NOVEMBER 24 — Malaysia talks a lot about the rising cost of medical insurance, but far less about those who can’t even get covered in the first place. 

This is especially concerning given that Malaysia’s gig economy surpasses three million workers in 2024.

Millions of Malaysians live one diagnosis, one job change, or one rejected application away from financial ruin. 

The uninsured and the underinsured are not a footnote in our healthcare system. They are the majority; they’re the centre of a growing crisis.

We often talk about affordability. But less about exclusion, the quiet, systemic filtering-out of people who don’t fit the neat, profitable profile: Pre-existing conditions; Irregular income; High-risk occupations; Older age groups; Lower-wage or informal jobs.

Malaysia has 34 million people, but only 7.7 million have any form of health insurance. That means nearly three out of four Malaysians are fully exposed to medical costs, relying on public hospitals already stretched thin. 

And within the insured group, many are badly underinsured, stuck with outdated plans, insufficient limits, or policies that quietly exclude the very conditions they need treated.

But zoom out and you see the deeper fault line: Our insurance system is designed around risk avoidance, not risk pooling. 

The healthier and younger you are, the more the system likes you. The more complex your life is, a chronic illness, unstable income, a hazardous job, the more the system quietly nudges you out.

This isn’t a business quirk. It’s a structural design.

A framework built on exclusion will always leave the most vulnerable outside the gate. And when they fall sick, they don’t disappear, they turn to public hospitals, pushing an already strained system even further toward breaking point.

As Malaysia’s population ages and chronic disease rises, these cracks are widening. We can’t keep patching the surface while the foundation shifts.

What’s missing in today’s landscape is a baseline layer of protection, something simple, essential, and accessible, designed not to maximise risk avoidance but to ensure no one is left completely outside the safety net. 

A product that doesn’t rely on cherry-picking but offers every Malaysian at least a minimum level of financial protection against medical shocks.

Such a foundation wouldn’t replace comprehensive plans. But it would finally acknowledge the reality that not everyone fits the underwriting mould, and that universal access to basic protection is the starting point, not the end point, of a fair system.

Malaysia doesn’t need more short-term interventions or one-off premium relief. It needs a structural rethink of how protection is distributed, and who gets to have it.

The question now is simple: Do we keep building a system around avoiding risk, or start building one that shares it?

* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.