Malaysian Medical Association (MMA) president Dr Ravindran Naidu says insurance intermediaries even place restrictions on which medications doctors can prescribe.
PETALING JAYA: The Malaysian Medical Association (MMA) has warned the health ministry that leaving third party administrators (TPAs) unregulated comes at the cost of patients’ healthcare.
This came after MMA president Dr Ravindran Naidu cited a study on the health economics of general practitioners in Malaysia last year in an interview with The Star.
The study revealed that expenses for managing general practitioners’ services had increased over the years due to changes in policies as well as the involvement of unregulated TPAs.
TPAs process insurance claims or certain aspects of employee benefit plans for insurance companies. As such, they serve as an intermediary between insurer and policyholder.
This can be considered as “outsourcing” the administration of the claims processing, since the TPA is performing a task traditionally handled by the company providing the insurance.
Speaking to FMT, Ravindran said the main problem with unregulated TPAs was that they could set whatever restrictions they wanted on doctors without repercussions.
One of these restrictions, he said, was which medications doctors could and could not prescribe.
“Without regulations, the law cannot touch them.
“So if they come and tell me that I cannot give this medication, what happens? I’m restricted in my treatment for the patient.
“I’m not free to prescribe medicine which I believe should be given to the patient.
“At the end of the day, the doctor must be given the right to decide what medication should be prescribed because doctors should know best.
“That is the biggest problem here.”
Ravindran said unlike doctors, most TPAs were only thinking of the business aspect of healthcare, which often led to compromising patients’ care.
“For us, the patient is the most important. You must think of the patient.
“For example, if I’m treating a patient who requires medicine A, and they say: ‘No you can’t give this medication, you have to give some other choice,’ then I’m not doing what is best for the patient. It’s a massive compromise.”
Because TPAs were putting fixed prices on fees for patients, he added, there was no fair market as it would end up either becoming costlier for the patient or for the doctors.
“Take consultations fees, for example. They don’t give you a range but instead fix it, so whether you see a patient for half an hour or one hour, the range is fixed.
“Another example is when you’re dressing a wound. The cost for dressing one wound is the same as the cost of dressing 10 wounds.”
According to Ravindran, TPAs have been operating since 1995.
Source : http://www.freemalaysiatoday.com/category/nation/2017/06/22/unregulated-tpas-are-compromising-healthcare-warns-mma/