I refer to the letters by Ms Ng Sout San (Insurance company making it hard for policyholders to have continuity of care, April 8) and Dr Tan Yia Swam (Insurers should be transparent about how they pay doctors, April 10) lamenting the practices that benefit insurers at the expense of other stakeholders in the healthcare ecosystem.
Insurers introduced American-style insurance panels and pre-authorisation to counter decreasing profits from their Integrated Shield Plan segments. Along with Ministry of Health (MOH) fee benchmarks, this resulted in increased profits. Despite this, insurance premiums keep increasing, while patient benefits and doctors’ reimbursements are being progressively tightened.
After office hours or during holidays, patients may have difficulty getting urgent care because a panel specialist cannot easily be found. Some insurers encourage patients to use the restructured hospital system even if they have full private health cover, defeating the purpose of paying insurance premiums.
Insurers also use non-medical staff, or non-specialist doctors, to decide which treatments to authorise. Patients have been unreasonably denied coverage or had surgery delayed waiting for authorisation. Who is responsible if the delay or denial results in a poor outcome?
The panel system stifles competition in the private healthcare industry. Panel doctors’ charges are restricted to the lower half of the MOH benchmarks. Doctors will not charge less for simpler procedures, because they are unable to charge more for complex ones covered by the same procedure code.
Thus, simple cases subsidise complex ones, which is unfair to patients.
Doctors with rare skills or greater experience cannot charge more to reflect this, and patients cannot see these doctors if not on the panel unless they pay more. Conversely, doctors new to private practice have difficulty joining panels, hamstringing their competitiveness.
I urge the authorities to look into these practices, which negatively impact patient care and stifle competition.
I propose that all panels be abolished so that patients can see any doctor without penalty. Doctors should be allowed to use the full range of the MOH benchmarks. Insurers could still fix their reimbursements, with patients topping up the rest (called the “gap” in Australia). Instead of panels, insurers could have agreements with doctors who do not charge a “gap”, featuring them as preferred providers.
Pre-authorisation should also be reviewed, to be signed off by a relevant specialist doctor who is accountable for the decision.
Andrew Yam (Dr)
