, you know, I think in the current white paper it's still 85. if I'm correct, you know, but you can already see the the that they have said. Those over 70 at the moment are not included.

Oh okay.

Yeah. You can only enroll till 70. I think that's just to keep the cost down. So there has to be some limitations in the beginning. So that will be there. But that's to answer your question what's our role, I think.

Preventive health.

We should look into more of the preventive health and.

Take ownership of your.

Health and take ownership of your health.

Okay. Thank you so much, professor, for your insights today. It's very inspiring to have you with us.

Thank you.

And we hope our viewers learn learn something about base health insurance takaful plan today. Stay tuned for more upcoming episodes in our series InsuredTruths. Thank you.