Tag Archives: Medical

Contoh Tuntutan @ Claim 4

  • Kes : Prolapsed Piles
  • Warded : 3 hari (Prince Court Medical Centre)
  • Bil Hospital : RM5406.85 (Client claim medical benefit yg. disediakan majikan, Medical card client kekal 100%)
  • Elaun Wad & Surgery : RM900.00
Ringkasan Tuntutan/Claim

Ringkasan Tuntutan/Claim

Cheque

Cheque

 

 

Sign

 

Medical Card? tak perlu laa, company saya cover bil perubatan saya….

Seringkali aku dengar alasan kat atas ni dari orang-orang yang aku temui, bila bercakap tentang perlindungan Takaful amnya atau khususnya bercakap tentang Medical Card. Alhamdulillah, korang semua bertuah kerana mendapat majikan yang perihatin dengan kebajikan pekerja. Tetapi, adakah korang masih memerlukan perlindungan Takaful / Medical Card?

Jawapannya masih sama, YA, korang masih memerlukan perlindungan Takaful / Medical Card…Persoalannya, mengapa???

Kemudahan perubatan yg disediakan oleh majikan biasanya akan tamat apabila korang berhenti kerja atau bersara. Jadi semasa itu, korang tidak bekerja dan tiada pendapatan. Jadi, alangkah bagusnya jika korang bersedia dari sekarang dengan menyertai Takaful untuk persediaan masa hadapan. Jika korang bersara dengan wang yang banyak mahupun bergelar Jutawan, bukankah lebih baik, jika rawatan korang ditanggung oleh Takaful dan wang tabungan persaraan korang itu digunakan untuk perkara-perkara lain?

Mereka juga sering memberi alasan seperti “Nanti bila pencen, aku cari la Takaful @ Medical Card, buat apa nak ambil sekarang, majikan aku cover sepenuhnya..buat rugi duit jer” Namun, adakah korang tahu, sumbangan bulanan yg perlu dibayar oleh seseorang yang berumur 55 tahun (umur standard persaraan)? Sumbangan bulanannya mungkin mencecah antara RM500 – RM750 sebulan! mampu korang nak untuk membayarnya???

Selain itu, adakah korang yakin permohonan korang untuk menyertai Takaful pada umur 55 tahun diterima? Ramai rakyat Malaysia apabila tiba umur 55 tahun, disahkan menghidap pelbagai penyakit. Kebiasaannya jantung, buah pinggang, kencing manis dan pelbagai lagi. Jadi masa tu, korang tidak layak untuk menyertai Takaful dan permohonan korang kemungkinan ditolak atau mungkin di terima tetapi penyakit yg korang hidapi tidak dilindungi kerana dikira ‘pre-existing illness’ bukankah itu lebih membazir???

Kesimpulannya, sertai Takaful dan dapatkan Perlindungan Perubatan semasa korang masih muda dan sihat. Jangan terlalu selesa dengan kemudahan yang disediakan oleh Syarikat / Majikan kerana kemudahan itu boleh hilang bila-bila masa. Fikir-fikirkanlah……

“Buy life insurance when you don’t need it, because when you need it, you can’t buy”

Know your rights

Patients’ rights are protected by professional ethics and by statute.

THERE are occasions during a person’s life when an interaction with the healthcare delivery system occurs.

The reasons vary and they may be physiological, e.g. giving birth, or because of ill health, i.e. medical conditions like heart attack, diabetes, appendicitis, and fractures.

During hospitalisation or even during the consultation with the doctor, many patients are placed in a vulnerable position.

Healthcare is heavily regulated, with more than 20 laws, which include laws for the various healthcare professions, Poisons Act, Dangerous Drugs Act, Infectious Diseases Act, Food Act, etc.

It is not uncommon for patients to fear that they may lose their rights when they step into a healthcare facility, particularly during hospitalisation.

The reasons for this misperception vary. A major reason is the asymmetrical information gap between the patient and the doctors, other healthcare professionals, or healthcare facility staff.

Another major reason is the patients’ lack of awareness of their rights.

Patients’ rights are protected by professional ethics and by statute, i.e. by the Malaysian Medical Council (MMC) for the former and the Ministry of Health, the latter.

The MMC regulates the professional conduct of all doctors, irrespective of whether they are practising in the public, private, or voluntary sectors.

