Heart Attack - Leading Cause Of Death - Malaysia

Heart attack remains the leading cause of death in Malaysia for the 14th year. Ischaemic heart diseases, which occur when arteries of the heart cannot deliver enough oxygen-rich blood to the heart, continued to be the main cause of death in Malaysia last year with a total of 18,267 deaths or 15.6% of total deaths from various causes, the latest Statistics on Causes of Death in Malaysia released by the Department of Statistics Malaysia (DOSM) revealed. 

It was the principal cause of death for males in Malaysia with 12,510 deaths (17.8%) while for females, the principal cause of death was pneumonia with 6,033 deaths (12.8%), it said.

Last year, 172,031 total deaths from various causes were recorded, an increase of 2.3% compared to 168,168 in 2017, it said.

“On average, 50 persons in Malaysia die of ischaemic heart diseases every day,” DOSM said in the statistics released yesterday.

According to the National Heart, Lung and Blood Institute in the United States, the most common type of ischaemic heart diseases is coronary heart disease (also known as coronary artery disease).

It is caused by the build-up of plaque inside the coronary arteries. The build-up can partially or totally block blood flow in the large arteries of the heart. The condition may be caused by disease or injury which affects how the arteries work in the heart.

Coronary microvascular disease is another type of ischaemic heart diseases which occurs when the heart’s tiny arteries do not function normally.

Risk factors include smoking, high blood pressure, high cholesterol, diabetes, being physically inactive, overweight or obese, and family history.

DOSM said ischaemic heart diseases were the principal cause of death in 90 administrative districts in Malaysia and the highest percentage was recorded in Petaling, Selangor (16.3%).

Urban areas recorded 12,101 cases, double that in rural areas (6,166 cases), it said.

Pneumonia was the principal cause of death in 48 administrative districts with the highest percentage recorded in Kota Setar, Kedah (17.8%).

The number of deaths due to ischaemic heart diseases in Malaysia in 2010 was 9,371 and the figures increased gradually through the years. The jump increased more prominently from 2016 to 2017 (13.9%) and from 2017 to 2018 (15.6%).

After ischaemic heart diseases, the second main cause of death last year was pneumonia (11.8%), followed by cerebrovascular diseases (7.8%), transport accidents (3.7%) and chronic lower respiratory diseases (2.6%).

On the main causes of death by age group, 4.8% of those aged 0 to 14 died of pneumonia and 20.4% of those aged 15 to 40 died in transport accidents.

The main cause of death among those above age 40 was ischaemic heart diseases: ages 41 to 59 (19.2%) and ages 60 and above (16.6%).

Malaysia Medical Insurance Inflation

Controlling the unabated rise of medical inflation in Malaysia is integral in ensuring that health insurers remain relevant in the industry and are able to provide affordable and extensive coverage in the market.

Malaysia’s medical and health insurance market reportedly has the highest average gross medical inflation, coming in at approximately 15.4% in 2018, and is expected to continue rising.

Among the reasons driving medical inflation higher in the country are the rise in non-communicable diseases, higher average life expectancy and the costs associated with employing the relevant staff to operate new and advance medical technology.

This means Malaysians will be paying more for healthcare in the coming years and medical insurance premiums will be pushed higher.

There is immense untapped potential in the life insurance market today, with only an estimated 54% of the Malaysian population covered by life insurance or takaful plans. This means only 34 out of 100 people in Malaysia are insured when accounting for policyholders with more than one life or takaful policy, according to findings by LIAM.

Escalating private healthcare costs are prompting more and more Malaysians to seek out protection, but insurance premiums rising in tandem with medical costs could keep many Malaysians uninsured or having protection plans without extensive coverage.

In its 2018 annual report, LIAM said discussions are being held with the Ministry of Health (MoH) and Association of Private Hospitals Malaysia to look into medical cost containment measures.

Among the initiatives being explored is standardising the billings used by private healthcare providers and introducing medical fee benchmarks by publishing the charges of common medical procedures in private hospitals.

These are in view of promoting transparency in how healthcare expenditure is being charged across various private settings, LIAM said.

