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Title page 1

Contents 4

Acknowledgements 3

Executive summary 7

1. Introduction 11

2. Healthcare in Malaysia 15

3. Data and methodology 25

4. Overall trends in the private health insurance sector 29

5. Service-level medical inflation 35

6. Drivers of cost growth and decomposition 40

7. Efficiency of spending 49

8. Summary and recommendations 53

References 56

Annex A. MHIT central claims database structure 58

Annex B. Methodology for relative price and service-level medical inflation 61

Annex C. Decomposition of PHI spending growth 63

Annex D. Predicted prices and relative price index 65

Tables 5

TABLE 1. The spectrum of healthcare inflation metrics 12

TABLE 2. Some estimates of medical inflation in Malaysia, 2024 13

TABLE 3. Interim premium adjustment measures (2024-2026) 23

TABLE 4. Base MHIT vs. current MHIT plans 24

TABLE 5. Growth and affordability of private health insurance premiums, 2018-2024 30

TABLE 6. Age distribution of insured members, 2021-2024 31

TABLE 7. Insurance enrolment growth rate by age groups, 2021-2024 (individual policy holders only) 31

TABLE 8. Total number of claims, billed and paid amount, 2022-2024 32

TABLE 9. Distribution of claims by state, 2022-2024 33

TABLE 10. Distribution of claims by nationality, 2022-2024 33

TABLE 11. Predicted price for 50 selected inpatient service baskets (in RM) 36

TABLE 12. Inpatient inflation and relative prices 39

TABLE 13. Outpatient/daycare inflation and relative prices 39

TABLE 14. Pre- and post-hospitalization inflation and relative prices 39

TABLE 15. Framework for analysing cost growth in insurance markets 41

TABLE 16. Share of HSS to total hospital bill (Inpatient only) 44

TABLE 17. Different provider payment methods and its impact on costs 45

TABLE 18. Distribution of claims by age and sex (Group and individual plans) 47

TABLE 19. Value of top ACSCs, 2022-2024 51

Figures 6

FIGURE 1. Trends in Disability-Adjusted Life Years (DALYs) 4 by cause, 1990-2023 16

FIGURE 2. Premature mortality from non-communicable diseases (NCDs) by income level, 2021 17

FIGURE 3. Population aged 65+ years, 2010-2040 17

FIGURE 4. Health expenditure as a share of GDP, 2023 18

FIGURE 5. Current health expenditure per capita (in USD), 2023 19

FIGURE 6. Current health expenditure for voluntary health insurance, 2023 19

FIGURE 7. Health expenditure at all hospitals by sources of financing, 2023 20

FIGURE 8. Private health insurance coverage, 2018-2024 21

FIGURE 9. Key strategies under RESET 23

FIGURE 10. Distribution of claims and total bill by age group, 2022-2024 33

FIGURE 11. Average number of claims by age groups, 2022-2024 34

FIGURE 12. Average claims paid amount by age groups, 2022-2024 34

FIGURE 13. Results of decomposition analysis 43

FIGURE 14. Average cost per claim by age and sex (Inpatient) 46

FIGURE 15. Total billed amount for cashless and non-cashless claims 48

FIGURE 16. Share of ACSC to total inpatient admissions 50

FIGURE 17. Distribution of share of ACSC across facilities 51

FIGURE 18. Average length of stay (ALOS) in top 50 hospitals 52

FIGURE 19. ALOS by hospital size (proxied by number of claims) 52

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