ProtectHealth On Track To Roll Out DRG Pricing Guidelines By January 2027

CYBERJAYA, May 15 (Bernama) -- ProtectHealth Corporation Sdn Bhd (ProtectHealth)  is on track to roll out the Diagnosis-Related Group (DRG)-based pricing guidelines under the base Malaysia Health Insurance and Takaful Initiative (MHIT) plan by January next year, with more than 100 private hospitals having submitted data for the system since this February.

Its chief executive officer, Wan Mohd Hazwan Wan Mohd Najib said data submitted by participating hospitals are currently being analysed together with technical experts from the Ministry of Health (MOH), Bank Negara Malaysia (BNM), and other agencies to develop the initial DRG pricing framework ahead of a pilot rollout in the third quarter of this year.

“We expect an initial version to be ready before the pilot and we will continue refining it towards the national launch,” he said during a media briefing here today.

He said the DRG-pricing guidelines are intended to improve transparency in hospital charges while avoiding 'pricing shock’ to hospitals and patients through a phased implementation approach.

Wan Mohd Hazwan said that the government’s healthcare reform agenda, including the rollout of the DRG-based pricing mechanism and expansion of public-private healthcare collaboration, had not been disrupted by ongoing global economic uncertainties and healthcare inflation pressures worldwide.

He said Malaysia’s dual healthcare system remained resilient and that efforts to optimise both public and private healthcare resources were crucial to ensuring Malaysians continue to receive timely and affordable treatment, especially amid rising global medical costs and insurance premiums.

“We recognise the global healthcare environment remains challenging, with rising medical inflation and economic uncertainties, but our focus is to ensure Malaysians continue to receive accessible and affordable healthcare through stronger collaboration between the public and private sectors,” he added.

Meanwhile, ProtectHealth strategic programme development head Dr Gan Saw Chien said Malaysia already possesses strong foundational capability in DRG implementation, noting that the MOH had been using medical coding systems linked to DRG for more than a decade.

He also said the DRG framework under the base MHIT plan would apply to inpatient hospital cases and differs from the Hospital Services Outsourcing Programme, which currently uses a separate case-based payment model for elective procedures.

“The grouping mechanism is different. Hospital outsourcing uses preset criteria while DRG uses a structured classification system for inpatient cases,” he shared.

In January, Finance Minister II Datuk Seri Amir Hamzah Azizan said Bank Negara Malaysia would strengthen regulatory requirements for all MHIT products following the introduction of a standardised base MHIT plan aimed at improving consumer protection and ensuring long-term premium sustainability.

MHIT, which will be offered on a voluntary basis, is slated for a pilot rollout in the second half of this year, while full implementation is targeted for early 2027.

-- BERNAMA