“It is important that hospital and medical charges are transparent to the public to help them make informed decisions of the cost of treatment. Moving forward, the industry will continue to engage with the MoH and other stakeholders to manage the increasing healthcare expenditure,” it said.

The life insurance industry has been regulated by Bank Negara Malaysia since the supervision of the entire insurance industry was brought under the central bank’s ambit back in 1988.

Riot Insurance - Hong Kong

Hong Kong’s businesses will likely foot the bill for vandalism inflicted over the past four months during the territory’s most violent protests in living memory as few of them bought insurance coverage for riot damage, industry insiders said.

Businesses big and small have suffered smashed windows, graffiti and even fire for their perceived support of mainland China by activists concerned that the central government in Beijing is exerting increased control over the special administrative region at the cost of democratic freedoms.
Displaying a banner in support of the police – who protesters have complained of being heavy-handed – was enough to see a small video game shop in western New Territories vandalised four times this month.

“I don’t know whether I’ll get insurance compensation,” said shop owner KK Man. There’s a chance that I won’t get compensation because the damage is due to social unrest … I don’t think riot damage is covered.”

While businesses flood insurers with claims for such damage, few are likely to be fully compensated as Hong Kong insurance usually protects against events such as fire and natural disasters, such as typhoons.

Coverage for civil unrest, particularly for small and mid-sized firms, is uncommon, industry insiders said.

Hong Kong is a lucrative market for global insurers including American International Group Inc, AXA SA and Zurich Insurance Group AG, with the value of premiums as a percentage of gross domestic product at 18.16%, second only to Taiwan in the Asia-Pacific region.

Total insurance premium volume in the territory last year rose 8.3% to US$66 billion, the quickest growth rate in the advanced Asia-Pacific region that includes Australia, Japan and Singapore, a Swiss Re study showed.

Near term, Hong Kong insurers expect a surge in demand for coverage that includes riot damage, though profit is likely to suffer from payouts for event cancellations, a drop in demand for travel insurance and, more generally, economic downturn. 

“Overall financial damage from these events will be quite significant and neither insurers nor most of the businesses would have prepared for something like this,” said an insurance sector lawyer with a global law firm. “So you will see a sharp rise in litigation around what’s covered and what’s not, as well as pressure on earnings of insurance companies because of a surge in claim settlements and a drop in premium income,” the lawyer said.

The financial impact of the protests could not be determined with unrest ongoing, but two insurance executives said liabilities for insurers could run into millions of dollars.

The executives and the lawyer declined to be identified due to the sensitivity of the matter.

Anti-government demonstrations have taken place on almost every weekend since June 9. Yesterday, riot police and protesters exchanged tear gas and petrol bombs as an illegal march descended into chaos, with hundreds of shops trashed and Chinese banks and metro stations targeted.

Retailer Best Mart 360 Holdings Ltd on Wednesday said as of Oct 13, 59 of its stores had suffered damage during protests.

“The Group is discussing and handling with its insurance company,” it said. In the event that the insurance company refuses to compensate or inadequately compensates its claims, the Group may be required to bear the corresponding economic losses.”

Best Mart did not identify its insurer or elaborate on why compensation might be refused. An external spokeswoman for the retailer declined to comment beyond the statement.

Damage to subway stations of operator MTR Corp Ltd may not be fully covered by its insurance, and its inability to recover such costs is likely to weaken its credit profile, credit-rating firm Moody’s Investors Service said last week.

MTR declined to comment.

“Hong Kong property insurers have been making a profit for 20 years, but following two super typhoons in the past two years, they lost all 20 years’ worth of profit,” said a non-life insurance broker in Hong Kong.

“That’s why in 2019 they have been extra prudent in covering property,” the broker said. “Luckily there’s been no big typhoon this year, but the unlucky thing is there have been riots.”

Medical Increasing Premium

While Malaysians are becoming more aware of the need to have medical insurance/takaful, they also have to contend with increasing premiums/ contributions. This second article of a three-part series on medical insurance/ takaful in Malaysia examines the drivers behind this current scenario.

