17th April 2026
Dr Musa Mohd Nordin, Paediatrician, Damansara Specialist Hospital (DSH)
Dr Rajeentheran Suntheralingam, Urologist, DSH
Dr Ahmad Faizal Mohd Perdaus, Respirologist, DSH
Dr Sng Kim Hock, Neurologist, Pantai Hospital, KL
CodeBlue’s recent article quoting National Cancer Society Malaysia (NCSM) managing director Assoc Prof Dr M. Murallitharan paints a troubling picture of private health care, suggesting that a “trust deficit” driven by perceptions of physician greed is forcing patients into an already overwhelmed public system.
The narrative is simple: patients fear their doctors are billing to pay for “Ferraris” and insurers complicate matters with opaque jargon.
We have great respect for NCSM’s work. However, as clinicians who have spent decades on the frontlines of both public and private medicine, we must respectfully disagree with this diagnosis.
It confuses a symptom (distrust) with the true underlying disease. To blame the character of doctors or the complexity of insurance policies is to miss the forest for the trees. The real, measurable, and undeniable driver of anxiety, delayed care, and the exodus to government hospitals is one thing: uncontrolled medical inflation.
In our recent piece, “DRG: One Step Forward Or Two Steps Back?: Part 1” (CodeBlue), we laid out the hard economics. Medical inflation in Malaysia has consistently outstripped general inflation and wage growth for over a decade. This is not a matter of perception; it is a financial reality.
When a patient is quoted RM50,000 for a cardiac stent or RM80,000 for cancer immunotherapy, their “distrust” is not born from a suspicion of a doctor’s car loan. It is born from sticker shock and the terrifying realisation that their insurance coverage—bought in good faith years ago—is now grossly inadequate.
Let us reframe NCSM’s central anecdote. A patient questions the need for an echocardiogram. The NCSM suggests this is because the patient doubts the doctor’s “neutrality.” We suggest a more logical explanation: the patient is terrified that the test itself, plus the potential findings, will trigger a cascade of unaffordable bills and a fight with their insurer over co-payments and deductibles.
The “apprehension” is not about a Ferrari; it is about bankruptcy. The patient is not worried about a doctor’s ethics; they are worried about their own savings.
CodeBlue’s article rightly notes that 53 per cent of respondents cited affordability concerns. Yet NCSM reportedly pivoted to blame “complex systems” and “trust.” This is backwards. Affordability is the primary cause; complexity and distrust are the secondary consequences of a system where prices have no anchor.
When a private hospital’s charges are driven by a fee-for-service model amplified by expensive technology and drug monopolies, the bill grows exponentially. Insurers, in turn, raise premiums and tighten policy exclusions to protect their risk pools. The patient is then caught in a vicious cycle: rising premiums → higher out-of-pocket costs → suspicion of every new charge → loss of trust.
To blame the final symptom (distrust) while ignoring the primary pathology (inflation) will lead to the wrong treatment.
Furthermore, the suggestion that patients flee to the government sector because it is “neutral ground” is only half true. They flee because it is free at the point of service. In a rational economic environment, private care offers speed and choice. But when the price of that speed becomes exponentially higher than public care, patients will tolerate long waits to avoid financial ruin.
That is not a referendum on physician ethics; it is a basic consumer response to a broken pricing market.
So what is the solution? Not just simplifying insurance language, though that helps. The solution is what we proposed in our DRG article: implementing a fair, transparent Diagnosis-Related Group (DRG) system. A DRG system sets a fixed, predictable package price for an entire episode of care (e.g., RM15,000 for an uncomplicated appendectomy).
Crucially, this fixes the hospital charge component, which is currently the major source of the variability. This immediately removes the incentive for “transactional” billing.
The doctor’s advice becomes neutral again because the hospital charge is fixed regardless of how many tests are run. The patient trusts the recommendation because it is not linked to a variable fee. The insurer knows exactly what to cover. And the doctor—already capped by Schedule 13—is no longer unfairly maligned as greedy.
Without fair, transparent, and scheduled hospital charges, no amount of “clear communication” will fix the fundamental misalignment of incentives. Patients will continue to see every test as a potential bill, and doctors will continue to be unfairly blamed for a problem they did not create.
We call on all stakeholders to move the debate away from emotional accusations of bad faith and toward the unglamorous, difficult work of price regulation. Stop blaming doctors for the medical inflation they did not create. Stop pretending that simplifying a policy document solves the crisis of a RM100,000 cancer bill.
The distrust will only disappear when the bills become predictable and fair. That begins with DRGs and hospital charge regulation, not diatribes against physicians.
*Also published on CodeBlue: https://codeblue.galencentre.org/2026/04/distrust-is-a-symptom-not-the-disease-in-malaysias-health-care-crisis-dr-musa-mohd-nordin-dr-rajeentheran-suntheralingam-dr-ahmad-faizal-mohd-perdaus-dr-sng-kim-hock/
