13/04/2026

MONDAY | APR 13, 2026

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COMMENT by Nur Balqis Zahirah Ali, Ng Rui Jie and Rumana Akhter Saifi

The illusion of medical coverage H AVE you ever assumed that having private health insurance means you are financially protected when

“What initially appears to be comprehensive coverage may, in practice, leave patients responsible for

LIKE it or not, we are living in the Age of Apps. In Malaysia, both businesses and government agencies are moving more services online. As a result, many of us now have to download apps to buy things, pay bills or access services that used to be done over the counter. Overall, this is a good thing. Apps can make processes faster, more convenient and sometimes cheaper. Take the JustGO app, which is being used to test barrierless tolling through Automated Number Plate Recognition at the Hutan Kampung– Sungai Dua stretch. It is free to use and does not require a physical device or sticker. Still, not everyone is thrilled. Even though most Malaysians now own a smartphone, many feel that having to download too many apps is troublesome. Keeping track of passwords can be frustrating, illness strikes? For many Malaysians, private health insurance (PHI) is seen as a safety net. It promises faster access to treatment, more comfortable facilities and protection against rising medical costs. It offers reassurance, particularly in a system where public hospitals are often crowded and waiting times can be long. Yet, when patients actually need care, that sense of security does not always hold. Increasingly, evidence suggests that while PHI improves access to healthcare, it does not necessarily shield individuals from financial strain. Malaysia’s healthcare system operates within a delicate balance. Public hospitals provide highly subsidised care but face persistent congestion while private hospitals offer speed and convenience at a significantly higher cost. This trade off between access, quality and cost often leads individuals to turn to PHI as a bridge between the two systems. Over time, policy measures such as tax relief for insurance purchases and the option to use EPF savings have expanded PHI coverage, transforming it from a niche product into a significant component of healthcare financing. However, wider coverage has not eliminated financial risk. Patients with serious or chronic conditions often discover that their insurance does not cover as much as they had expected. The gap between perception and reality becomes most apparent during prolonged illness, when repeated treatments, medications and follow-up care begin to accumulate. What initially appears to be comprehensive coverage may, in practice, leave patients responsible for substantial out-of-pocket expenses. This disconnect arises for

substantial out-of pocket expenses.

especially for older users. There are also genuine concerns about cybersecurity and data privacy. These concerns are understandable. The question many people ask is simple: How many apps are too many? The government’s MyGov “super app” now brings together 44 services from 16 agencies, with 30 more services planned for integration this year. The Digital Ministry has rightly pointed out in Parliament that merging everything into one platform is not easy and cannot be done overnight. That is a sensible position. Big changes rarely work if rushed. While gradual reform may not sound sexy, it is often more practical and sustainable. Most people have probably accepted that our lives will continue several reasons. Insurance policies vary widely in their coverage limits and not all are designed to support long-term or complex conditions. Certain treatments, medications or technologies may fall outside policy provisions, especially as medical advancements outpace existing coverage frameworks. Even when hospitalisation is covered, additional costs such as co-payments, deductibles, transportation and caregiving can quietly accumulate. These are rarely considered at the point of purchase, when decisions are often guided more by affordability of monthly premiums than by adequacy of long term protection. Another growing concern lies in the sustainability of premiums themselves. While rising medical costs are frequently cited as the main driver, there are structural dynamics within insurance pools that may also contribute. In some cases, younger and healthier individuals are drawn into newer, lower-cost plans while older or higher-risk policyholders remain in existing pools with increasing claims. Over time, this can lead to sharp premium increases for those who are

Patients with serious or chronic conditions often discover that their insurance does not cover as much as they had expected. – BERNAMAPIC

payment options at toll plazas. That flexibility should continue. It is unlikely that we can roll back the Age of Apps. Technology is always advancing and over time it will make life easier. Perhaps the real issue is not the number of apps but how digital services are introduced and explained. With better communication and thoughtful implementation, having multiple apps can feel manageable and even logical. This should not be a debate about one app versus many. The focus should be on quality, security and ease of use. If we get those right, we can ensure resilience, inclusivity and user choice. Sharon Ling Sue Ann Petaling Jaya The assumption that being insured automatically means being protected is a comforting one. However, in practice, the more important question may not be whether you have private health insurance but whether your coverage is truly sufficient when it matters most. Nur Balqis Zahirah Ali and Rumana Akhter Saifi are from the Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya. Ng Rui Jie is from the National Health Financing Unit, Health Ministry. financial risks associated with illness. Personal savings, informed decision-making, and a clear understanding of policy details remain equally important in navigating an increasingly complex healthcare landscape.

On a personal level, digital literacy is no longer optional. Managing apps is part of modern life. It does not have to be overwhelming, and strong community support can help those who struggle, especially senior citizens. Inclusivity means recognising that different users require different features. Some need accessibility tools while others need offline or low data modes. Many still use older phones or have limited digital skills. During this transition, the key is to provide choices and backup options rather than forcing everyone into a single system. Governments and companies should also invest in helping people learn how to use new apps instead of simply expecting instant adoption. Take toll payments as an example. Motorists are currently given several limits or higher cost-sharing. Despite the importance of these decisions, health insurance literacy among Malaysians remains limited. Many policyholders are unaware of the specifics of their coverage until they need to make a claim. Questions about coverage limits for major procedures, exclusions for certain conditions, long-term affordability of premiums or the role of additional protection such as critical illness insurance are often considered too late. As a result, financial vulnerability emerges not from a lack of insurance, but from a mismatch between expectations and reality. Private health insurance should, therefore, be understood as one component of a broader approach to financial protection, rather than a complete solution. While it can significantly improve access to timely care, it does not eliminate the

to become more digital. The real question is how to make that shift as smooth and painless as possible. Two things will matter most: building resilience and ensuring inclusivity. Resilience means strengthening cybersecurity and maintaining systems properly. If too many services are placed under one app, there is always the risk of a single point of failure. It also means putting proper laws in place. The amendments to the Personal Data Protection Act in 2024 are a step in the right direction. Stronger legal safeguards help build public trust. At the same time, one size rarely fits all. Different services have different needs. That is why integrating apps gradually makes sense and why, at least for now, having a few different apps is unavoidable. most dependent on their coverage, forcing difficult decisions between paying higher costs, reducing benefits or discontinuing insurance altogether. Understanding what PHI can and cannot do is therefore essential. In Malaysia, PHI plays both a supplementary role, allowing individuals to bypass delays in the public sector and an increasingly complementary role, covering treatments or devices that are not readily available in public facilities. Employer-sponsored plans add another layer of support, but they are often tied to employment and may not provide continuity during career transitions or retirement. More recent initiatives to expand access through basic medical and health insurance or takaful products are a step in the right direction, but these entry-level plans often involve trade-offs such as lower coverage

LETTERS letters@thesundaily.com Apps should make life easier, not harder