马来西亚医疗和健康保险以及Takaful行业的成本驱动因素：集中索赔数据库初探

Claims DatabasePublic Disclosure Authorized APRIL 2026 Valerie T Ulep, Hwa Ching Hue, Aakash Mohpal, Christophe Lemiere and Sarah Bales © 2026 International Bank for Reconstruction and Development / The World Bank 1818 H Street NWWashington DC 20433Telephone: 202-473-1000Internet: www.worldbank.org This work is a product of the staff of The World Bank with external contributions. Thefindings, interpretations, and conclusions expressed in this work do not necessarily reflectthe views of The World Bank, its Board of Executive Directors, or the governments theyrepresent. The World Bank does not guarantee the accuracy, completeness, or currency of the dataincluded in this work and does not assume responsibility for any errors, omissions, ordiscrepancies in the information, or liability with respect to the use of or failure to usethe information, methods, processes, or conclusions set forth. The boundaries, colors,denominations, and other information shown on any map in this work do not imply anyjudgment on the part of The World Bank concerning the legal status of any territory or theendorsement or acceptance of such boundaries. Nothing herein shall constitute or be construed or considered to be a limitation upon orwaiver of the privileges and immunities of The World Bank, all of which are specificallyreserved. Rights and Permissions The material in this work is subject to copyright. Because The World Bank encouragesdissemination of its knowledge, this work may be reproduced, in whole or in part, for non-commercial purposes as long as full attribution to this work is given. Attribution:Please cite the work as follows: World Bank (2026) “Cost Drivers in Malaysia’sMedical and Health Insurance/Takaful Sector: A First Look at the Centralized ClaimsDatabase”, Washington, DC: The World Bank. Any queries on rights and licenses, including subsidiary rights, should be addressed toWorld Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC20433, USA; fax: 202-522-2625; e-mail: pubrights@worldbank.org. Cover photo: © 2474856299/ShutterstockDesign and layout: Good News Resources Sdn. Bhd., Malaysia / www.gnrsb.com Acknowledgements The task was led by Christophe Lemiere, Lead Health Specialist under the guidanceof Caryn Bredenkamp, Practice Manager for Health, Nutrition and PopulationGlobal Practice for the East Asia and Pacific Region, and Judith Green, WorldBank Group Country Manager for Malaysia. We are thankful to Matthew Dornan,Victoria Fan, Hideki Higashi and Ajay Tandon for their valuable feedback. The teamis grateful for excellent technical and organizational support received from RuzitaAhmed, Jeannette Goon, Anandita Mishra, Dina Murad, Reka Palaniappan andMei Ling Tan. This report was produced at the request of Government of Malaysia under theJoint Ministerial Committee on Private Healthcare Costs (JMCPHC) as part of theRESET initiative. The authors would like to express their sincere appreciation tothe Bank Negara Malaysia (BNM) team, led by Datuk Jessica Chew Cheng Lian, fortheir invaluable guidance and feedback throughout the production of this report.The team is also thankful to Ministry of Health, Malaysia for their collaboration andcontributions. The report would not have been possible without close collaboration with InsuranceServices Malaysia (ISM) led by Mahendran Samiappan. ISM provided the databasethat form the basis of the analysis in the report. Beyond providing the data, ISMundertook the years long effort of producing the standardized, centralized Medicaland Health Insurance/Takaful (MHIT) claims database. The team is grateful for the opportunity to present preliminary results and receivefeedback from the JMCPHC meeting held on January 22, 2026. The team alsoacknowledges inputs from Department of Statistics Malaysia (DOSM). Pleasecontact Aakash Mohpal at amohpal@worldbank.org for questions,comments, or suggestions related to the report. CONTENTS Acknowledgements........................................................................................................................................iiiExecutive summary..........................................................................................................................................1 1. Introduction..................................................................................................................................................52. Healthcare in Malaysia.................................................................................................................................93. Data and methodology.............................................................................................................................194. Overall trends in the private health insurance sector.............................................................................235. Service-level medical inflation.......................................................................................