KUALA LUMPUR, Aug 12 — The diagnosis-related group (DRG) system will be implemented with the introduction of the basic Medical and Health Takaful Insurance (MHIT) from next year, the Dewan Rakyat was told today.
Deputy Health Minister Datuk Lukanisman Awang Sauni said the basic MHIT would serve as a standard platform to ensure the continuity and effectiveness of the DRG-based payment system.
“The implementation of the private sector DRG system is an interim measure to control the rising private medical costs that place a burden on the people, using a slightly different methodology from the national DRG.
“The private sector DRG is being developed in parallel and can later be integrated with the national DRG through system interoperability,” he said during the question-and-answer session.
Lukanisman was responding to Pulai MP Suhaizan Kaiat on the government’s five-year plan to introduce the DRG system as a measure to streamline health cost structures, following numerous complaints about high treatment costs in private hospitals.
The national DRG was formulated as early as 2023 under a five-year plan for nationwide implementation beginning in 2027, reflecting the Health Ministry's (MOH) commitment to coordinating the structuring of health costs and implementation.
He noted that inflation in private sector medical costs had prompted MOH and the Finance Ministry to set up the Joint Ministerial Committee on Private Healthcare Costs (JBMKKS) to oversee the implementation of various initiatives under the RESET strategy, including the DRG system.
“Although the DRG will be implemented earlier in the private sector, this initiative still supports the creation of a more inclusive national DRG system as it incorporates data integration and more accurate analysis, together with university teaching hospitals and Armed Forces hospitals,” Lukanisman said.
The national DRG implementation plan was on track, involving the establishment of a special committee comprising government and private agencies, technical studies and applications, as well as approving allocations for developing the National DRG ICT system between 2023 and 2024.
This year will see the implementation of the National DRG system’s development, workshops on solutions and training, as well as the setting of clinical codes in government and private hospitals.
He added that next year, the development of the National DRG algorithm, coding model and system integration will be carried out, followed by system testing, implementing critical projects, and the official launch of the National DRG system in 2027.
On whether the government planned to set up a patient tribunal to allow them to express their dissatisfaction, the deputy minister said there were no such plans.
“However, complaints against private hospitals come under the responsibility of the MOH’s Private Medical Practice Control Section (CKAPS), per the provisions under the Private Healthcare Facilities and Services Act 1998 (Act 586).
“The mechanism for patients to channel their dissatisfaction with private hospitals is provided under Section 36 of Act 586 and Regulation 40 of the Private Healthcare Facilities and Services Regulations 2006,” Lukanisman said.
Every complaint received would be investigated, and if there was a violation of the law, enforcement actions such as issuing show cause notices, warnings, compounds, suspension, or revocation of licences could be taken against the hospital.
