(Meeting between the Malaysian Society of Anaesthesiologists, College of Anaesthesiologists, Academy of Medicine Malaysia, Malaysian Medical Association and senior Management team of MediExpress Sdn Bhd)

The meeting was convened to discuss the recent memorandum that was released regarding the choice of anaesthesia for daycare surgical procedures. The memorandum suggested that local anaesthesia (LA) should be prioritised as the first-line anaesthetic modality for procedures and surgeries unless clinically contraindicated

The discussion was held in a cordial mutually respectful manner with open and constructive engagement from all parties. Representatives from the MSA, CoA, and MMA reiterated that any directive or memorandum issued by the healthcare industry or third- party administrators (TPAs) cannot supersede clinical decision-making which must always remain the prerogative of qualified medical practitioners. This principle was duly acknowledged and agreed upon by the MediExpress management team.

Key points that were discussed:

1. Clinical Autonomy and Patient Safety
   The clinicians present emphasised that the choice of anaesthetic technique must be guided by clinical judgment, patient safety, the specific procedural context, and not by administrative or financial policies. It was also noted that advancements in anaesthetic techniques and perioperative care have expanded the range of procedures that can safely be performed as daycare surgeries, further supporting evidence-based and individualised clinical decision-making.
    
2. MediExpress Sdn Bhd Clarifications
   The MediExpress team clarified their position and stressed that the intent of the memorandum was not to interfere with clinical management, but to ensure clarity in the claims review and approval process. They explained that their goal was to understand the rationale behind certain choices for transparency and claims verification purposes, not to dictate or restrict clinical decisions.
    
3. Communication and Role Clarity
   It was highlighted that any communication regarding claims decisions or financial explanations should be the responsibility of the financial planner, agent, or TPA representative, rather than the attending doctors. Clinicians are not in a position to address insurance-specific terms or reimbursement justifications, and such communication should be handled directly by the relevant administrative parties.
    
4. Addressing Future Disputes and Unethical Practices
   The meeting also discussed the importance of establishing clear mechanisms to manage future disputes between hospitals, doctors, and TPAs. All parties agreed on the need to curb unethical practices and potential abuse, including instances where unnecessary procedures may be performed for financial gain. It was mutually agreed that errant hospitals or practitioners should be flagged through appropriate channels, enabling corrective or disciplinary measures where necessary. Direct communication, transparency, and trust among all stakeholders were identified as key elements in maintaining integrity and fairness within the system.

The meeting concluded on a positive note, with all parties agreeing to maintain open communication and foster collaborative relationships between clinicians, hospitals, TPAs, and insurers. The spirit of cooperation demonstrated during this discussion was acknowledged as a vital step toward building mutual understanding and safeguarding patient welfare. Ultimately, all participants reaffirmed that patients must remain at the centre of all decision-making, and that trust, professionalism, and transparency should guide every aspect of healthcare delivery and financing.

Prepared by

Dr Gunalan Palari
Chairman
MSA/CoA Fee Committee
9th October 2025