When you or your loved one is sick or hurt, getting adequate and timely medical care is a must. More and more Malaysians are turning to private doctors and hospitals because of the greater number of qualified specialists on staff, newer facilities and a full suite of diagnostic and procedural equipment.

Going to a private hospital however can be an expensive affair. For this reason, a growing number of consumers are purchasing medical insurance/ takaful to cover the costs when the need arises.

Medical insurance/takaful can come in all shapes and sizes. These days most policies/certificates are comprehensive and come with medical cards, allowing the policyholder/certificate holder to be admitted to hospital and doctor charges guaranteed by the insurance company/ takaful operator.

The most common coverage taken today will often pay for the entire hospital bill.

Although they are popular, these policies/certificates have seen premium/ contribution increases in recent years. Before we look at the drivers behind the increases, we must first understand that the cost of comprehensive medical policies/certificates would automatically rise as you get older. With a typical standalone policy/certificate, you can expect your premiums/contributions to go up, often according to five-year age bands.

If you have taken your medical insurance/takaful as a unit deducting rider on an investment linked policy, the monthly cost for your coverage would gradually increase throughout the policy/certificate term. This pricing practice is in line with the fact that the older you get, the higher the chances that you’d make a claim.

All medical plans in Malaysia are priced carefully by qualified actuaries. Using the best available data and experience on the expected frequency and severity of potential hospitalisation, premiums/contributions are set according to your age and gender.

These premiums/contributions are drawn up based on a variety of assumptions including the probability of a yearly medical inflation. The pricing is then reviewed periodically. If actual claim volume differs from the assumptions, insurers would then consider to revise the premiums/contributions charged.

Medical inflation is often higher than other goods and services due to improvements in technology and treatments, new drugs, people living longer and requiring more medical care, etc. Insurance companies/takaful operators might reasonably price an inflation rate of six to eight per cent to cover medical inflation.

But with Malaysia having experienced one of the highest medical inflation rates in Asean in recent years, the expected increase in claims for 2019 is 13 per cent. As a result, insurance companies/takaful operators have had to revise their premiums/contributions upwards.

In response, the industry has formed a joint task force to understand the issue better and address it. The Life Insurance Association of Malaysia (LIAM), the Malaysian Takaful Association (MTA) and the Persatuan Insurans Am Malaysia (PIAM) have jointly commissioned an independent consultant to conduct a comprehensive study on the drivers of medical claims inflation.

The outcome will be used to produce a plan, together with other industry stakeholders, to reduce the high undesirable rate of premium/contribution increases.

The bottom line is to be a wise consumer. Remember that, even in the case where your hospital bill will be covered in full by the insurance company/takaful operator, the cost of each treatment will count towards your yearly and lifetime limits. In the end, lower claims will result in lower premiums for all policyholders.

Medical Insurance Options

While medical care and treatment at government hospitals are generally affordable, the average Malaysian will oftentimes choose to seek care from private hospitals, as service and care are perceived to be better, and the waiting time much shorter.

However, medical cost has been ascending at a rate exceeding 12 per cent per annum – making the cost of seeking treatment at such facilities a little out of reach for some. Getting medical insurance has therefore become essential.

As it stands, the insurance penetration rate in Malaysia is currently around 41 per cent, which makes it crucial for Malaysians to be better informed on the need to get protection.

Before deciding on the kind of coverage needed, it is a good idea to understand the basics of insurance to have a clearer picture. With so much industry-specific jargon floating around, the concept of insurance and the mechanics that go behind it may be a little hard to grasp for most people.

To help you along, we’ve listed some key terms that you will encounter in your quest to find an insurance coverage that’s best suited to your needs.

Medical Card - Generally, an individual medical insurance coverage offers a medical card facility for hospital admission.

The types of coverage vary with the products which may range from comprehensive to budget cover and includes expenses for surgeries, room and board, in-hospital related fees (operating theatre, hospital supplies and services, anesthetist, pre- and post-hospitalisation fees, among others).

