Apart from being the implementer of the National Covid-19 Immunisation Programme (NIP), ProtectHealth coordinates, administers and manages initiatives related to financing healthcare services, as mandated by the MoH.
One of them is the Skim Peduli Kesihatan untuk Kumpulan B40 (PeKa B40) healthcare scheme and it has since established a partnership with the private sector.
“ProtectHealth is the healthcare scheme administrator for Skim Peduli Kesihatan untuk Kumpulan B40 (PeKa B40),” shared Dato’ Dr Anas Alam Faizli, CEO of ProtectHealth.
The PeKa B40 healthcare scheme is an initiative by the government through the Ministry of Health to address the health needs of the lower-income, focusing primarily on non-communicable diseases (NCDs).
PeKa B40 is offered to Malaysians who fall within the lower 40 per cent of the household income range, known as the B40 group.
Recipients of Household Living Aid or Bantuan Sara Hidup (BSH) and their spouses, aged 40 years and above, are automatically enrolled in PeKa B40.
Anas shared: “As of May 30, 504,034 beneficiaries had been screened and 23,826 applications for health aid approved. Another 5,271 applications for completing cancer treatment incentives have been approved, and 17,293 applications for transport incentives approved.”
Health-related benefits under PeKa B40
No registration is specifically required to join PeKa B40. Through this scheme, recipients will receive four health-related benefits where appropriate.
“The first is health screening which includes medical history taking and physical examination, mental health screening, clinical breast examination for female recipients, and clinical prostate examination for male recipients who are at risks, and blood and urine tests.”
Health aid is the second benefit under PeKa B40. A maximum of RM20,000 is given to the recipients in the form of purchased medical equipment.
The health aid benefit includes medical equipment in 10 categories – stents for the heart, artificial joint equipment, hearing aid devices, heart pacemakers, prostheses and implants for the spine, prostheses and orthoses for the limb bones, intraocular lenses, breathing therapy equipment and oxygen concentrator, nutritional support assistance and wheelchairs.
The third benefit is the Completing Cancer Treatment Incentive (CCTI). An incentive of RM1,000 is given in two phases to encourage cancer patients, especially those in the early stages of treatment and disease, to complete their treatment plan.
Lastly is the transport incentive benefit. To alleviate the burden of paying for transportation, whenever recipients have to travel to receive treatment at MoH hospitals, they receive RM500 for Peninsular Malaysia and RM1,000 to Sabah, Sarawak & Labuan.”
Medical audits important
How does ProtectHealth register, coordinate, monitor, and manage the payments for GPs under the PeKa B40 healthcare scheme?
According to Anas, ProtectHealth has in-house proprietary software called Benefit Management System (BMS). It integrates all processes related to this scheme with 2112 GPs, 897 government clinics, 145 government hospitals and 182 pathology labs.
“All GPs who are interested in PeKa B40 can register online via our BMS and are required to fulfil minimum requirements to become PeKa B40 clinics.
“Through our in-house medical claims management, we organise, bill, file, update and process more than 500,000 medical claims related to patient diagnoses, treatment and medication.
“We also have a medical audit that is responsible for a step-by-step analysis for the quality improvement of patient outcomes and financial risk protection for an effective and efficient healthcare system. GP audits that are performed both periodic and random also investigate data anomalies.”
ProtectHealth is also the Electronic Service Provider (ESP) operator for Skim Perlindungan Insurans Kesihatan Pekerja Asing (SPIKPA).
“It is an annual renewable hospital and surgical insurance scheme designed to reduce the financial burden of the employer of foreign workers in the event of hospital admission of their foreign workers to MoH hospitals,” explained Anas.
“Through the ESP system, it enables insurance companies and Third-Party Claim Administrators (TPCA) to create and submit the relevant documents required for the scheme via the platform that we manage.”
ProtectHealth is also mandated to do strategic purchasing to reduce healthcare costs and to enhance primary health care.
“Under strategic purchasing, we manage to standardise the price and reduce the cost. For example, we have saved the government more than RM10 million by reducing the cost for the drug-eluting stent.”
“Healthcare costs are rising at inflation rates. The workload distribution is still heavy towards the public sector, but the facilities are better in the private sector.
“So, the challenge is to rationalise and redistribute this workload and reduce the private health care costs.”
According to Anas, developing affordable healthcare financing for all is the best way, and it would be a game-changer.
“Going forward, I think ProtectHealth should consider doing all the other financing health financing mandates.
It’s a long process, but I think we are taking the necessary steps to reach the goals.
“In essence, ProtectHealth will continue to be the main part and key driver of any plan for health reforms in the country.” — The Health