Latest news with #medicalcosts
Free Malaysia Today
2 days ago
- Health
- Free Malaysia Today
Medical insurance first product under diagnosis pricing system, says Dzulkefly
Health minister Dzulkefly Ahmad said 78 health clinics have adopted the cloud-based clinic management system, with another 90 set to come on board later this year. (Bernama pic) KUALA LUMPUR : Health minister Dzulkefly Ahmad says the government's introduction of a basic medical and health insurance and takaful (MHIT) product marks the first step in the phased implementation of a diagnosis-related group (DRG) pricing system. Speaking at the launch of the APHM International Healthcare Conference & Exhibition 2025 here today, he said the product would broaden private sector financing options and steer private healthcare towards a value-based healthcare model. 'We are also exploring a more diversified health financing ecosystem that will combine tax-based allocations, social contributions, employer-based schemes and targeted subsidies under a progressive and equitable framework,' he said. In March, deputy prime minister Ahmad Zahid Hamidi said the finance ministry, Bank Negara Malaysia, and the EPF would develop MHIT products in view of the rising medical costs. He said the initiative was part of the national health sector reform effort to ensure access to more sustainable medical treatment. Dzulkefly said the DRG pricing system would be a key driver for value-based healthcare, with fairer rules for those with pre-existing conditions in the context of an ageing nation where the prevalence of non-communicable diseases is high. 'Diagnosis-related groups incentivise efficiency. 'We expect this to drive innovation in ambulatory and day-case surgery, and expand the use of health technologies that demonstrate strong cost-effectiveness in improving health outcomes and reducing total costs,' he said. Separately, he said a joint ministerial committee would coordinate health-focused initiatives under GEAR-uP, which will see six GLICs invest RM120 billion in 'high growth, high value' industries over five years to stimulate domestic economic growth. 'This is expected to drive further investments into the health sector, particularly in the spectrum of healthcare providers, not limited to large multi-speciality tertiary hospitals,' he said. Dzulkefly also said that 78 health clinics had adopted the cloud-based clinic management system, with another 90 set to come on board later this year. He said the clinics saw more than 70% of patients receiving treatment in under 30 minutes, 20% attended to within 30 to 60 minutes, and 10% attended to within 90 minutes.
News24
2 days ago
- Health
- News24
Who pays my medical expenses when I am in a road accident?
The lengthy, ongoing legal battle between Discovery Health and the Road Accident Fund (RAF) may leave you wondering who is liable for your medical costs if you are injured in a motor vehicle accident. The Discovery Health case is confusing and unresolved, but in the meantime, the courts continue to issue judgments ordering the RAF to pay medical scheme members' medical bills. Where does this leave you if you are a medical scheme member injured in a motor vehicle accident? The court cases highlight that the RAF is legally liable for your medical costs, and potentially lost income, when you are injured in a motor vehicle accident and unable to work. However, as a scheme member you are also entitled to claim from your scheme and your scheme is most likely to pay your immediate costs and ensure you are admitted to a private hospital. Schemes pay medical expenses immediately Jaco Rupping, COO of Short-Term Insurance at ASI Insure, says medical schemes are often the first line of financial support for individuals injured in vehicle accidents. 'Your medical scheme will cover immediate and ongoing medical treatment or care, for instance hospitalisation, surgery, and rehabilitation,' he says. The RAF is an after-the-fact insurer, as it takes longer to claim, Rupping says. 'Medical schemes will step in to ensure that treatment is not delayed due to funding concerns,' he says, while cases before the courts prove that RAF claims can take a long time Dr Ron Whelan, chief executive officer of Discovery Health, says that your medical scheme will generally cover the cost of medical care associated with road accidents, particularly where this is an emergency. Schemes are obliged in terms of the Medical Schemes Act to cover all medical emergencies and a number of other listed serious conditions as prescribed minimum benefits (PMBs). Many scheme options also cover you for private hospital admissions. What is the RAF and what does it do? The RAF is a South African state-supported fund that provides compensation to victims of road accidents. It is a form of compulsory social insurance funded by a fuel levy that everyone who puts petrol or diesel into their vehicles pays. The amount of the levy used to fund the RAF is determined annually in the National Budget. In the 2023/24 fiscal year, it was 218c a litre. Last year, almost 80 000 claims were filed and just over 63 000 were finalised. However, the RAF admits that it hasn't resolved all claims dating back several years. It says 90 percent of these have not been paid as a result of inadequate paperwork, which it is attempting to resolve. In addition, the fund has massive liabilities amounting to hundreds of millions of rands and recently lost a court battle