Dialysis subsidy drying up

The Star - 7th Nov 2013

KUALA LUMPUR: Thousands of kidney patients are facing a tough time as the Health Ministry has not approved subsidies for haemodialysis treatment thus far this year. Some are reported to have waited for as long as three years for the nod.

The number of approvals for the RM600 monthly subsidy began to decrease in 2011, and became minimal from mid-2012.

NGO-run haemodialysis centres said they were told by the Health Minitry to source for funds elsewhere as it was focusing on new patients.

They also said that some patients had waited for the subsidy approval for as long as three years, instead of the usual one to three months.

In Malaysia, the poor receive heavily subsidised dialysis treatment but due to the shortage of government-run centres many turned to those managed by non-profit NGOs.

Through these NGO-run centres they could apply for RM600 dialysis subsidy (RM50 per dialysis) per month and free injections.

A random check revealed that the National Kidney Foundation had 200 patients still waiting for subsidy, 50 patients in St John’s Pt Selangor in Klang, 40 in dialysis centres run by a religious body that declined to be named, 22 at Pontian Rotary Haemodialysis Centre, and five patients in KL Lions Renal Centre.

The actual number of the affected poor was not known but it could be in the thousands going by the estimated 5,000 new kidney patients diagnosed with end-stage kidney failure each year in the last three years.

Patients affected appear to be from NGO haemodialysis centres as those in private and government dialysis centres did not have to deal with subsidy applications.

According to the National Kidney Foundation, treatment for a patient who undergoes haemodialysis at an NGO or a private clinic costs between RM150 and RM250 per session.

The Malaysian Registry of Dialysis and Transplants said that as many as 7,088 (26.9%) end-stage renal failure patients had haemodialysis treatment at NGO centres out of 26,404 patients receiving dialysis treatment last year.

The remaining 13,159 patients (49.8%) sought treatment at private dialysis centres and 6,157 patients (23.3%) at public facilities under the Health Ministry, university hospitals and Defence Ministry hospitals.

A nurse who declined to be named said that Muslims had less issues with getting the subsidy as they could apply for aid from the Baitumal or zakat foundation.

Some NGO haemodialysis centres were not happy that the Government had pushed patients to them without providing the needed subsidy.

The halt in subsidy was also depleting the rolling fund of the centres since some NGOs help to pay for their patients’ dialysis treatments, a dialysis centre manager said.

“If they make it difficult for patients to get the subsidy, they should just get the patients to do it at government dialysis centres,” she said, adding that such centres were limited.

Private hospitals unable to meet criteria imposed for organ transplants

Source The Star: Private hospitals unable to meet criteria imposed for organ transplants

PETALING JAYA: Malaysians hoping for an organ transplant find themselves having to go overseas because private hospitals here are struggling to meet the new criteria imposed by the Health Ministry (MOH) two years ago.

Several private hospitals used to do transplant surgeries until there was a death and the ministry shut down their operations.

A new requirement is a hospital must have a dedicated transplant team.

“A transplant procedure needs a complete team, not only of transplant surgeons, but of radiologists, pathologists, and anaesthetists to provide total continuum of care to the patient,” said Ministry deputy director-general Datuk Dr Jeyaindran Sinnadurai.

“The team must also work on a regular basis, with at least two people on the team at any given time, because imagine what would happen if there is only one surgeon, and he goes on leave after operating on a patient.

“What happens if the patient suddenly has post-surgery complications?” he asked.

But it does not make financial sense to a private hospital here to have such a team because the amount of work it gets does not justify it.

As a result, the number of patients seeking kidney transplants at teaching hospital Universiti Malaya Medical Centre (UMMC) has swelled.

Making the situation worse is the fact that Hospital Universiti Kebangsaan Malaysia (HUKM) stopped its transplant programme after its surgeon left.

Although government hospitals like Hospital Kuala Lumpur (HKL) and Selayang Hospital are able to do transplant work, much of the brunt of the MOH directive has apparently fallen on UMMC as transplants have either slowed down or ceased in HKL and Selayang a few months ago.

Dr Jeyaindran said the ministry was doing its part to reduce the long waiting list for transplants by collaborative partnerships with overseas institutions to train local talent.

“We are open to private hospitals taking up organ transplant procedures, but they must fulfil the minimum criteria which was drawn up two years ago by a team of experts.”

