Methods to Reduce Outstanding Medical Fees at Public Hospital in Malaysia: An Action Research Project

Abstract

AbstractThe aim of the study to solve problems related to revenue collection at Public Hospitals in Malaysia. Using the action research approach, two phases were adapted to review the state of metastasizing outstanding medical fees at one of the public hospitals located at west coast of Sabah and its contributing factors. The secondary data from monthly or annual financial reports, focus group discussions (N = 20), and review of government documented regulations and manuals were gathered in this study. It was revealed that the significant proportion of outstanding medical fees in the public hospital is attributed to non-citizens. The main problems faced include noncompliance with policies and procedures in the revenue collection process; lack of IT-based revenue cycle management; and poor engagement of hospital staff in revenue cycle management. Implementation of an IT-based billing system has improved communication between frontline and backend staff and hence improved revenue collection efficiency. Further collaboration with higher authorities in the implementation of a comprehensive online payment system and to increase insurance coverage for non-citizens via medical and social services are explored.Keywords: Action researchoutstanding medical feesrevenue cycle managementpublic hospital AcknowledgmentsThe authors would like to thank the Director General of Health Malaysia for his permission to publish this article. A special acknowledgement goes to Sabah Women and Children Hospital, the Ministry of Health Malaysia, and the University of Technology Malaysia (UTM) for this study.Ethical and Site ApprovalThe Medical Research and Ethics Committee (MREC), Ministry of Health Malaysia, granted this study its ethical approval (NMRR-ID-22-02147-ILW). In addition, permission to conduct the study in the studied public hospital was granted from the Hospital Director.Authors’ ContributionsL.S.Y and Z.M.A conceived the original idea. This was discussed with R.B and D.R.S. Eventually all authors discussed and agreed with the main focus and ideas of the paper. L.S.Y conducted most the data collection. The results were done by L.S.Y., R.B., and Z.M.A. The main text and experimental results of the paper was written by L.S.Y. and subsequently improved by R.B., Z.M.A., D.R.S., with many helpful suggestions from Z.M.A. and R.B. D.R.S. helped edit the manuscript and writing part of the paper.Informed consentInformed consent is obtained from the participants of FDGs prior to the conduct of the interview.Disclosure statementThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.Data availability statementData and materials will be made upon request.Additional informationFundingThis research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit organizations.