with the attorney general to restate its liabilities to a fraction of this amount. In an effort to fix the fund's problems, more proposals have been put forward to limit claims from foreigners and wealthy individuals. What will the RAF pay? The RAF's fact sheet lists the costs for which it will pay, or reimburse, claimants as long as they are not responsible for the accident: Medical expenses, which include emergency and non-emergency medical treatment, only in cases where the expenses have not been paid by your medical scheme; Past and future loss of earnings or income; Future medical expenses; General damages for serious injuries; Direct funeral expenses (excluding aspects such as catering); Past and future loss of support; and, Home modifications and caregivers if needed. Recent court rulings show that if you are in any way to blame for your accident, the RAF will not pay all your costs. Why are Discovery and the RAF arguing over medical costs? In one of the RAF's recent attempts to limit its liabilities, it directed its staff in 2022 not to pay the medical claims of medical scheme members whose schemes had paid their medical bills. Discovery Health succeeded in having this directive declared unlawful in 2023. The RAF then issued a new directive to its employees not to pay medical costs that schemes are obliged to pay as prescribed minimum benefits (PMBs) or emergency medical conditions. Discovery Health challenged this directive as being in contempt of the court order made against the first directive, but two out of three High Court judges ruled against the medical scheme administrator and the challenge was dismissed. Discovery Health has been granted the right to appeal the judgment, and the appeal has yet to be heard. Despite this, in January this year, the RAF was ordered to pay medical costs incurred by Rahldeyah Esack to his estate even though Esack's medical expenses relating to an accident in 2015 were paid by Discovery Health Medical Scheme. Most recently, in March, the RAF was ordered to pay the medical costs of John Moss, a cyclist and medical scheme member who was hit by a vehicle in 2017. The scheme's view Whelan said Discovery Health went to court to stop both the RAF and the Minister of Transport from implementing these directives not only on behalf of the schemes it administers, but also 'in the interests of all medical scheme members in South Africa'. 'Discovery Health's firm contention is that medical scheme members' valid road accident-related medical claims must be processed and paid by the RAF, on the same basis as for any other eligible claimant – as has been the case for the past eighty years,' Whelan says. Whelan said there are two reasons why some medical schemes, such as Discovery Health Medical Scheme, want members to claim medical costs from the RAF and repay the scheme: It ensures that individuals do not benefit from being refunded for medical expenses which they did not actually pay in the first place. The cost of medical schemes is kept as low as possible. Model rules published by the Council for Medical Schemes mean that expenses that can be recovered from other parties are not paid for by the scheme. 'Where these medical claims, which have been paid by the medical scheme, are settled by the RAF, they are refunded to the medical scheme. This protects members from higher medical scheme contribution increases,' Whelan says. Some medical schemes have taken a different approach. The Government Employees Medical Scheme, for example, does not expect members to claim accident-related medical expenses from the RAF. Are scheme members expected to claim from the RAF? Whelan said that, as the process of claiming back from the RAF can take between four and five years on average, Discovery helps members claim these costs back from the RAF. He provided the following bullet-pointed explainer: In terms of the registered rules of the Discovery Health Medical Scheme, members who have lodged a claim against the RAF must: Inform the scheme of such claim; Include the scheme's accident-related medical expenses in the claim against the RAF; Promptly reimburse the scheme with any payment made by the RAF in respect of accident-related medical expenses which were paid by the Scheme; and Inform the scheme of any undertaking made by the RAF in respect of future accident-related medical expenses. KEEP THIS IN MIND Claims against the Road Accident Fund (RAF) can take long and may not cover all your losses, especially income-related losses or non-medical expenses, so it is best to have additional cover to protect yourself, Jaco Rupping, COO of Short-Term Insurance at ASI Insure, says. Also the fund will not pay claims, or not pay them in full, if you were to blame for the accident. Rupping suggests you consider: Disability insurance that pays a lump sum or income if you're permanently disabled; Income protection that covers your loss of earnings if you cannot work either permanently or temporarily; Life insurance that provides for your dependants in the event of death; Severe illness insurance that pays you a lump sum if you are diagnosed with a serious condition; Gap cover insurance that pays shortfalls in medical scheme cover for doctors who treat you in hospital; and, Personal accident cover that pays out a lump sum for injuries, regardless of fault. 'RAF is helpful but not a replacement for these kinds of cover as it is often delayed, partial, and limited,' Rupping says.
