KUALA LUMPUR: The Malaysian Medical Association (MMA) has called for the regulation of Third Party Administrators (TPAs) to curb unethical practices such as fee-splitting and to protect the healthcare system against commercialism.
Its president, Dr Azizan Abdul Aziz said the current lack of regulation for TPAs could lead to a rise in healthcare costs, particularly in private primary care services.
“As this issue significantly impacts healthcare delivery to the public, we urge Members of Parliament (MPs) to address this matter in the upcoming parliamentary session,“ she said in a statement today.
Dr Azizan explained that TPAs are privately owned managed care organisations hired by companies to manage their employee health benefits and these intermediaries also profit from fees charged to private general practitioner (GP) clinics to be included in their network.
She said the majority of private GPs depend on TPAs for their client base (companies) and for administrative services to manage various employers.
Dr Azizan said one of the concerns raised is the practice of fee-splitting, where TPAs deduct a percentage from the total bill charged to patients, leading to increased costs for private GPs and specialists involved.
She said TPAs typically deduct between 10 to 15 per cent from the total bill, impacting the sustainability of private clinics and the quality of patient care, which may force GPs to consider cost-cutting measures or adjust charges to offset losses.
“We wish to remind all private medical practitioners that fee-splitting is considered unethical under the guidelines established by the Malaysian Medical Council (MMC),” she emphasised.
Dr Azizan also pointed out other issues such as high registration fees of up to RM5,000 just to be listed as a panel clinic, delayed payments and claim rejections, operational inefficiencies, lack of transparency and concerns over pricing and fee caps.
To resolve these issues, she said MMA has proposed several measures which include urging the government to address fee-splitting within contracts, establish a regulatory body to oversee TPAs and enforce ethical standards and standardise processes to create a unified clinic registration system.
