THE commercial interests of insurance companies should not take precedence over clinical considerations and patient welfare when it comes to the management of national healthcare services.
Malaysian Medical Association (MMA) President Dr L. Sivanaesan stated that the association is concerned by revelations made during a recent Dewan Rakyat debate, which indicated that approximately 190 medical specialists in the private sector have allegedly lost access to "cashless" (direct-billing) facilities provided by insurance companies.
He noted that such developments suggest healthcare services in the country are increasingly being dictated by business interests, rather than by medical guidelines and patient needs.
"We are grateful to the Member of Parliament for Pulai, Suhaizan Kayat, and the Member of Parliament for Kuala Kangsar, Datuk Iskandar Dzulkarnain Abdul Khalid, for raising this issue in the Dewan Rakyat.
"The concerns raised, which transcend political affiliations, demonstrate that this is not a political issue, but rather a matter of patients' rights," he said in a statement today.
Sivanaesan noted that Malaysians pay monthly medical insurance premiums with the expectation of receiving financial protection in the event of illness.
However, he pointed out that an increasing number of patients are now facing situations where their chosen specialists are removed from insurance panels, or their access to 'cashless' (direct-billing) facilities is restricted.
"This forces patients to switch doctors, move to a different hospital, or pay tens of thousands of ringgit upfront just to receive treatment.
"Delays in obtaining care, especially during emergencies, pose a life-threatening risk to patients, who should not be made victims of commercial disputes between insurance companies, hospitals, and doctors," he said.
According to Sivanaesan, the MMA is concerned about requirements imposed by some insurance companies, which mandate that new specialists must serve at a private hospital for a period of nine months to a year before they are permitted to treat patients covered by that insurance.
"These specialists have already undergone training and are duly recognised and accredited by the relevant authorities. Insurance companies have no right to override such official recognition.
"Furthermore, the practice of conducting retrospective audits and demanding the recovery of payments for past cases, based on administrative grounds, without providing written justification or an opportunity for a fair explanation, must be stopped immediately," he added.
Sivanaesan also urged Bank Negara Malaysia (BNM) to establish a transparent framework regarding the management of insurance panels and to disclose the number of complaints received concerning the restriction of cashless facilities.
"The Ministry of Health (MOH) should also review its procedure codes and medical fee schedules to prevent recurring disputes, while ensuring that patient treatment is not interrupted while these administrative issues are being resolved.
"If this trend of commercial control continues, it will push more patients toward already overcrowded government hospitals, thereby weakening the entire healthcare service ecosystem," he added. – October 22, 2026