03 Oct 2025

Press Statement

3rd October 2025
Kuala Lumpur

The Malaysian Society of Anaesthesiologists (MSA) and the College of Anaesthesiologists (CoA), Academy of Medicine of Malaysia expresses their serious concerns regarding a recent circular issued by a third party administrator (TPA). This circular appears to recommend that surgeons should prioritise local anaesthesia over general anaesthesia for surgical procedures. This profit-driven dictation by an insurance company represents an intrusion into medical decision-making and constitute an unethical attempt to dictate patient care. Medical treatment must be guided by professional judgment, patient needs, and evidence-based practice and not financial imperatives imposed by insurers or TPAs.

The practice of anaesthesia is a complex medical speciality that requires careful, individualised decision-making. Every patient presents a unique challenge, and it is essential for doctors to customise our approach rather than relying on a one-size-fits-all rule. While local anaesthesia is indeed appropriate and beneficial for many procedures, it is not universally suitable or safe to be designated as the first choice. Attempting to generalise its use without medical assessment risks compromising patient safety, surgical outcomes, and the ethical standards of care. Moreover, undermining the clinical judgment of surgeons not only erodes professional autonomy but also places undue pressure on these surgeons to prioritise cost over care, potentially endangering patient safety thereby leading to unnecessary litigation. In short, surgical colleagues should, in consultation with patients, determine who are suitable for daycare or inpatient surgeries and which modality of anaesthesia is needed. Decisions on whether a surgery should be performed as a day-care or inpatient procedure, and which modality of anaesthesia should be employed, must remain with the treating surgeon and anaesthesiologist in consultation with the patient.

Both MSA and CoA firmly maintain that:

  1. The choice of anaesthetics must be based on medical necessity rather than financial factors. We have observed instances where approvals are declined by insurance companies, despite clear justifications provided for the chosen anaesthetic. These denials often lack proper explanation, forcing patients to pay out-of-pocket and later file claims. The requirement to justify every case to obtain approval imposes unnecessary administrative barriers, disrupting what should be a seamless process of care.
  2. Patient safety, comfort, and dignity should always be the primary focus in all perioperative decisions. Autonomy in clinical decision-making lies between the patient and the doctor, which includes the patient's right to choose the type of procedure relevant to his clinical condition. This right also extends to the choice of anaesthesia. The choice between local, regional, or general anaesthesia depends on critical factors such as the nature and duration of surgery, patient comorbidities, risk of complications, and, importantly, the patient’s safety and comfort. Such decisions, guided by the expertise of the attending anaesthesiologist and surgical team, must remain the prerogative of the professionals and not an administrative or financial directive. It is imperative that a blanket rule cannot be applied across the board, as no two patients are the same.

We call upon insurers, TPAs and managed care organisations to respect the boundaries of clinical decision-making and to collaborate with medical professionals in improving patient outcomes, rather than imposing prescriptive and potentially harmful directives.

Both MSA and CoA stand united with all anaesthesiologists and surgical colleagues in reaffirming our unwavering commitment: every patient deserves safe, evidence-based, and individualised anaesthetic care. This commitment to patient safety is at the core of our opposition to directives that threaten clinical autonomy.

 

Dr Hasmizy Muhammad
President
Malaysian Society of Anaesthesiologists
Dato’ Dr Yong Chow Yen
President
College of Anaesthesiologists, AMM

 

 

 

 

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