MediAsas DRG Pricing Framework Built On RM4.8 Bln Patient-Paid Hospital Bills

KUALA LUMPUR, Sept 25 (Bernama) – Data supporting Malaysia’s new MediAsas Diagnosis Related Group (DRG) pricing framework reveals that third-party payers covered RM3.9 billion in hospital billings, while patients paid RM932 million out of pocket. 

ProtectHealth Corporation Sdn Bhd chief executive officer Wan Mohd Hazwan Wan Mohd Najib said that the company will introduce DRG pricing, shifting hospital reimbursement from itemised fee-for-service billing to fixed whole-case pricing based on diagnosis, procedure and severity.

“The implementation will adopt a phased and hybrid approach, combining elements of DRG and fee-for-service to avoid sudden disruptions to hospital revenue structures.

“DRG does not change clinical decision-making or the patient journey. It only changes how hospitals are paid at the end of treatment,” Wan Mohd Hazwan said during a medical and health insurance/takaful media briefing organised by Bank Negara Malaysia today.

To date, more than 150 private hospitals and over 2,500 healthcare professionals have undergone training in clinical coding and data standards, which are critical for accurate grouping and reimbursement under the DRG system, he said.

ProtectHealth is a government-owned, not-for-profit entity under the Ministry of Health, tasked with supporting the rollout, including building provider networks, managing data platforms and strengthening industry capacity.

The media briefing highlighted that MediAsas is not intended to eliminate medical inflation, as healthcare costs will continue to rise due to disease burdens, demographic changes, wage inflation and medical advancements.

Broader initiatives under the RESET Strategy will address the drivers of medical inflation, while MediAsas focuses on improving individuals’ access to medical coverage.

The plan aims to provide an affordable healthcare protection option that supports long-term sustainability, particularly for Malaysians who lack coverage or face difficulties obtaining it.

MediAsas also complements wider efforts to transform private and public healthcare delivery, but is not intended to meet every consumer’s healthcare needs or replace universal coverage provided by the public healthcare system.

-- BERNAMA