The MOH enforces the laws regulating all private healthcare facilities, which include the voluntary sector.

Most of the public sector healthcare facilities are operated by the MOH. Some are operated by the Ministry of Higher Education, in the case of university hospitals, and the Ministry of Defences, in the case of military hospitals.

Although there are no laws regulating patients rights in the public sector healthcare facilities, there are policies and procedures in place that protect their rights.

In addition, there are various healthcare laws enforced by the MOH that protect the public interest. In fact, healthcare is heavily regulated, with more than 20 laws, which include Acts for the various healthcare professions, Poisons Act, Dangerous Drugs Act, Infectious Diseases Act, Food Act, etc.

This article was written with the objective of enhancing patients’ awareness of their rights in the healthcare delivery system, particularly in hospitals, where they are usually most vulnerable.

Private sector healthcare facilities

Patients’ rights are specifically stated in the Private Health Care Facilities and Services Act (PHCFSA), which provides for:

● The provision of medical care by a registered doctor

● A grievance mechanism plan for patients using the premises of the private healthcare facility or service

● The manner of accessing a patient’s medical records and the manner of obtaining a patient’s medical report by the patient, the patient’s representative, or a healthcare provider

● The obtaining of a valid consent for a surgical operation or procedure

● The fees that may be charged by private healthcare facilities and services ● Matters relating to patients’ rights in relation to healthcare services provided by any healthcare facility or service, including patients’ privacy, confidentiality of information, and access to patients’ medical reports and records

● The minimum standards and requirements for all healthcare facilities.

There are regulations in the PHCFSA for the above provisions in the Act except for the manner of accessing a patient’s medical record; and fees charged by the healthcare facility with the exception of doctors’ professional fees.

Specific provisions on patients’ rights are found in the PHCFSA regulations. Section 27 of the Private Hospitals and Other Private Health Care Facilities and Services Regulations (PHCFSR) states that the licensee or person in charge shall take reasonable steps to ensure that a patient is:

1. Provided with information about the nature of his medical condition and any proposed treatment, investigation, or procedure and the likely costs of the treatment, investigation or procedure;

2. Treated with strict regard to decency; and

3. Provided with a medical report within a reasonable time upon request by the patient and upon payment of a reasonable fee.

The licensee and/or person in charge of the healthcare facility is responsible for ensuring compliance with the PHCFSA and PHCFSR. Non-compliance can lead to prosecution, and the penalties, upon conviction, include a fine, jail sentence, or both.

Professional care

A patient admitted to a healthcare facility has a right to be provided professional care or treatment of a doctor registered with the MMC.

Prior to admission to a healthcare facility, a patient is entitled to be provided with all the necessary explanation, instruction, and education for pre- and post-procedure or pre- and post-operative care.

Emergencies

The healthcare facility has to ensure that at least one doctor is on duty to respond immediately to an emergency in the intensive care unit. The facility also has to have an on-call system for doctors to be available at all times for emergencies.

Resuscitation facilities including equipment, drugs, and materials needed for life support purposes or for the treatment of any emergencies have to be available.

Identification

The healthcare facility has to ensure that all in-patients are properly identified. A mother and her newborn at the healthcare facility must be properly identified after childbirth, before they leave the labour/delivery room.

Patients have the right to know the identities of the staff providing care as well as the names and professional status of the staff providing care or treatment.

Policies

The healthcare facility has to have written policies on the procedures of patients’ admission, discharge, and transfer and the procedures of patients’ registration, attendance, and referrals.

There must also be written policies that protect patients’ safety. They include incident reporting, particularly in relation to adverse events, and requiring its staff to report incidents to it; infection control; activities and responsibilities of the doctor(s) or dentist(s) in relation to patient care and supervision of patient care; transportation of laboratory specimens; and maintenance of the facility.

Consent to treatment

The healthcare facility has to provide a policy statement on valid consent and the manner in which it is to be obtained.

The essential elements of valid consent are capacity, voluntariness, and adequate provision of information for a patient to make a decision.

The policy statement has to also state patients’ rights to information concerning medical treatment and care; be informed of the facility’s grievance procedure; and be supplied or provided with their medical reports.

This policy statement has to be exhibited in a conspicuous part of the facility.

Bills

Doctors’ professional fees are regulated, but there is no regulation of the bills of private hospitals and other private healthcare facilities. The vast majority of complaints are about the charges made by private hospitals.

