Numerous letters to the Forum have highlighted the issues of Integrated Shield Plan (IP) panels, from the perspective of policyholders and doctors. This was followed by an Opinion piece “How to fix S’pore’s healthcare insurance and preserve care continuity for patients” (April 25).

Policyholders with private IPs are steered towards panel specialists to get benefits, or to avoid incurring extra out-of-pocket costs.

The enrolment and removal of panel specialists are entirely at the discretion of the insurers. Many specialists, especially those new to private practice, continue to have difficulty getting onto panels.

Long-term policyholders have been adversely affected by panel restrictions, but are unable to change insurers (Insurer making it hard for policyholders to have continuity of care, April 7).

Doctors have pointed out that steering patients to panel doctors may affect the timeliness of urgent care, and disrupt existing patient-doctor relationships. (Abolish medical panels – they negatively impact patient care, stifle competition, April 12; and Should patient-doctor relationship be cornerstone of healthcare system? April 17).

There has also been increased scrutiny of claims, which may delay claims settlement.

There is a power imbalance between IP insurers and their policyholders. Insurers are free to vary the terms and conditions of the policy by serving notice to policyholders. 

Even if policyholders disagree with changes in terms and conditions, they may feel compelled to accept them, as any medical condition they have developed over the years would be considered as pre-existing conditions by other insurers.

Other insurers may impose premium loading, exclude coverage of pre-existing conditions, or reject coverage altogether. 

Panels were implemented by IP insurers to mitigate healthcare inflation.

The Singapore Medical Association feels that doctor fee inflation has been adequately addressed through the Ministry of Health (MOH) fee benchmarks, as well as efforts by the MOH claims management office to reduce inappropriate claims.

We continue to recommend that IP panels be open to all specialists who undertake to charge reasonably, or alternatively to have panels abolished. 

To address the issue of power imbalance, stakeholders and regulators could look into whether changes in insurance design, such as the portability of IPs, would be beneficial. If policyholders can change their IPs without losing coverage for pre-existing conditions, it could promote healthy competition among insurers and ensure that policyholders get a fair deal.

Ng Chee Kwan (Dr)
President
Singapore Medical Association