Forum: Don't repeat mistakes made in US insurance and healthcare system

Forum contributor Tara Hasnain has hit the nail on the head in voicing her concerns about the risk of Singapore's private healthcare system becoming like the nightmarish model she saw in the United States (Negative outcomes from insurers' panels in the US, April 19).

I would not be surprised if healthcare insurers here view the annual profits generated by their counterparts in the US enviously.

So great are those profits that their dividends grow every year, making them fantastic stocks to buy and hold.

But these profits come at a great cost to patients and doctors who are the victims of "managed healthcare", designed to minimise the amounts paid out.

It is both interesting and sad that at annual scientific meetings for surgeons in the US, an entire session is dedicated to the topic of how to handle insurers to get the best care for patients expeditiously and to maximise panel surgeons' reimbursements.

Doctors there have to deal with so much insurance-related paperwork and so many phone calls to provide patients with the necessary treatment and to claim their dues that they have to employ staff specifically for this task.

Studies have shown that delays or denials in getting appropriate treatment as a direct result of insurers' onerous requirements are detrimental to patient outcomes and are a significant source of stress for doctors.

All of this leads to an overall increase in healthcare expenditure, and it is not surprising that the US has one of the highest such expenditure in the world.

This disease is now spreading into Singapore's system.

Doctors here are increasingly being asked by non-medical staff of insurance companies to justify treatment plans.

There have even been instances when our diagnosis has been questioned.

Some insurers deliberately delay pre-authorisation or letters of guarantee for treatment, asking all kinds of questions regarding its necessity up until the day of the planned surgery, thus causing patient and surgeon undue stress because of the uncertainty of coverage.

This level of interference could be deemed as trying to dictate or influence treatment, which breaches local ethical guidelines and law, which state that even a doctor cannot prescribe treatment for someone he has not examined personally.

I sincerely hope the Ministry of Health will study the US private health system and not allow the same mistakes to be made here.

Rising costs must be managed, but insurers must never be allowed, directly or indirectly, to dictate or influence patients' medical treatment.

Andrew Yam (Dr)