Compulsory insurance good for doctor and patient

If the doctor needs to pay the patient, the insurance will cover the cost.
If the doctor needs to pay the patient, the insurance will cover the cost. PHOTO: ST FILE

When an aggrieved patient wanted to sue a surgeon for a bariatric surgical procedure that had gone wrong, the patient found out that the surgeon was not insured for that procedure, although he had insurance for general surgery.

The patient settled for an apology and a payment of $200,000, which did not even cover the additional medical costs he had incurred for intensive care and corrective surgery.

Since news of that case surfaced, the authorities have said they are looking at making medical indemnity insurance a requirement.

The law allows for it. It has just not been exercised.

The question now is not whether it ought to be made compulsory for all practising doctors to have such coverage, for the answer to that is a definite "yes", but why it is not currently the case.

Hopefully, when the Singapore Medical Council (SMC) said it was considering the proposal, it was talking about how to implement rather than whether to implement the requirement for all doctors to be insured.

The vast majority of doctors already buy such coverage. It protects not only them, but also patients from financial loss should the unforeseen happen.

If the doctor needs to pay the patient, the insurance will cover the cost. Patients whose problems are caused by doctors are guaranteed of at least financial reimbursement. This might not seem enough, but at least it should pay for any additional treatments and for unwarranted suffering.

The SMC said it has not made it compulsory so far because "the majority are insured either by themselves or by their employers. Patients still have a recourse through the insurance or the doctor himself, unless the doctor is bankrupt and not covered by his employer".

Insurance is to cover the unforeseen.While a doctor might be willing to risk bankruptcy should he be required to pay a patient more than he has money to, he should not be allowed to place a patient in the position where he is unable to get proper compensation should he deserve it.

It is very much like vehicle insurance which every driver must have, so that at least the other party is guaranteed financial reimbursement if the driver was the one in the wrong.

So, too, should all doctors, who hold their patients' lives in their hands, have insurance against a calamity.

Nobody expects things to go wrong. All doctors do their best for their patients. But sometimes, things do go wrong.

Often, when a patient's health takes a turn for the worse, it is nobody's fault. The illness could have been that severe, or the patient was unlucky to suffer from a known, but unavoidable, side effect.

However, on the rare occasion when the problem is caused by the doctor, and this does happen several times a year given the large number of procedures carried out, having sufficient insurance could provide financial help to both patient and doctor.

Medical indemnity insurance does not come cheap. Depending on what the doctor does, the annual premium could range from $2,000 to $40,000. And the premiums have been going up almost every year. Just 15 years ago, in 2002, the highest premium was less than $10,000.

General practitioners and medical officers pay lower premiums since problems they might cause are unlikely to be severe or costly.

At the other extreme are non-plastic surgeons doing aesthetic or cosmetic surgery. There has already been at least three deaths linked to such treatments, with payout for one death exceeding $3 million.

The main insurer for doctors here is the London-based Medical Protection Society (MPS), which is a not-for-profit doctors' cooperative.

Said Dr Alison Metcalfe, head of medical services at MPS: "We set subscriptions carefully to meet our expectation of the future cost of claims and complaints against our members, so we are in a position to defend their interests in the future. Our membership subscriptions are therefore based on the anticipated claims experience."

This means that while premiums might appear high, they have been calibrated according to possible claims.

With about 13,500 doctors here, the premiums collected each year should be in the tens of millions.

This means there are either many claims or some very high claims.

To allow some doctors not to have coverage for what they do will be putting patients at unnecessary financial risk.

It is bad enough that their medical treatment had gone wrong. It rubs salt into the wound when patients are not able to make a claim because the doctor has no insurance and cannot afford to pay.

In the case of the patient mentioned in the beginning of the article, Mr Loh Yuen Chun, 59, whose bariatric surgery to reduce the size of his stomach went wrong resulting in the need for several more operations as well as weeks in intensive care, the total medical costs came to $500,000.

Because the case did not end up in court, it is not certain if the problem was unavoidable or the doctor's fault. The reason it did not go to court was that the doctor's insurance did not cover this high-risk procedure, and the doctor was not rich enough to pay should the patient have won.

So they compromised with a payment of $200,000 and a public apology, with half the payment being made over 33 months.

No other patient should be placed in Mr Loh's position. The solution is simple: The SMC should ensure that all doctors take up sufficient coverage for all treatments they offer.

If the cost of the premiums is passed on to patients, so be it, since this insurance provides coverage, not just for the doctor, but for the patients too.

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A version of this article appeared in the print edition of The Straits Times on July 29, 2017, with the headline 'Compulsory insurance good for doctor and patient'. Print Edition | Subscribe