Section 26 of the PHCFSR is reproduced verbatim so that patients are aware of the legal provisions that protect their rights with regard to bills i.e.

1. A private healthcare facility or service shall, upon request prior to the initiation of care or treatment, inform the patient of the estimated charges for services based upon an average patient with a diagnosis similar to the tentative or preliminary diagnosis of the patient; and of other unanticipated charges for services that are routine, usual, and customary.

2. A patient has the right to be informed by a private healthcare facility or service prior to the initiation of care or treatment of the private healthcare facility or service’s billing procedures.

3. A patient has the right to obtain from a private healthcare facility or service upon request, itemised billing for the whole course of the patient’s treatment at the private healthcare facility or service at no extra cost.

Confidentiality

The healthcare facility has to “safeguard the information on the patient’s medical record against loss, tampering or use by unauthorised persons.”

Although there is provision in PHCFSR for statistical returns to the MOH, they must contain only anonymised patient data. There are also provisions for the maintenance of confidentiality in investigations carried out by the MOH.

Quality standards

There are quality standards prescribed in the PHCFSR for various aspects of healthcare. These quality standards support patients’ rights, i.e. infection control; standards for obstetrical or gynaecological care, newborn nursery facilities, paediatric care, anaesthesia, surgical facilities and services, intensive care unit, emergency care services, pharmaceutical services, dietary services, rehabilitation facilities and services, specialist outpatient facilities and services, ambulatory care centres; special requirements for central sterilising and supply facilities and services, blood bank and blood transfusion services, haemodialysis facilities and services, radiological or diagnostic imaging services and radiotherapy and radioisotope services; standards for private nursing homes and special provisions for hospice and palliative care services.

Grievance mechanism

The licensee or person in charge of a healthcare facility has to provide a patient grievance mechanism plan which include the appointment of a patient relations officer (PRO) to serve as a liaison between the patient and the facility; the extent of decision-making authority given to the PRO; a method by which each patient will be informed of the PRO and how he or she may be contacted; and the documentation of all complaints.

Any grievance against the facility may be submitted by the patient orally or in writing to the PRO or to any healthcare professional of the facility at any time. A complaint submitted to the latter has to be forwarded to the PRO by the next working day.

The PRO is required to document all complaints received and resolve the matter. If the PRO cannot resolve the complaint, it has to be referred to the licensee or person in charge immediately or within three working days.

The licensee or person in charge has to institute an investigation and provide a reply, which includes the result of the investigation to the complainant within 10 working days after the complaint was received by the licensee or person in charge.

The report of the investigation to the complainant has to state that if he or she is dissatisfied with the reply of the licensee or person in charge, the complainant could refer matter to the Director-General of Health.

The Director-General will then institute an investigation of the complaint and inform the complainant and the facility of his findings or any recommendations based on the findings.

Public sector healthcare facilities

There is no specific law regarding the provision of healthcare or treatment in public sector health care facilities.

However, there are policies and procedures put in place by the MOH and the boards of the University hospitals that protect patients’ rights.

Patients and their families can avail themselves of the grievance mechanisms that are in place in the public sector health care facilities.

Complaints

The advances in medicine have contributed to patients’ expectations of the perfect outcome when the best possible outcome is all that is achievable in many situations. This has lead to patient dissatisfaction, particularly when adverse events occur.

The resolution of grievances at the healthcare facility level is encouraged as speedy resolution is possible. Areas in the provision of care or treatment that have given rise to grievance can be discussed in private rather than before other parties.

Customised solutions like explanation, apology, and dissemination of the lessons learned are more likely with local resolution.

When local resolution is not possible for whatever reasons, complaints can be made to the regulators.

Complaints about a doctor can be sent to the President, Malaysian Medical Council, Level 2 Block E1, Federal Government Administrative Complex, 62518 Putrajaya (Telephone: 03-26947920, facsimile: 03-26938569, email: admin@mmc.gov.my).

Complaints about both private and public sector healthcare facilities can be sent to the Director, Medical Practices Division, Floor Block E1, Federal Government Administrative Complex, 62590 Putrajaya (Telephone: 03-88831309, facsimile: 03-88810902, email: ckaps@moh.gov.my).

Patients’ rights are protected by professional ethics, statute in the case of private healthcare facilities, and policies and procedures in the case of public sector healthcare facilities.