The medical card provides you with insurance coverage. Upon presenting the card, the hospital will contact and inform the insurance company of your admission, diagnosis and prescribed treatment. The insurance company will then review and, upon confirmation of eligible coverage, issue a guarantee letter to the hospital for the expected expenses.

This card often saves the need for paying large deposits and filing your claim after you’ve settled the bill. For non-emergency cases, you can save time and hassle by obtaining your hospital guarantee from the insurer/takaful operator a few days ahead of admission.

Meanwhile, for medical coverage provided by employers, most people make the mistake of thinking they don’t need to purchase additional health insurance as they believe they are already “covered”. What they don’t realise is the coverage provided by their employer may be restricted (in terms of limit and in-patient care). In this instance, it would be wise to get additional health insurance to “top up” any additional costs that may be incurred.

Panel hospital - The medical card that you sign up for comes with a list of participating hospitals. You need to use the hospitals on the panel to enjoy the insurance guarantee facility.

Premiums = This is the payment made to the insurance company that the consumer needs to bear, regardless of whether he/she has visited the doctor’s office or used any of the benefits offered by the insurance company. Insurance premiums can be done monthly, quarterly or yearly. Depending on the insurer, the annual premium payment option may give you better savings in the long run.

Using the accompanying table as an example, here are a couple of scenarios on the types of schemes available for two young adults with no pre-existing conditions:

A 25-year-old man who signs up for the zero deductible MHE150 plan can expect to pay a monthly premium of RM89.50. This policy has an annual limit of RM1 million and no lifetime limit.

Meanwhile, a 29-year-old woman who opts for the MHE150 plan with RM500 deductible has the same coverage but pays a slightly lower premium of about RM78 a month or RM937 annually.

Lifetime and Annual limits - This is the maximum amount claimable from your insurer during your lifetime as long as your policy is still inforce with the company. Once your lifetime limit is exhausted, any further medical costs will no longer be covered. The amount of lifetime maximum limits may differ, depending on the plan/insurer chosen. Annual limit, on the other hand, is the maximum amount (as stated in your selected plan) you are entitled to claim for one policy year.

Deductible - This is the amount of money you have to pay out of your own pocket before your actual coverage begins. Your insurance company will only cover costs that are above your deductible.

For example, most plans today come with the option of either a zero or RM500 deductible. A zero deductible plan means you pay nothing in the event that you are admitted to hospital; the total cost will be borne by the insurer.

Meanwhile, with a RM500 deductible, you only need to pay RM500 of your total bill while the balance is paid by the insurer.

The benefit of having a deductible means that your health insurance is cheaper – your monthly premium with a deductible will cost 10-20 per cent less than one without.

Standalone vs Rider - A standalone medical plan behaves like a term insurance in that you are covered as long as you pay your premium. On the other hand, a medical insurance rider comes attached to a basic life insurance policy, most commonly an investment-linked policy (ILP). The cost of a medical rider attached to an ILP is generally lower than a standalone plan. However, your total cost is higher given the additional life insurance protection afforded with the ILP.

Guaranteed Renewal - As long as your policy is paid on time and you want to continue with the insurance, the insurance company is obligated to renew the policy (provided the lifetime claim limit has not been exceeded and you have not reached the maximum eligible age for coverage).

Non-Guaranteed Renewal - This simply means your policy is renewed on a yearly basis, subject to the insurer’s approval. For instance, if you are struck by an illness that is likely to recur in the future, the insurer may decide not to renew your policy. When you shop around for new insurance, you’d have to disclose your pre-existing condition. This will lead to higher premiums or in some cases that particular illness may even be excluded from coverage. For these reasons, policies that are non-guaranteed renewable are less costly.

Buying medical insurance can seem complicating and daunting. The advice of a professional advisor is often needed, however the better informed you are, the better purchase decisions you will make.

Lessons From Forever 21

When Forever 21 filed for bankruptcy last month, the fast-fashion chain described its history in documents that read, at times, like a pitch for a memoir or a Netflix special. The filing emphasized the improbable success of the Changs, who immigrated to the United States from South Korea in 1981 and built a multibillion-dollar business from scratch. 

