Malaysia introduces diagnosis-based pricing in health insurance reforms

The Health Minister said the product aims to support more sustainable private sector financing.

Malaysia will introduce its first medical and health insurance and takaful (MHIT) product under a diagnosis-related group (DRG) pricing system by end-2025, as part of ongoing healthcare reforms, as reported by Free Malaysia Today.

Health Minister Dzulkefly Ahmad said the product aims to support more sustainable private sector financing and offer fairer coverage, especially for patients with pre-existing conditions.

The DRG model sets fixed prices based on diagnosis categories to improve cost control and care efficiency.

The rollout will begin with simpler diagnosis groups and expand gradually. 

Separately, Dzulkefly said 78 public clinics have adopted a cloud-based management system, with another 90 to follow by year-end. Data shows 70% of patients are treated within 30 minutes.