Transplant work started in 1999 in private hospitals such as Subang Jaya Medical Centre and Gleneagles followed by Prince Court Medical Centre in 2009.

Until the clampdown in 2012, private hospitals contributed up to 19% of kidney transplantation in Malaysia, with 17% from Prince Court. However, because of the new criteria for private hospitals, patients who have previously gone to private hospitals here are now seeking help in UMMC.

Those who have the means, go to Singapore where a kidney transplant costs between S$100,000 and S$200,000. The cost has increased as a result of the weak ringgit this year.

Another option is to buy a kidney and do the surgery in China or India, which costs between RM500,000 and RM600,000 now.

Those with a ready donor will try to avoid this illegal route. The World Health Organisation estimated in 2007 that 10% of organ transplants performed worldwide involved unacceptable activities that endangered the poorest and vulnerable groups

Types of Insurance in Malaysia

There are few types of insurance and each serves a different purpose. 

People buy insurance is for financial protection and for risk transference.

The risk transfer here means that by paying a fee to the insurer, the insurer in turn provides insurance cover for a particular event.

Basically the life insurance can be segmented to the life insurance, critical illness, medical insurance & accidental insurance.

Life insurance is meant to replace the income of the breadwinner of the family if sudden death were to occur.

Example if the family needs at least Rm5k per month to pay for bills, food, tuition fees, clothings, that translates to Rm60k per year or Rm600k for 10 years. 

This doesnt even take into account the education fees if he has a young 1 yo daughter nor does it take into account the inflation.

The purpose of the Critical Illness is to provide a lump sum of money if the person being covered is down with a critical illness.

Example Stroke, bedridden and unable to generate an income for the family.

This is even worse than death because on top of the daily family expenses, the family needs money for the medical bills.

This is where the medical insurance comes in. A 60 days ICU due to Stroke at a private hospital can costs Rm400k.

Of course the medical insurance is optional if you think the general hospital is goid enough for you. If you do buy the medical card, there is option to get treatment from second opinion. Choice is yours.

Accidental insurance pays in the event of death due to accident or lost of limbs die to accident. 

Example if a programmer lost both of his arms due to accident, will it impact his ability to generate an income?

MM2H Expats Insurance

Those whom are applying for the Malaysia My 2nd Home (MM2H) Program are required to purchase health insurance if they do not have a valid health insurance that works in Malaysia.

A valid health insurance in Malaysia provides hassle free admission to both the private and public hospital in times of medical emergencies.

Here are some of the general guidelines for people applying for Health Insurance:-

The Age of Applicant

The Malaysian health care insurance can only be purchased  by individuals whom are below the age of 70. 

If accepted, it is able to provide coverage until the age of 80, 90 or 100 (depending on the how long you plan to stay in Malaysia).

For the applicants whom are above the age of 70, your only option is to purchase International Insurance such as Bupa, Red Cross etc.

The Health of Applicant

a. Applications that can be approved - Healthy with no known pre-existing medical condition

b. Applications that may be considered - Borderline cases (Blood pressure, cholesterol, depending on the Doctor's findings) 

c. Applications that may be declined - Diabetic patients, Severe obesity, Cancer patient, kidney dialysis patient

To read the Frequently Asked Questions (FAQ) on the MM2H Insurance Application, please Click << HERE>>

The 'medical card' as term by locals will allow the insured to get treated at their panel clinic/hospitals in Malaysia based on the agreed amount being insured.

Whenever people shop for a medical card, mostly people are incline to only look at the cost and the coverage being offered while forgo some of the most important aspect, which is the policy contract. 

Do take the time to study the contract and in insurance, anything that sounds too flowery we need to raise our alarm to inquire more. One of the most important aspect is the renew-ability. For example, plans that are renewed annually vs life insurance with medical rider. 

Most of the plans that are annually renewed are port-folio renewal whilst plans with life insurance with medical riders. Under the port-folio renewal, if the claims are getting too excessive, it gives the insurer the right to remove the product from the market but they are required to honor the coverage until the end of the term (which is one year). 

Removing of a product from the market will means that should you need to get covered the next year, you will be subjected to undergo the health check as you are buying a new product. This is not a problem if we are still healthy, and if not the coverage may be declined.