Being aware of one’s rights will go a long way in reducing one’s feelings of vulnerability when accessing care in the healthcare delivery system.

Credit : The Star Online

36 Critical Illnesses

A total 36 Critical Illnesses are covered under the Critical Illness and Payor Benefits

*This  is for illustrative purposes only. You are advised to refer to the terms and conditions in the policy document for details of the important features of the plan.

Insurans RM1 b

Tuntutan Insurans Hayat (Kos Perubatan) 2006 - 2009

Tuntutan biayai kos perubatan meningkat setiap tahun

KUALA LUMPUR: Syarikat insurans di negara ini membayar lebih RM1 bilion setahun kepada pemegang polisi bagi membiayai kos rawatan perubatan mereka yang meningkat setiap tahun.

Statistik Bank Negara dalam Jadual Petunjuk Utama Insurans menunjukkan jumlah tuntutan insurans hayat dibayar untuk perbelanjaan perubatan mencatat peningkatan sejak empat tahun lalu daripada RM877.6 juta pada 2006 kepada RM1.05 bilion (2007), RM1.27 bilion (2008) dan RM1.45 bilion (2009).

Trend peningkatan itu membuktikan kos rawatan perubatan antara aspek kritikal di kalangan masyarakat di negara ini.

Menteri Kesihatan, Datuk Seri Liow Tiong Lai ketika diminta mengulas perkara itu, berkata statistik itu menunjukkan tahap kesedaran rakyat terhadap perlindungan kesihatan diri dan keluarga semakin meningkat.

Trend peningkatan itu membuktikan kos rawatan perubatan antara aspek kritikal di kalangan masyarakat di negara ini.

Menteri Kesihatan, Datuk Seri Liow Tiong Lai ketika diminta mengulas perkara itu, berkata statistik itu menunjukkan tahap kesedaran rakyat terhadap perlindungan kesihatan diri dan keluarga semakin meningkat.

Katanya, kerajaan menyedari peningkatan kos perubatan terutama ubat yang meningkat sekitar 12 peratus tahun lalu sekali gus menyebabkan caj perubatan di hospital termasuk hospital swasta meningkat.
Namun, katanya, itu tidak bermakna operator pusat perubatan swasta boleh mengambil kesempatan atas kenaikan itu dengan mengenakan caj terlalu tinggi untuk mengaut keuntungan singkat sehingga membebankan rakyat.

“Saya sudah mengarahkan Ketua Pengarah Kesihatan, Tan Sri Dr Ismail Merican supaya berbincang dengan semua pemilik hospital swasta di negara ini berhubung kos perubatan supaya kenaikan itu rasional,” katanya.

Sementara itu, sumber industri berkata, tuntutan insurans bagi menanggung kos rawatan dan perubatan diramal terus meningkat sejajar dengan peningkatan jumlah penduduk dan perubahan gaya hidup masyarakat.

“Peratusan peningkatan tahunan bukan kecil, tetapi meningkat dengan mendadak,” katanya.

Katanya, orang ramai mengambil polisi insurans kerana mahu mendapatkan perlindungan kewangan ketika ditimpa musibah seperti sakit atau kemalangan.

Isnin lalu, Berita Harian melaporkan sehingga Oktober lalu, 26 peratus kegagalan pembayaran balik pinjaman bank atau kad kredit berlaku berikutan pembiayaan kos rawatan tinggi di hospital swasta yang mendorong individu berhutang di luar kemampuan.

Sebelum ini, banyak pihak termasuk seorang doktor dengan 25 tahun pengalaman, tampil mengadu caj dikenakan pusat perubatan swasta adalah terlalu mahal dan mahu pihak berwajib mengambil tindakan sewajarnya mengatasi masalah itu.

Presiden Persatuan Perubatan Malaysia (MMA), Dr David KL Quek ketika dihubungi berkata, hanya bayaran kepada doktor berkhidmat di hospital swasta dikawal kerajaan menerusi Akta Perubatan namun caj lain tidak dikawal dan bergantung kepada institusi perubatan swasta terbabit.

Katanya, ini menyebabkan caj rawatan, perubatan, makmal dan perkhidmatan lain berbeza antara sesebuah pusat perubatan swasta selain bergantung kepada faktor seperti lokasinya.

Credit : Berita Harian Online