There were references to the daughters' degrees from "Ivy League universities" - both are top executives at the company - and summer breaks spent at Forever 21 stores. A definition of the American dream, as explained by Investopedia.com, even appeared on one page.

The Changs were indeed a unique success story, and Forever 21 was far from a run-of-the-mill family operation. At its peak, the retailer took in more than US$4 billion (S$5.4 billion) in annual sales and employed more than 43,000 people worldwide in hundreds of stores.

Now, it is leaving 40 countries and closing up to 199, or more than 30 per cent, of its stores in the US as part of its bankruptcy, and former employees and industry experts are pointing to the Changs' insular management style as a significant reason for the collapse.

Real Estate Mistake - They cite disastrous real estate deals and the chain's bungled merchandising strategy in recent years.

"On the founder side, this hubris thing is pretty common, but it's particularly deadly if you've been successful for a long time," said Mr Erik Gordon, a management expert at the University of Michigan Ross School of Business. "They didn't have a board of directors to give them a reality check, they didn't have equity analysts to give them a reality check."

He added: "You can live in your self-created bubble for a lot longer, but then the bubble pops."

The bankruptcy filing provides a rare glimpse inside a retailer that has been intensely secretive and privately held for decades. Six former employees, including three executives, also spoke to The New York Times about their experiences at Forever 21 on condition of anonymity, citing non-disclosure agreements.

Forever 21's missteps, combined with industry-wide changes in consumer tastes and shopping habits, will have far-reaching effects for thousands of people who work for the company, its vendors and malls. The chain says it will still operate hundreds of stores, along with its website. Through a spokesman, the Chang family declined to comment for this article.

Forever 21 - named because Mr Chang considered 21 to be "the most enviable age" - was built on the idea of identifying apparel trends, then working with vendors to bring those products to stores quickly at cut-rate prices. From its early days, Mr Chang, who is still the company's chief executive, oversaw landlord and vendor relationships while Mrs Chang led design and merchandising. 

Former employees say that the top floor of the company's Los Angeles headquarters was viewed as Mr Chang's world, where corporate strategy unfolded and people kept quiet outside his office, while the bottom floor was Mrs Chang's domain of buyers and planners, who showed their bags to security when leaving the building.

Three former employees said that, as recently as this year, Mr Chang was personally signing off on employee expenses and questioning executives about receipts for lunches or Uber rides.

The couple's daughters eventually joined the executive ranks. The elder, Linda, is the executive vice-president and has been viewed as Mr Chang's successor; her sister, Esther, is vice-president of merchandising.

The Changs never took Forever 21 public, unlike their biggest fast-fashion rivals, "declining numerous opportunities that would facilitate generational wealth", the filing said.

Their inner circle - included another Korean-American couple: Mr Alex Ok, Forever 21's president and a former supplier, and his wife, Seong Eun Kim Ok, who works in merchandising.

Internally, some referred to Mrs Chang and Mrs Ok as the "Missuses", a powerful pair who directed the tens of thousands of styles that landed in Forever 21's bustling stores. The filing showed that the Chang family owned 99 per cent of equity in the chain, while Mr Ok held 1 per cent. 

As the business expanded, the Changs struggled with their desire to hire experienced executives and their distrust of outsiders, five of the employees said. In recent years, they said, Forever 21 eagerly recruited experts to overhaul parts of the business, then later ignored their recommendations on everything from new technology to marketing.

Some were reminded of that dynamic after singer Ariana Grande filed a lawsuit against Forever 21 in September.

The company's marketers had urged it to partner with Grande for a holiday campaign in 2014, according to two former employees, but management hired rapper Iggy Azalea instead.

Now, Grande is far more popular, and Forever 21 is defending itself against claims that it used a look-alike model of the singer in online ads.

The Changs' Christian faith - played a role in the way they ran the company. Forever 21's bright yellow shopping bags are stamped with "John 3:16", a reference to a Bible verse. Mr Chang has said the verse "shows us how much God loves us", and hoped others would learn of that love.

