Malaysia's medical claims inflation jumped 12.28% in 2025, with 11.22 percentage points attributed to a rise in the number of claims reflecting higher healthcare utilisation, according to the Life Insurance Association of Malaysia (LIAM) and other sources [1, 2]. Mark O’Dell, LIAM CEO, said, "Medical claims inflation remained high at 12.28 per cent in 2025. Importantly, 11.22 percentage points came from the increase in the number of claims. This shows that utilisation, and not just medical prices, is a major driver of rising claims costs" [1]. The insurance and takaful industry paid RM13.5 billion in claims last year, up roughly 10.7% from RM12.2 billion in 2024 [1, 2].
Public hospital claims represented 9% of total claims but saw a 14% drop in claim costs from the previous year, while private hospital care costs rose 5.89%, and private day-care claims costs increased by 2.3% [1, 2]. Inpatient claims dipped slightly from about 808,200 in 2024 to 803,400 in 2025, but day-care claims climbed from 314,500 to 354,100 during the same period [1]. Leading inpatient diagnoses included heart disease, disc disorders, infectious gastroenteritis and colitis, pneumonia, and bronchitis, while cataracts, breast cancer, gastritis, lung cancer, and other eye disorders topped day-care claims [1].
Healthcare utilisation encompasses factors such as the number of patients seeking treatment, frequency of treatments, procedure types, and care intensity. The ageing population and rise in non-communicable diseases drive these trends, the report notes [1]. The World Bank’s analysis aligns with LIAM’s findings, identifying healthcare utilisation and service intensity as key contributors to rising medical claims costs in Malaysia [1, 2].
蔡金顺, CEO of the Malaysian General Insurance Association, stated, "Managing the growing claims requires stakeholders to unite and implement transparent operations and more efficient healthcare services to respond to increased healthcare utilisation and ensure affordability and sustainability of medical coverage" [2].
The report noted that the average annual medical claims inflation between 2023 and 2025 stood at 13.63%, higher than the 8% average during 2013-2018 [2]. It recommended measures such as cost controls, fraud prevention, greater transparency, diagnosis-related group payment models, and primary care insurance plans to restrain claims growth [2].
