Translating policy signals into action
Improving healthcare equity and sustainability requires an ecosystem approach. This includes strengthening pharmacy governance, enabling more care to be delivered closer to the patient, increasing data transparency, and shifting payment models to reward value over volume.
Four key levers can help bend the cost curve while improving outcomes:
- Stabilise pharmacy spend with disciplined governance
- Shift appropriate care to day care or outpatient settings with robust quality safeguards
- Enhance price visibility through published price corridors and consumer‑friendly tools
- Focus on prevention through healthy lifestyles, free screenings, and medication adherence support
Here’s how key stakeholders can act now.
i. Payers
Payers include licensed insurers, family takaful operators, employers who self‑fund healthcare benefits, and risk‑bearing third‑party administrators. Their focus needs to move to total cost of care, where the greatest savings potential lies.
Cost containment measures include tightening formularies, implementing step therapy (starting with lower‑cost medication alternatives), and promoting biosimilars that have been tested for safety and efficacy as more affordable options to biologic medicines.
For infusion or catheter‑based treatments, payers can shift therapy to lower‑cost, clinically appropriate settings, supported by clear incentives and guidance to help members navigate coverage rules. Prevention should be emphasised in medical and health insurance/takaful designs by incorporating zero co‑pay screenings and embedding behaviour-based digital programmes (medication adherence, coaching) to reduce avoidable NCD episodes.
ii. Providers
Private hospitals, general practitioners and specialist clinics, and diagnostic labs will need to build foundations for value‑based care.
To prepare for DRG‑based payment, providers should invest in interoperable electronic medical records (EMR) to support secure exchange of clinical and financial data and make care episodes comparable across facilities. High‑volume patient pathways should shift towards day care or outpatient delivery where appropriate, guided by standardised clinical protocols and quality safeguards.
Providers can improve price transparency by publishing benchmark price ranges for common procedures and medicine fees. These efforts complement regulatory initiatives such as the Price Control and Anti‑Profiteering (Price Marking for Drugs) Order 2025 and Ministry of Health tools like MyPriMe.
Clinical settings are also key touchpoints for prevention efforts—through simple exercise plans, dietitian referrals, and virtual check‑ins.
iii. Employers
Micro, small, and medium enterprises (MSMEs) have been most affected by rising medical insurance costs, but large corporates are also under pressure. Regardless of size, employers can encourage “virtual‑first” access to care, with remote consultations before in‑person visits, while ensuring secure data sharing and oversight of third‑party virtual platform providers.
Employees should understand triage rules so care can be prioritised by severity. Price look‑up tools and MyPriMe links can be embedded in human resources portals to help employees check prices before receiving care.
Plan rules and carrier agreements should clearly set expectations on site‑of‑care (virtual vs in‑person) and the use of biosimilars. Incentives and vendor service levels can be tied to screening rates, medication adherence, and preventive behaviours, aligning rewards with outcomes rather than activity.
iv. Consumers
As virtual care becomes more prominent, data from AI‑enabled wearables and home monitoring tools can support better disease prevention and management, backed by strong privacy and data security safeguards.
A stronger culture of prevention is needed, making regular screenings, adherence to medication, and healthy living part of everyday life. Preventive care should also be embedded into plan rules and care pathways to help avoid long‑term costs.