Former employees said Bibles were sometimes visible in conference rooms and on Mr Chang's desk. It was not unusual for department leaders to have ties to the family or their church but no experience working for another retailer, employees said.

"Every once in a while, when we hired someone who had been there, we'd learn that they were never allowed to see the totality of the business performance and they were only given reporting on their specific sector," said Ms Margaret Coblentz, a former e-commerce director at Charlotte Russe.

Rivals saw Forever 21 "as both monolithic and inscrutable", she added. But Forever 21 made its biggest mistakes in real estate. In the years before and after the recession, the company expanded aggressively and decided to open huge flagship stores, setting up in cavernous spaces once occupied by Mervyn's, the bankrupt department store, as well as Borders, Sears and Saks. Its former head of real estate told Bloomberg Businessweek in 2011 that "having really big stores has always been Mr Chang's dream".

The stores became hard to fill with new merchandise, then turn over, however, and saddled Forever 21 with long leases just as technology was beginning to wreak havoc on American malls. Seven of the leases at the old Mervyn's stores were not set to expire until 2027 or 2028, which is longer than a typical lease, according to internal documents obtained by The New York Times.

Forever 21 said in the filing that most of its international locations were unprofitable as of 2015 and that its stores in Canada, Europe and Asia were losing an average of US$10 million per month in the past year. Overall, the annual occupancy cost of Forever 21's stores was US$450 million.

"They've gotten into categories and expression of fashion that are not closely aligned with their fast-fashion customer's preferences," said Mr Mark A. Cohen, the director of retail studies at Columbia Business School. "They never built the intelligence into the business that would have cautioned them from this real estate orgy and would have kept them from the kind of exposure that they have now." 

Yet even as its errors abroad became clear, Mr Chang and his real estate counterparts bet on even more US stores.

An internal playbook from 2015 described the retailer's plans for a new strip mall chain called F21 Red that would target mothers under 35. Its US$1.80 camisoles and US$7.80 jeans were meant to swipe at the Irish retailer Primark, which entered the US that year.

The playbook showed that six stores were already open, and that Forever 21 planned to open 35 more that year, including in regular malls, which was a surprise to the employees who had planned F21 Red. By 2017, several new F21 Red stores were posting sales that were around 50 per cent below company projections, internal sales reports show.

That year, Forever 21 also introduced a beauty chain, Riley Rose, that was viewed as the company's next wave of growth and sought to capitalise on the boom in Korean skincare products. It was created by Linda and Esther Chang and called "groundbreaking" in the bankruptcy filing, which grouped its sales with the slumping international division.

While former employees praised the sisters' work ethic, they said that Riley Rose, which had 15 stores this year, was an expensive gamble in high-priced malls and struggled to maintain vendor relationships. The company told The Times last month that Riley Rose may end up as a store within Forever 21 locations. It has filed to reject leases for nine previously planned Riley Rose locations.

Mrs Chang's side of the business was also making errors with the sprawling store base. Merchandising was based on the previous year's sales, and Forever 21 bought too little inventory in 2017, then too much in 2018, the filing said. It also duplicated merchandise by designing for "styles" like weekend or work looks, rather than categories like tops or dresses.

Forever 21 had about 6,400 full-time employees and 26,400 part-time employees when it filed, numbers that will likely shrink throughout the bankruptcy process. The company said that it would change how it merchandises, winnow its operations to the US, Mexico and Latin America, aim to increase e-commerce sales to more than just 16 per cent of the business and take other cost-cutting measures. When it filed, the company owed US$347 million to its vendors.

The Chang family will be listening to new voices. Its board of directors will grow from three members - Mr Chang, Ms Linda Chang and Mr Ok - to six, including Forever 21's former head of real estate, a lawyer and the former chief executive of Things Remembered. It also said that it had added several new managers in recent months, including a new chief financial officer. Mr Chang remains the chief executive.

"Forever 21 has basically been a one-trick pony," Mr Cohen said. "The founder and his wife did remarkably well until the business got too big for them to continue to do remarkably well by themselves."