First phase of DRG payment model planned for 2026, says Dzulkefly

The Star

The first phase rollout of the much-awaited diagnosis-related group (DRG) payment model is planned for 2026, says Datuk Seri Dr Dzulkefly Ahmad.  The Health Minister said DRG’s implementation was planned to be done incrementally over time, with its first phase to focus on minor cases.  Read more at https://tinyurl.com/3rent2cx   WATCH MORE: https://thestartv.com/c/news SUBSCRIBE: https://cutt.ly/TheStar LIKE: https://fb.com/TheStarOnline

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00:00I want to ask if this cooperation between the government and private healthcare providers,

00:05I want to know whether the diagnosis related to payment model,

00:10how is it we're going to be implemented, and what stage of advocacy is that?

00:16Right, I predicted this soalan, this is, you can imagine the soalan.

00:21So let me just say this, in the private sector,

00:25the private DRG implementation, okay, is governed under the newly formed,

00:37what we call it, Joint Ministerial Committee on Private Sector Cost.

00:44So it's a Joint Ministerial Committee, particularly Minister of Finance,

00:51or rather specifically, Second Finance Minister, MK2,

00:55with myself at the YBMK, Minister of Health.

01:00So that is, you know, that's how it's going to be governed, yeah.

01:05Now the phase implementation, we know, DRG, as you may or may not know,

01:10is, it can be simple and can be as complex.

01:13It all depends on the diagnostic related group according to the ICB,

01:18the International Classification of Diseases, 11, yeah, or even 10.

01:22Now, most importantly, how this is going to be implemented?

01:27Surely, at its completion or at its most complex, you know, system,

01:35it will certainly take time.

01:37So how we suggest to do it is to do it incrementally.

01:41At the phase one, the phase implementation of DRG is planned to be linked to the,

01:48okay, it will go, you know, easier cases and then we go to the complex cases

01:54as we move along throughout 2026.

01:57And to just remind you, this DRG is now related to our,

02:05this thing called base product of MHIT, yeah.

02:11This is the MHIT, the Medical Health Insurance Takaful Insurance product.

02:20So it is somehow linked to the DRG.

02:25Why? Because before, before DRG, payment to your services in the private hospital

02:33is paid through pay for services.

02:37Pay for service.

02:38You pay as to the volume of test curve, numbers of test curve, procedures curve, whatever.

02:44There is no kind of a classification, a grouping, the groupers of how complex particular disease.

02:51There is no such thing.

02:52You just pay as for the service you are rendered by the specialist or by the hospital, yeah.

02:59But now with DRG, what you have to get to see is that there is a way to standardize payment, okay,

03:08where they get to be grouped together in a bundle kind of case,

03:12and bundle kind of approach, then what you are paying is actually pay for what I like to call pay for outcome.

03:21Now, I stress on the importance of the overarching principle of getting a value-based healthcare.

03:29Now, with DRG, you have a semblance of getting to value-based because you are paying for outcome.

03:36The more efficient you are, the less become, you know, less complication there are, you know.

03:41So, you get to be, if you are efficient, you are not wasteful or whatever, by way of whatever.

03:47So, this is why the DRG is linked to this thing of the payment through this insurance thing called MHIT.

04:02So, the MHIT is a new, it's a novel product.

04:07There are many other insurances already out there, but this is our, you know, our introduction,

04:13which is a combination of us, MOH, Bank Negara, MOF, you know.

04:21So, we work together to produce this in a way, why we are nudging the people to subscribe to this

04:28because we want them to shift from paying out of pocket, which is very inflationary, I can tell you.

04:37It is inflationary as opposed to buying insurance product, which will be the element of prepaid and pool

04:47and you get better outcome and better efficiency in the sense of, you know, health outcome.

04:54So, this is why MHIT is linked to DRG and I wouldn't go further than that.

05:01I would like to talk about our Rakan TKM, but that's for another day.

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