KUALA LUMPUR: The Malaysian Medical Association (MMA) has called for the regulation of third-party administrators (TPAs) to curb unethical practices such as fee-splitting and to protect the healthcare system against commercialism.

Its president Dr Azizan Abdul Aziz said the present lack of regulation for TPAs could lead to a rise in healthcare costs, mainly in private primary care services.

“As this issue significantly impacts healthcare delivery to the public, we urge MPs to address this matter in the upcoming parliamentary meeting,” she said yesterday, Bernama reported.

Dr Azizan explained that TPAs were privately-owned and managed-care organisations hired by companies to handle their employee health benefits and these intermediaries also profited from fees charged to private general practitioner (GP) clinics to be included in their network.

She said the majority of private GPs depended on TPAs for their client base and for services to manage various employers.

Dr Azizan said one of the concerns raised was the practice of fee-splitting, where TPAs deducted a percentage from the total bill charged to patients, leading to increased costs for the private GPs and specialists involved.

She said TPAs typically deducted between 10% and 15% from the total bill, impacting the sustainability of private clinics and the quality of patient care – which may force GPs to consider cost-cutting measures or adjust charges to offset losses.

“We wish to remind all private medical practitioners that fee-splitting is considered unethical under the guidelines established by the Malaysian Medical Council,” she added.

Dr Azizan said other issues included high registration fees just to be listed as a panel clinic, delayed payments and rejected claims, operational inefficiencies, lack of transparency, as well as concerns over price and fee caps.

To resolve these issues, she said MMA had proposed several measures – which included urging the government to address fee-splitting within contracts, set up a regulatory body to oversee TPAs and enforce ethical standards, as well as standardise processes to create a unified clinic registration system.

https://www.thestar.com.my/news/nation/2024/06/20/regulate-healthcare-third-parties