Some insurer also have dodgy contracts with "Alteration Clause" whereby if the claims gets too much, it gives the insurer the right to change the benefit structures of the insurance plans by giving the client a 90 days written notice. Do look out for the word "Alteration Clause". Do not be surprise that it exists in some of the top insurer in Malaysia.

The Malaysian class health insurance policy does not cover dental (unless it was necessitated by an accidental injury)/cosmetic surgeries. This is across the board for all insurer in Malaysia as it is regulated by Bank Negara Malaysia.

The costs for dental is rather cheap though. Do read on the "Exclusions" of what is not covered which is available in most of the insurer's brochure. Pre-existing/congenital illness is not covered.

There is also a 30 days "Waiting Period" for common ailment like flu and fever. There after, there is also another 120 days for "Specified Illness". For accidental cases the coverage is immediate upon policy acceptance.

The last entry age for anyone to get health insurance (which is able to provide cover till the age 100) is before your age 70 next birthday. The most important factor that the insurer consider is the health status of the person being insured prior to approving of the insurance.

Of course in any insurance, you are required to declare albeit fully your health status, risks involve (for example smoker vs non-smoker), occupation (manual labor vs office desk job), any prior hospital admission/history, even family history. Failure to declare fully (especially on the health portion) may render the policy null and void. 

The bill will be paid directly from the insurance company to the hospital except for small hospital deposits, pre & post hospitalization and outpatient claims which is based on reimbursement basis.

Do note that as a foreigner your cover is only applicable in Malaysia. Treatment must be sought in Malaysia. Should you need to travel for a short duration, you'll need to get travel insurance with medical.

However, as a local buying a Malaysian class policy, coverage for overseas is also limited to 90 days. During that 90 days, they will have to pay and with the original receipt claim from the insurance company when they return to Malaysia. After the 90 days, they will have to get the treatment in Malaysia.

Private Hospital ICU Costs

Many people does not know that for Intensive Care Unit (ICU) cases, the medical bills can be rather staggering, shocking even!

Spoken to a prospect that has a friend admitted to a private hospital due to Stroke, for 60 days in the ICU.

The hospital bill was well over Rm400,000!

Do check your health insurance on whether it is able to work in times of crisis.

You may also look at PruValue Med, which offers up to Rm2,000,000 medical coverage.

Leave a message if you need a quote.

Common problems when applying for Health Insurance

In this article, I would like to talk about the common problems people faced when applying for health insurance and it could be useful to determine which product to go for.

The most common problem faced is the health issue, especially at older age. Hypertension (high blood pressure), raised sugar level, raised cholesterol level are common for a person above 45 of age. 

For borderline cases and under control with medications, the application may be considered albeit with a loading (extra premium) applied.

Alternatively the applicant (for borderline hypertensive and under control with medication) may also consider PruSenior med health insurance which comes with RM3,000 co-insurance. 

Since it comes with a RM3,000 co-insurance (or commonly known as excess), there will not be a loading or exclusion. However the decision on whether to accept the case will be subjected to full Underwriting.

Another problem could be due to a "pre-existing illness". The pre-existing illness is specifically excluded in most of the Malaysian insurer. 

If a person has a pre-existing illness prior to inception of the policy, for example, a knee pain, the knee pain condition will be specifically excluded and/or with loading implied.

This is why where possible, get a medical card with high limit so that you do not need to 'upgrade' or buy a new policy as add-on in later years. Do checkout PruValue med with a RM1,000,000 ~ RM2,000,000 coverage.

Lastly as we get older the insurance charges increases may undermine our budget. Plan the insurance early (of course you pay longer but at least you are able to get insured without any loading/exclusions!)

Leave a comment if you need further information. Thank you for reading

Cancer & High Drug Prices

Of Cancer & High Drug Prices - The Star (Monday March 3, 2014 MYT 12:00:00 AM)

"This brings us back to the high price of cancer medicines, and the TPP negotiations. There are in­­­­­­­­­creasing complaints that many new cancer drugs are much too expensive, usually more than US$100,000 (RM327,750) for a course of treatment for a patient."

Full Story from The Star << HERE >>

How to choose health insurance or medical card?

Insurance always comes at a costs and there is no best insurance so to speak. Most importantly, buy by your own budget and not the agent's budget as insurance is a lifetime commitment. 

