Educate policyholders on perils of healthcare over-consumption

Patients and medical staff at a ward of a hospital in Singapore.
Patients and medical staff at a ward of a hospital in Singapore.PHOTO: ST FILE

Amid timely interventions to stem the spiralling cost of healthcare insurance premiums, such as mandating a minimum co-payment for new integrated shield plans, it is regrettable that there are still quite a number of patients consulting doctors in the private sector who request hospital admission for illnesses which can be managed outpatient, or seek specialist referrals for simple illnesses, just because they are insured.

Understandably, from a patient's perspective, no bodily complaint should be deemed too minor and, therefore, no medical care can be deemed too excessive.

A migraine sufferer having an attack cannot be faulted for requesting admission to receive attentive specialist care from the neurologist, round-the-clock care from nurses, intravenous medication to abort the attack, and an MRI brain scan to investigate the cause of suffering.

A low-back pain sufferer can choose to do better with hospital bed rest, intravenous medication, spine imaging and inpatient physiotherapist sessions until he feels well again.

Unless, of course, when healthcare resources are finite.

Some patients admittedly do so because they feel entitled as they pay high premiums and want to be served "their money's worth".

On other occasions, patients request hospital admissions so that medical expenses can be claimed under their hospitalisation insurance policy.

On the ground, it is challenging for doctors, who act in the best interest of the patient, to turn down these requests.

They risk antagonising patients and, possibly, medico-legal complaints.

I propose that insurers take the lead in educating policyholders about prudence and policy fine print, and provide examples of rejected claims so as to deter over-consumption and abuse.

Insurers may risk appearing less competitive to consumers.

Yet, they cannot operate in a laissez-faire manner and raise premiums unsustainably to counter rising claims.

Policyholders ought to think of the following three questions whenever they seek medical care:

• Do I really need to be hospitalised?

• Do I really need to see a specialist?

• Do I really need those tests or investigations?

The general public should be aware of the iron triangle of healthcare which represents affordability, quality and access.

Oftentimes, all three components cannot improve simultaneously. Something has to give.

Roger Teo Chee Yih (Dr)

A version of this article appeared in the print edition of The Straits Times on April 09, 2019, with the headline 'Educate policyholders on perils of healthcare over-consumption'. Print Edition | Subscribe