MediAsas DRG Pricing Framework Built On RM4.8 Bln Patient-Paid Hospital Bills
Data supporting Malaysia’s new MediAsas Diagnosis Related Group (DRG) pricing framework reveals that third-party payers covered RM3.9 billion in hospital billings, while patients paid RM932 million ...
Source: BERNAMA · September 25, 2026 at 3:32 PM · AI-assisted report
Single-sourceKUALA LUMPUR, 25 SEPTEMBER 2026 —
KUALA LUMPUR, Sept 25 — ProtectHealth Corporation Sdn Bhd announced that its MediAsas Diagnosis Related Group (DRG) pricing framework will shift hospital reimbursement from itemised fee‑for‑service billing to fixed whole‑case pricing based on diagnosis, procedure and severity, the company said at a medical and health insurance/takaful media briefing organised by Bank Negara Malaysia.
Market Impact
The new framework is underpinned by data showing that third‑party payers covered RM3.9 billion of private‑hospital billings while patients paid RM932 million out‑of‑pocket, according to the briefing. ProtectHealth chief executive officer Wan Mohd Hazwan Wan Mohd Najib said the implementation will adopt a phased and hybrid approach, combining elements of DRG and fee‑for‑service to avoid sudden disruptions to hospital revenue structures.
“DRG does not change clinical decision‑making or the patient journey. It only changes how hospitals are paid at the end of treatment,” Wan Mohd Hazwan said. He added that more than 150 private hospitals and over 2,500 healthcare professionals have already undergone training in clinical coding and data standards, which are critical for accurate grouping and reimbursement under the DRG system.
ProtectHealth, a government‑owned not‑for‑profit entity under the Ministry of Health, is tasked with supporting the rollout, including building provider networks, managing data platforms and strengthening industry capacity. The agency said MediAsas is not intended to eliminate medical inflation, noting that healthcare costs will continue to rise because of disease burdens, demographic changes, wage inflation and medical advancements.
The briefing linked MediAsas to the broader RESET Strategy, which will address the drivers of medical inflation while MediAsas focuses on improving individuals’ access to medical coverage. The plan aims to provide an affordable healthcare protection option that supports long‑term sustainability, particularly for Malaysians who lack coverage or face difficulties obtaining it.
MediAsas also complements wider efforts to transform private and public healthcare delivery, but the agency clarified that it is not intended to meet every consumer’s healthcare needs or replace universal coverage provided by the public healthcare system.
The announcement was made public through Bernama’s wire service on Sept 24, 2026.
Related: Bank Negara Malaysia · KUALA LUMPUR