TPAs put patients' health at risk, says MMA

05 Aug 2023 02:54pm
Pix for illustration purpose only. - FILE PIX
Pix for illustration purpose only. - FILE PIX

SHAH ALAM - The Malaysian Medical Association (MMA) has expressed concern over the unregulated operations and activities of Third Party Administrators (TPAs) and Managed Care Organisations (MCOs).

In a statement, MMA president Dr Muruga Raj Rajathurai said that there are currently more than 30 TPAs registered with the Health Ministry (MOH).

These TPAs act as middlemen in managing employee medical benefits for employers.

Dr Muruga said that some TPAs charge private GP (General Practitioner) clinics substantial registration fees of up to RM5,000 just to be appointed as panel clinics.

He also said that some TPAs take a 10 to 15 per cent deduction from the total bill, which can potentially compromise patient care.

"These matters have been highlighted to MOH since 2015, and despite our many engagements on TPAs since then, no remedial action has been taken," said Dr Muruga.

Another matter of recent concern is the absence of monitoring of TPAs' practice of outsourcing prescription of long-term medications (LTM) to pharmacists via e-prescriptions.

MMA claims that this practice puts at risk the health of patients on long-term medicine and is contrary to the holistic approach to treatment in the management of chronic diseases, particularly Noncommunicable Diseases (NCDs), in order to achieve better outcomes.

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"A number of TPAs also have a notorious reputation in delaying claims payments, leaving many of their panel clinics struggling financially.

"Private clinics rely on these settlements to sustain their practice as managed care clients form a substantial portion of patients," said Dr Muruga.

Currently, the majority of private clinic patients are on a managed care plan, with only a small percentage of walk-in cash paying patients.

Up to now, the MOH has refused to interfere in these kinds of situations.

The MMA addressed these concerns at a recent meeting organised by the Malaysian Productivity Corporation's Private Healthcare Productivity Nexus.

MMA feels disappointed that organisations such as Bank Negara Malaysia (BNM) have shown unwillingness to collaborate while simultaneously expressing concern about rising healthcare expenditures.

MMA had also brought these malpractices to the attention of the Malaysian Medical Council (MMC), requesting that action be done against doctors who had signed questionable contracts with TPAs.

The MMC has stated that if legitimate written complaints concerning practitioners are received, action will be done.

TPA procedures have allegedly remained the same since 2015, and they remain unregulated.