The medical association says undervalued insurance products could influence treatment decisions.
MMA president Dr R Thirunavukarasu acknowledged that insurance products should be commercially sustainable but said healthcare benefits must also take clinical considerations into account.
“Commercial sustainability cannot come at the expense of clinical appropriateness. Insurance products require sound actuarial design. Healthcare benefits require sound clinical design. One cannot substitute for the other.
“Clinical governance must lead and corporate governance must support it,” he said in a statement.
Thirunavukarasu cited a report by health think tank, CodeBlue, about an insurance product offering up to RM50 per general practitioner visit for consultation and medication. The product’s premium can go as low as about RM55 a month with a RM3,000 deductible.
While Thirunavukarasu welcomed the inclusion of primary care in medical insurance coverage, he said RM50 was too low a benchmark for GP consultation and medication.
He pointed out that Selangor’s Skim Peduli Sihat initially had a RM50 limit while Madani medical scheme’s was fixed at RM60. Both were raised to RM70 after MMA voiced concerns on undervalued primary care.
“So in 2026, we should seriously ask why RM50 is appearing again as a benchmark for both GP consultation and medication,” he said.
Thirunavukarasu said strengthening primary care could also help contain healthcare costs by allowing patients to receive appropriate treatment earlier, which reduces complications, unnecessary emergency visits and more expensive hospital care.
“Primary care should therefore be seen as an investment in healthcare sustainability, not simply another cost to be capped.” - FMT
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