Analyse data to find cause of rising insurance claims

As a medical doctor, I am concerned about the recent report by a task force set up by the Life Insurance Association of Singapore on rising insurance claims.

It was stated that those with riders chalk up hospital bills that are 20 per cent to 25 per cent higher than those who co-pay for their treatment ("Policyholders with riders run up higher treatment bills"; last Friday).

But before we accept the statement that "some doctors, knowing that their patients have such cover, overcharge or over-service them", we ought to ask more basic questions, such as:

•Which components of the claims are excessive?

Hospital charges consist of fees for facilities, doctors, nursing, pharmacy, laboratory and therapists, among others. Is it the doctors or other components in the hospital bill that is excessive?

•Which doctors overcharge and what are the outcomes?

Are they senior doctors with better expertise and more experience? More importantly, do they have better clinical outcomes?

•Do some doctors purposely charge more for those with riders, or are they just experienced doctors who command higher charges?

Insurers can compare the charges by the same doctors on patients with and without riders to get the answer.

•Between those with and without riders, are there any differences in the patients' characteristics that can affect their bills?

How about their demographics, such as age and gender? What about factors like co-morbidities, length of hospital stay and severity of their diseases? Perhaps they are just sicker patients who require more resources.

It is in all stakeholders' interests to contain and control healthcare costs.

Insurers have all the data on the bills of their clients, and we should start doing data analysis to pinpoint the root cause of rising insurance claims.

Desmond Wai (Dr)

A version of this article appeared in the print edition of The Straits Times on October 17, 2016, with the headline 'Analyse data to find cause of rising insurance claims'. Print Edition | Subscribe