Forum: Not fair to blame only healthcare providers for insurance buffet syndrome

I refer to the article “Breaking health insurance vicious circle a top MOH priority, says Ong Ye Kung” (July 13).

It was suggested that some healthcare providers are asking for patients’ insurance details in order to prescribe unnecessary investigations and procedures because there is insurance coverage.

Before insurance companies’ widespread introduction of doctor panels, we doctors seldom asked about patients’ insurance details before initiating treatment.

Doctors now need this information because different insurers reimburse panel doctors at different rates for consultations and treatments, usually in the lower half of the Ministry of Health (MOH) fee benchmarks for Integrated Shield Plan (IP) providers, and well below this for corporate insurers.

Panel doctors are penalised for not complying with these fees. Patients are also penalised by their insurers for being treated by doctors not on the panel, so we need to inform them if we are not panel doctors.

It is not fair to blame only some healthcare providers for abusing insurance coverage and promoting the buffet syndrome. In reality, some patients insist on costly investigations or therapy immediately rather than have a stepwise, evidence-based wait, treat empirically and see approach, as the costs are covered so they might as well do everything now instead of wasting time if there is a possibility they may be needed later.

I have had patients being unhappy with me for not offering MRIs or physiotherapy when I felt they were unnecessary.

People who buy IPs with riders may see it as a necessity, so they can avoid the long wait times at restructured hospitals’ emergency departments or for a non-urgent specialist referral, or to have the option of treatment by a specific doctor in private practice. Most of us will not make a claim each year, subsidising those who do. We accept that this is how insurance works.

Why are half of those with IPs treated in restructured hospitals? Insurers financially incentivise people to get subsidised or semi-private B1 treatment to reduce their payouts. Some have so few doctors on their panels that patients are forced to go to the restructured hospitals’ emergency departments if one can’t be found after hours. In an emergency, ambulances default to the nearest restructured hospital, regardless of insurance coverage.

Spending on healthcare is an investment. For this doctor, health is the most important investment, and spending on adequate coverage for healthcare is a top priority. 

Andrew Yam Kean Tuck (Dr)