Limits set by insurers tie doctors', patients' hands

Full insurance coverage of medical fees has been said to have resulted in excessive and unnecessary tests and treatment, as patients and doctors know that patients will not have to pay a cent ("Keeping a lid on healthcare costs"; Tuesday).

As a doctor in a private hospital, I agree to some extent.

However, there is more to the picture.

Over the past 15 years, I have seen prices increase in both hospital and surgeon charges by more than the inflation rate.

Besides having to pay for clinic rentals and manpower costs, some doctors also have to pay "administrative fees" to the hospital and third-party agents.

Some insurance companies set surgical fee limits for their panel doctors that are so low that doctors are reluctant to accept these patients.

A senior gynaecologist recently told me that he would rather give up being on the panel of doctors and have fewer patients than accept these cases. One reason was that he could not find anaesthetists willing to do the cases for such low fees.

In implementing any change, there should be consideration given to whether the service provider - that is, the doctor - is willing to accept a lower fee.

The committee working on reining in health insurance costs must balance both doing public good and preventing public harm. What is the point of controlling fees when you have no takers to provide essential services?

The preferred-physician panel may also lead to corruption and kickbacks. The choice of a panel of doctors based on price of service may be unfair and unjust to the patient seeking the best for himself.

There is also a secondary point of interfering with a person's autonomy to choose his preferred doctor.

My suggestion is that fee guidelines be set for as many procedures as possible.

A patient's choice of doctors should never be based on insurance companies or third-party agents who squeeze doctors by charging fees for referral.

As long as the fees fall within the guidelines, insurance companies should honour the claim.

As for "as charged" riders, those who want to use these schemes should have the option to do so. But premiums should be set much higher and be prohibitive.

People should be given a choice in what they want to do with their money. As for doctors who overcharge, insurance companies can blacklist them.

Chong Jin Long (Dr)

A version of this article appeared in the print edition of The Straits Times on October 21, 2016, with the headline 'Limits set by insurers tie doctors', patients' hands'. Print Edition | Subscribe