You may gradually increase the coverage as your income improves. However do note that you can only upgrade the plan if your health permits.

There are few things that the readers may need to be aware, especially when choosing a medical card, for a lifetime protection.

1. Annual Limit
   The annual limit is more important than the lifetime limit as it denotes how much a person can claim in a policy year. A 30 days Intensive Care Unit (ICU) due to coma or stroke in a private hospital can costs RM100K or more.
   
   If the person has RM50K annual limit, the insurer is only liable to pay up to RM50K per policy year. Another RM50K will have to be paid by the policy holder.
   
   Suppose the person buys a medical card at age 20 with an annual limit of RM50K. The question is, would the amount of RM50K is still relevant when the person is age 50?
   
   Tip: Look for plans that does not have any Annual Limit or at least waive the annual limit, to plan ahead.
   
   
2. Lifetime Limit
   The Lifetime Limit is the limit that the policy holder can claim. Once the lifetime limit has been exceeded, the medical plan will cease coverage.
   
   Tip: Where possible, look for plans that does not have lifetime limit or at least plans that are able to cater for the next 5-10 years medical inflation.
   
   
3. Cancer Treatment & Kidney Dialysis
   Not many are aware that for Cancer Treatment or Kidney Dialysis is an OUTPATIENT procedure. This means that the client is needed to pay first and claim later.
   
   Tip: Check if the plan covers TAKE HOME DRUGS, LONG TERM MEDICATION & CONSULTATION CHARGES. It is rather pointless to have a high annual/lifetime limit if it excludes the take home drugs, long term medication & consultation charges, no?
   
4. Full Claim, Co-Insurance & DeductibleGet accustomed to whether the plan is able to be claim in full, or you will have to pay certain excess.
   
   Tip: Do not be put off with plans that needs the client to pay excess. As you may already know having the insurer to bear all the risk means transferring higher risk to the insurer. By agreeing to pay the excess, the policy holder is transferring lesser risk to the insurer, hence a lower insurance charges will be imposed.
   
   It is not everyday that one needs to be admitted and if the policy holder is able to absorb more (during hospitalization), it will help to save on the insurance charges resulting in lower insurance premium.
   
   In short, plans that are full claim, the policy holder is already paying the 'excess' upfront.
5. Guaranteed Renewal
   Always check to ensure that the plan is NON-CANCELLABLE, irrespective of how much has been claimed (as long as the policy holder does not exceed the lifetime limit).
   
   
6. Covered Term (70, 80, 90 or 100?)
   If possible, try to get covered until age 80 or more (if you are able to afford).
   
   The retirement age in Malaysia is generally at age 60, whereby one will lose the company health insurance coverage and one will have to rely on their own personal medical card. 
   
   Tip: The annual & lifetime limit plays an important role as we do not want to be 'medically bought out' once we are retired with no company medical coverage.
   
   Do note that the insurance charges will increase as we get older. The premium will also needs to be paid until the end of the tenure. Hence it is vital to plan ahead for some savings in order to pay off the higher insurance charges at later years.
   
   
7. Insurance Charges
   
   Insurance is about risk transference or risk sharing. Let it be known that the insurance charges is relative to the 'risk' being insured and the insurance charges will increase as we get older.
   
   
   The insurance charges is NOT GUARANTEED and in general the insurer reserves the right to increase the insurance charges should the claims for that plan exceeds its threshold.
   
   
   Tip: Therefore, plan upfront and be prepared to fork out more as the insurance charges increases. For plans that has cash value, do get to know how much cash values is in the policy.

Remember, as we get older, and with illnesses slowly creeping it, it will be harder to upgrade/extend the coverage

The Star: Insurance fees to go up by 6%

<< Full Story Here >>

PETALING JAYA: Staying healthy will cost even more as medical insurance fees, charges and premiums, go up next month.

Although life insurance is exempted from the Goods and Services Tax (GST), policyholders must pay at least 6% more for medical and health-related insurance coverage.

The National Association of Malaysian Life Insurance Fieldforce and Advisers has appealed to the Government to exempt “necessity policies” covering hospitalisation and critical illnesses from the GST.

Otherwise, many may surrender their policies or lapse in their premium payments, said its president Victor Kho Chui Ing.

“GST will be an additional cost for individual policies that are coming up for renewal.

