Source: TODAY Online

Premiums could “rise significantly” if insurers decide to “recklessly increase” the number of doctors on Integrated Shield Plans (IP) panels, said the Life Insurance Association (LIA) Singapore on Friday (2 Apr).

Increasing panel sizes, said LIA Singapore, should be done “in a careful manner, while paying the doctors reasonable fees”, said an LIA spokesman.

“Insurers agree that we should control our own costs but we don’t really think there’s a lot of fat in our expenses to be cut,” the spokesman added.

Instead of increasing panel sizes, insurers could explore other ways to reduce costs such as by increasing premiums or co-payments or by pre-approving treatments, said LIA Singapore.

LIA Singapore was responding to a position statement on IPs released by the Singapore Medical Association (SMA) almost a week ago, in which SMA lamented the limited number of private specialists on the said panels and the low fees they receive, near the tail end of the fee benchmarks set by the Ministry of Health (MOH).

The medical association claimed that they are faced with higher costs than before due to an increase in management expenses and commission costs for insurers rather than higher claims.

LIA Singapore said this could be the Health Insurance Task Force’s recommendations being implemented, which not only skyrocketed insurers’ expenses in recent years but also had moderated claims growth.

The task force had in 2016 recommended that patients foot a portion of their bills, as well as for panels of approved healthcare providers to be set up and fee benchmarks to be set.

LIA Singapore, however, highlighted issues with the MOH fee benchmarks, stating that doctors are not obligated to follow them and the thresholds are thus not effective enough in guiding prices.

The upper end of fee benchmarks is 1.8 times higher than the lower end. For two per cent of procedures, the highest limit of the fee benchmarks is 4.2 to 6.3 times the lowest bound.

In contrast, doctors on panels sign contracts that compel them to charge within the fee range stipulated in the said contracts.

“Many procedures do not have descriptors for when a doctor should charge towards the upper end and when a doctor should charge towards the lower end,” said LIA Singapore, noting that doctors have considerable discretion in deciding fees.

“Through panels, insurers can help address this by setting a default fee below the upper bound, as well as allowing charges above the default for cases which are more complex than the norm,” it said.

“So long as insurers are fair in allowing deviations, this should be a reasonable way to conduct panels,” LIA Singapore added.

Citing a study it conducted at the end of Nov last year, in which all five insurers have approved claims from doctors that went beyond the fee benchmark but have approved considerably more claims below the lower end of the benchmark, LIA Singapore also noted that setting panel fees at the upper bound of MOH’s benchmarks may result in escalating claims.

SMA claimed that many IP insurers have “highly exclusive” panels, which does not only affect doctors who are not made part of the panels, but also policyholders who seek to choose their doctors more freely.

Some may wish to consult a doctor recommended by a friend or relative, or stick with a familiar doctor who is not on the panel, SMA added.

To this, LIA Singapore said that it would continue to enlarge the pool of doctors included on the IP panels to help policyholders avoid “having to consult non-panel doctors, which incurs higher costs”.

Addressing SMA’s concerns about a lack of transparency in the selection process of doctors on the panels, LIA Singapore said that insurers typically review the prospective panel doctor’s past claims to see if they have been reasonable, whether there are any red flags in terms of volume of suspicious claims, and look if available markers of quality such as re-admission rates are present.

“The process includes looking into doctors’ overall reputation, doctors’ training records and credentials, as well as checks on whether there are any disciplinary issues with the Singapore Medical Council,” said LIA Singapore.

Commenters on TODAY’s and The Straits Times’ Facebook posts on the matter agreed with LIA Singapore that patients “will ultimately bear the cost” with the current system, and that it is a sign that the insurance contract is profit-driven rather than focusing on “providing care for the insured”.

Other commenters said that doctors should not complain about being paid on the lower end of the MOH fee benchmarks.

“If they don’t overcharge they have nothing to fear,” said one commenter.

One commenter opined that “it seems only the government is benefiting from this whole scheme” despite compulsory medical insurance being implemented to address rising healthcare costs.

“Just abolish all private insurers from the scheme. Gov just implement basic scheme up to class B. and who ever wants better treatment just pay the difference in pricing,” said one commenter.

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