Reuters
7 days ago
- Business
- Reuters
Indonesian policyholders must pay part of medical insurance claims from 2026
JAKARTA, June 4 (Reuters) - Starting next year, Indonesian policyholders will have to bear some of the cost of their hospital bills through co-payment, according to a new regulation intended to curb overclaims and curb a rise in medical costs. Under the new rules, policyholders will have to pay at least 10% of their total claim or a maximum of 300,000 rupiah ($18.39) for outpatient care and 3 million rupiah ($183.94) for inpatient care. Indonesia's Financial Services Authority (OJK) said the regulations were a response to a significant increase in insurance claims due to the higher cost of health services. It did not say by how much claims had risen. The rule was also to prevent moral hazard and overtreatment, OJK added. "If this continues, we fear the sustainability of the health insurance business could be disrupted," OJK said in a statement this week. Indonesia's medical insurance industry is dominated by foreign players, including Prudential (PRU.L), opens new tab, Allianz Group ( opens new tab and AIA Group ( opens new tab. ($1 = 16,310.0000 rupiah)
Japan Times
30-05-2025
- Business
- Japan Times
LDP-Komeito, Nippon Ishin agree to phase out redundant hospital beds
The ruling Liberal Democratic Party-Komeito coalition and opposition Nippon Ishin no Kai agreed Thursday to remove up to 110,000 redundant hospital beds across the country in an effort to reduce social security costs. The three parties will formalize the agreement soon with the aim of including the reduction in the government's upcoming economic and fiscal policy guidelines, which will be adopted in June. Nippon Ishin estimates that removing 110,000 hospital beds would save around ¥1 trillion ($6.9 billion) in medical costs. "The three parties share the same recognition (about the effect of reducing hospital beds)," Ryohei Iwatani, Nippon Ishin's secretary-general, told reporters after meeting with officials from the LDP and Komeito earlier on Thursday. "We have reached an agreement (on the reduction of hospital beds)," former health minister Norihisa Tamura of the LDP said. "It doesn't make sense to maintain unnecessary beds." The three parties also agreed to raise the adoption rate of electronic medical records to 100% within the next five years. Meanwhile, they will continue talks on Nippon Ishin's proposal to stop health insurance coverage for drugs containing elements similar to over-the-counter medicines.
Yahoo
27-05-2025
- Business
- Yahoo
House takes up injury lawsuit reform bill
AUSTIN (KXAN) — An injury lawsuit reform bill critics say will make it harder for victims to receive justice inched closer to becoming law when the Texas House voted to pass it 94-52 late Monday evening. Under Senate Bill 30, a jury would hear if an attorney referred their client — and others over the past two years — to a doctor. That provider must submit an affidavit that treatment was reasonable and medical expenses should be based off rates paid by Medicare and workers' compensation insurance. The House debated and added multiple amendments to the bill, which was backed by Texans for Lawsuit Reform. This legislative session, TLR has pushed for bills related to trucking accidents and personal injury and wrongful death lawsuits aimed at lowering insurance costs and stopping what it calls 'nuclear verdicts.' 'Even though the proponents of these bills talk about lowering insurance costs, the bills never mention the word 'insurance.' The bills don't do anything to insurance companies,' said Ware Wendell with the consumer and patient advocacy group Texas Watch. 'They just infringe upon our rights.' Lt. Gov. Dan Patrick had listed SB 30 as a priority bill this session along with the goal of 'curbing' large jury verdicts. Despite victim pushback, Senate passes trucking lawsuit bill TLR said the bill targets what it believes are often 'inflated' medical costs that are presented at trial, which attorneys and medical providers dispute. 'It will limit the ability of some lawyers and collaborating health care providers to cheat,' TLR General Counsel Lee Parsley told lawmakers in March. Parsley said the bill does not cap damages or 'prevent an injured person from recovering the full measure of compensatory and non-economic damages.' The Lone Star Economic Alliance, which represents a coalition of Texas businesses, said the bill addresses 'the rising wave of abusive lawsuits' and reduces pressure to settle 'meritless claims.' Last year, a KXAN investigation first revealed LSEA's intention to push for more lawsuit reforms. 'Texas is known as the best state for business,' LSEA previously said in a statement. 'Unfortunately, our legal system has become a liability in an otherwise strong pro-business climate, and if we fail to fix it, we threaten the competitive advantages that generations of Texans have worked hard to build.' Wendell, however, said the bill creates unnecessary 'burdens for patients' when it comes to how medical costs and damages can be presented to a jury. 'It's really a giveaway to the insurance companies, who aren't going to have to pay full medical costs under the bill,' said Wendell. Deadly truck crashes foreshadowed fight between business, safety at Capitol The Senate version of the bill required corroborating medical evidence, or 'prior consistent statements,' for a jury to consider pain and suffering damages. Survivors of childhood sexual assault pushed back on that in recent months, worried it would make it harder to hold abusers accountable in a civil cases. Among those who spoke out was a 20-year-old who told a Senate panel he was repeatedly raped and groomed at 11-years-old by his adopted step-father, who is serving time in prison. 'This abuse was not just sexual but also physical, verbal and emotional and the effects will continue for the rest of my life,' the survivor told lawmakers. 'When I think back on what happened to me, I can only describe it as a personal hell. How do you put a cap on seven years of hell?' The bill will get another procedural vote on Tuesday before heading back to the Senate for final approval. Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
