Forum: Implementation of insurers' panels endangers many existing patient-doctor relationships

About 2.8 million Singapore residents have bought Integrated Shield Plans (IPs) as at last year. It would not be unreasonable to expect that in this pool are many existing healthy and long-term patient-doctor relationships.

All responsible stakeholders in healthcare agree that good medical care is underpinned by a healthy patient-doctor relationship.

Such a relationship engenders trust, better patient and doctor satisfaction and a less litigious medico-legal climate; all these ultimately lead to better patient outcomes and a more cost-effective healthcare delivery system.

An IP policyholder may have a good patient-doctor relationship with a non-panel doctor. In that case, the implementation of preferred healthcare provider panels by IP insurers - in the form of small panel sizes, as well as disincentives and increased friction (for example, stricter pre-authorisation, increased co-pays and so on) imposed should the policyholder choose to stick to the non-panel doctor - has the effect of encouraging the destruction of an existing patient-doctor relationship in favour of a new relationship with a panel doctor.

Taking all things to be equal between a panel doctor and a non-panel doctor, the establishment of a new patient-doctor relationship often entails much effort, time and even physical resources.

Sadly, the investment put into building a healthy, existing patient-doctor relationship (and the value therein) is irretrievably and unnecessarily lost, or at least put in serious danger of being lost, so that IP insurers can enjoy the benefits of using "the insurer's bargaining power to negotiate preferential rates from healthcare providers in exchange for higher volumes" in the name of cost containment.

I believe a panel is neither good nor bad in itself; a lot would depend on how panels are designed and implemented.

As a member of the 2015 to 2016 Health Insurance Task Force (HITF), I cannot help but wonder now: Had the HITF members known then that the implementation of panels in its current form would have endangered many existing healthy patient-doctor relationships, would they, or at least the majority of them, have recommended the use of preferred healthcare provider panels in the 2016 HITF report?

Wong Chiang Yin (Dr)