Currently, health insurance providers only provide medical claims when patients are admitted at hospitals and do not reimburse patients who are not admitted.
As most public hospitals carry out minimal invasive surgeries, this means that hospitalisation is usually not necessary and resources can be maximised while costs are also reduced. Therefore the government is urging health insurance providers to reconsider editing their policies.
Dr. Noor Hisham said that insurance companies may not understand the concept of Day Care Procedures or Day of Surgery Admission, in which patients are discharged the same day or the day after their surgery.
Traditionally, a patient would be admitted two days before a procedure and discharged after two days, totalling the stay to five days, which may not be necessary for small procedures, he added.
“We want insurance companies not only to reimburse but encourage day care procedures. This is the message we want to send to them,” he said.
Deliberately extending hospital stay to claim insurance coverage
Due to the policies as well, patients have deliberately decided on how long they wanted to stay in hospital for minor procedures - such as appendicitis - to be able to claim their coverages.
Dr. Noor Hisham has warned that it is not the patient's choice to stay longer as a private hospital is not a hotel and they are taking up valuable space, resources and time.
Many companies have considered the move, but others are taking more time to review their process after discussions with the Health Ministry.
Increasing bed-population ratio
The Ministry aims to have 2.5 beds for every 1,000 people instead of the current ratio of 1.9:1000. Efforts to reach this goal have been undergoing including the implementation of the LEAN Healthcare System.
Dr. Noor Hisham also emphasised that the infrastructure and know how are available in public hospitals, but only 10% of all surgeries carried out utilise the day care facilities unlike other countries such as 60% in Britain and Germany and 70% in the United States.
“We are still behind. The best centre we have is in Ipoh where between 40% and 45% of procedures are carried out under day care," he added. MIMS
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