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Private Healthcare Sector Faces Rising Medical Inflation Pressures, CIMB

Private Healthcare Sector Faces Rising Medical Inflation Pressures, CIMB

BusinessToday3 days ago
Malaysia's private healthcare sector is grappling with rising medical inflation and potential structural changes as discussions advance on the adoption of a diagnosis-related group (DRG)–based hospital payment system, according to insights from a recent meeting between CIMB Securities and Datuk Dr Kuljit Singh, President of the Association of Private Hospitals Malaysia (APHM).
Private hospitals currently cater to about 30% of Malaysia's patient load—funded primarily through self-payment, personal insurance, and employee benefits—while the public sector supports the remaining 70%. Dr Kuljit highlighted that Malaysia's healthcare quality remains on par with, or better than, many ASEAN peers, sustaining the nation's appeal as a medical tourism hub.
Medical Inflation Above Global Average
Bank Negara Malaysia (BNM) data shows that medical inflation hit 15% in 2024, surpassing the global average of 10% and the Asia-Pacific average of 11%. Key cost drivers include the adoption of advanced medical technologies, rising medical supply costs, manpower shortages, and overall inflationary pressures.
Between 2021 and 2023, claims in the Medical and Health Insurance/Takaful (MHIT) segment surged 73%, outstripping the 21% growth in premiums. Claim frequency more than doubled to 25 per 100 policyholders in 2023 from 11 in 2018. In response, BNM has capped annual premium increases at 10% until the end of 2026, with hikes staggered over three years.
Dr Kuljit cautioned that prolonged premium caps could prompt insurers to tighten reimbursement terms and limit hospital or treatment options, potentially curbing investment in private healthcare.
To mitigate rising claims, private hospitals are offering negotiated discounts to insurers, which in turn lower out-of-pocket costs for insured patients compared with self-paying patients.
Exploring DRG to Curb Costs
The proposed DRG system would replace the traditional fee-for-service model with fixed prices for treatments based on case complexity and industry benchmarks. APHM is working with the Ministry of Health to collect and standardise data for a private healthcare DRG database. However, implementation challenges remain due to the lack of a universal healthcare financing framework and comprehensive private-sector data.
Globally, DRG models are largely confined to public healthcare systems, with limited adoption in private healthcare. Dr Kuljit noted that complications or additional care beyond the DRG package often create billing and coverage issues in private settings.
Sector Outlook
CIMB Securities noted that KPJ Healthcare Bhd could be more exposed to DRG-related risks, with 98.1% of its revenue derived locally in 1Q25, compared with IHH Healthcare Bhd's 18–21% Malaysian revenue contribution.
The brokerage maintains an Overweight stance on Malaysia's healthcare sector, citing its defensive nature, resilient demand, organic expansion, and favourable demographics. IHH remains its top pick with a Buy rating and a target price of RM8.50, trading at attractive valuations relative to historical and regional averages. KPJ is rated Hold with a TP of RM2.90, as its current share price is seen to have priced in recent operational improvements.
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