DECEMBER 16 — The recent tragic murder of the CEO of United Healthcare in the United States reveals a deep-seated and growing frustration with rising healthcare costs, corporate greed, and systemic inequities. While this event occurred in a different healthcare context, it underscores ethical challenges that resonate profoundly with Malaysians, especially in light of the recent surge in medical insurance premiums. The escalation of these premiums, combined with persistent issues in healthcare industry ethics and equity, raises critical concerns about moral responsibility, fairness, transparency, and public trust. These interconnected challenges within the insurance industry, healthcare providers, and policy frameworks demand immediate attention to ensure healthcare in Malaysia remains a universal right, not an exclusive privilege.
Healthcare as a moral responsibility
Healthcare is a fundamental human right, and ensuring equitable access is a moral duty for insurers, healthcare providers, and policymakers. The tragic event in the United States demonstrates the societal breakdown that occurs when healthcare becomes unaffordable due to relentless profit motives. When the healthcare system prioritises corporate interests over patient welfare, the result is alienation, distrust, and desperation.
In Malaysia, the rising cost of medical insurance premiums raises similar ethical concerns. Insurers often justify premium hikes by citing factors like medical inflation, new technologies, and risk management. However, when these increases are driven more by profit motives than by genuine improvements in care, they breach the moral duty to protect citizens’ well-being. This dynamic creates a system where the most vulnerable are priced out of necessary care, fostering exploitation and societal inequality.
The need for ethical stewardship within the insurance industry is clear. Financial sustainability must be balanced with a commitment to affordable and accessible healthcare for all. Without this balance, the system risks deepening inequities and eroding public trust.
Healthcare is a fundamental human right, and ensuring equitable access is a moral duty for insurers, healthcare providers, and policymakers. — Reuters file pic
Systemic inequities and the role of the insurance industry
Malaysia’s healthcare system operates on a dual structure of public and private sectors, inherently creating disparities. The increasing reliance on private healthcare, driven by public sector limitations and rising insurance premiums, exacerbates these inequalities.
For the B40 income group (bottom 40 per cent of earners), private health insurance is often unaffordable. They depend heavily on public hospitals, which are frequently under-resourced and overcrowded. The widening gap between those who can afford private care and those who cannot reinforces systemic inequities. The M40 income group (middle 40 per cent) faces a financial dilemma, forced to choose between maintaining insurance coverage and meeting essential living expenses. This group risks becoming underinsured or abandoning private insurance entirely, leaving them vulnerable to medical emergencies and potential financial ruin.
These disparities raise the issue of distributive justice: Are healthcare benefits and burdens being fairly distributed? When insurance costs rise disproportionately for lower-income groups, the inequality deepens. The insurance industry must address these inequities by adopting fairer pricing models, offering subsidies, or developing products tailored to lower-income groups.
Another major challenge is the lack of transparency in insurance practices. Insurance policies are often complex, leaving many consumers confused about their coverage. This opacity can lead to unexpected out-of-pocket expenses and financial distress. Patients frequently face surprise charges due to unclear policy terms, and the rationale for premium hikes is rarely communicated clearly. Insurers must ensure full transparency by clearly explaining policy terms, cost structures, and the reasons behind premium increases. Such transparency fosters public trust and enables patients to make informed decisions about their healthcare.
Balancing care, costs, and integrity
The healthcare industry — including hospitals and insurance providers — must uphold ethical standards while balancing financial sustainability. The influence of rising premiums on how care is delivered and how resources are allocated raises significant ethical concerns. Private hospitals, driven by financial pressures, may prioritise high-revenue treatments over medically necessary care. This practice raises an ethical question: Are treatments recommended based on patient needs or potential profits influenced by insurance coverage? Hospitals must ensure that medical decisions prioritise clinical necessity and patient welfare over financial incentives.
Limited resources in hospitals also lead to dilemmas about how to allocate care fairly. Rising insurance premiums may result in preferential treatment for insured patients, disadvantaging those relying on public care. Ethical resource allocation must be guided by medical urgency rather than financial status, ensuring fairness in the delivery of care. Transparency in billing and costs is another ethical challenge. Patients often face confusing bills with hidden fees and unclear charges, while misunderstandings about insurance coverage can lead to financial distress. Hospitals and insurers must provide clear upfront cost estimates, detailed itemised bills, and simplified explanations of insurance coverage to help patients manage their healthcare expenses more effectively. Improving transparency in billing practices can rebuild public trust in the healthcare system.
Ethical alignment in the healthcare ecosystem
The tragic event in the United States highlights the dangers of a system that prioritises profit over patients. Malaysia faces similar ethical challenges with rising insurance premiums and systemic inequities. Addressing these issues requires a coordinated effort among insurers, healthcare providers, and policymakers. This includes:
- Ethical Insurance Practices: Ensuring premium increases are transparent, justified, and tied to real healthcare improvements.
- Policy Oversight: Implementing government regulations to protect consumers from exploitative practices and ensure fair pricing.
- Healthcare Industry Integrity: Upholding ethical standards in care delivery, billing, and resource allocation.
- Public-Private Collaboration: Promoting joint initiatives to ensure equitable access through subsidies, outreach programmes, and community health initiatives.
Conclusion
The murder of the United Healthcare CEO serves as a stark reminder of what happens when healthcare systems fail to balance profit motives with moral responsibility. In Malaysia, rising insurance premiums and persistent inequities present a similar challenge. By fostering transparency, ethical integrity, and a commitment to equity, Malaysia can build a healthcare system where quality healthcare remains a right for all, not a privilege for a few. Proactively addressing these issues can prevent societal breakdowns and ensure the well-being and trust of all Malaysians.
* The author is a Senior Lecturer at the Department of Syariah and Management, Academy of Islamic Studies, Universiti Malaya, and may be contacted at [email protected]
** This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.