“If a family of five with a medical policy pay a total of RM7,500 per annum, the additional cost to them would amount to RM450 yearly.”

He said many prospective clients and those planning on topping up their existing policies had adopted a “wait-and-see” attitude.

“They want to gauge the GST impact on their finances first because the new tax applies not only to insurance but to most of their daily expenses,” Kho said.

He warned that it was crucial for policyholders to understand that GST would impact all traditional and investment-linked policies which had medical, critical illness or personal accident benefits attached.

For traditional policies, the GST is imposed on the premium. For investment-linked policies, it is charged on the insurance charges.

For investment-linked policies, insurance charges escalated with age because of higher insurance charges, he said.

“For example, at age 35, insurance charges for the medical benefit alone is about RM422. At age 65, it rises to almost RM2,500 – exceeding the RM1,176 annual premium paid for the medical coverage alone,” he said, adding that some policyholders above age 60 might pay up to RM5,000 in annual insurance charges.

“With a 6% GST imposed on insurance charges, many senior citizens may potentially lose their coverage or need to top up premiums to sustain their coverage.”

Kho urged policy holders to check their policy statements regularly.

“For investment-linked policies, the annual premium may not increase as the GST and insurance charges are deducted from the policy’s cash value, thus eroding the accumulated cash value meant for retirement, children’s education and sustaining future premiums.

“You need to keep tabs on the cash value or you may wake up at age 60 without a retirement fund.”

He said the majority of more than two million life insurance policy holders nationwide had investment-linked and traditional policies with attached medical coverage.

Life Insurance Association of Malaysia (LIAM), in a statement, said fees and charges imposed on investment-linked policies and critical illness, medical and health and personal accident premiums were subject to GST.

LIAM advised all policyholders to contact their insurance companies to find out the amount payable from April 1.

General Insurance Association of Malaysia (PIAM) chairman Chua Seck Guan said policyholders were required to pay the additional 6% as all general insurance policies were subject to GST “unless the risks are located outside Malaysia”.

“However, general insurance premiums will remain the same,” he said.

A Prudential Assurance Malaysia Berhad spokesman said there was no GST for life insurance products like endowment, child, education and annuity.

Insurance Charges (Cost of Insurance)

To the readers of this blog, you may already know that insurance is a business of Risk Transfer or Risk Sharing (Takaful Concept).

The risks can be categorized into a few category:-

1. The age of the person (the older the person, the higher risk of claiming)

2. Smoking status (a smoker has higher chances of developing smoking related illness)  

3. Occupation (a construction worker posses different risk as compared to an office worker)

4. Gender (based on mortality rate)

5. Health Status of the person (a loading or extra charges may apply, for example mild hypertension)

By agreeing to pay a 'price' known as 'premium' the insurer in turn shall provide the financial assistance (coverage) in times of unexpected events such as untimely Death, Dread Disease (Critical Illness), Accidents, Total Disability & Hospitalization.

The coverage given comes with a costs based on the attained risk (as mentioned above) and not known to many, the costs (Insurance Charges) will INCREASE as we get older.

The next time you are given the Sales Illustration, do try to read and understand the associated charges and not only based on the 'flowery' sales talk by the agents.

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Introducing PRUvalue med - A REVOLUTIONARY Medical Plan from PRUDENTIAL

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1. Choose the Med Value Point (MVP) Coverage from RM1m, RM1.5m or RM2m. 

For claims within the MVP, Prudential will cover in full. For every Ringgit that exceeded the MVP, Prudential will still pays 80% of the bill, while you only pay 20% of the bill

2. No Annual Limit (NEW), providing a peace of mind against Future Medical Inflation

3. The 1st Medical Plan that offers up to 11 Maternity Complications (NEW) - Up to RM5,000 per year

4. Intraocular Lens - RM 6,000 per lifetime

5. The 1st Medical Plan that offers Day Care Procedures, issuance of Guarantee Letter directly to the hospital (NEW). 

6. Cancer Treatment & Kidney Dialysis (NEW), Covers:-
6.1 Take Home Drugs
6.2 Long Term Medication
6.3 Consultation Charges

Up to 1.5x Of Med Value Point!

7. Option to include Med Saver - a RM300 deductible plan to save on the insurance charges as we do not get admitted to the hospital frequently

8. Comes with NON-CANCELLABLE clause and is Guaranteed To Be Renewed