Letter of the day

Relook fee guidelines in healthcare insurance

I refer to the article "Insurance panel poser: What do specialists want?" (May 28) by Straits Times senior health correspondent Salma Khalik.

The current phase two (heightened alert) exposes a flaw in the current panel system - it restricts the free flow of elective surgery patients to private specialists at a time when public hospitals have to conserve resources for Covid-19.

Furthermore, most private specialists are not on the panel.

A new committee has been formed and I hope the committee will consider the following:

• An opt-in panel: Ideally, there should be no panel. Alternatively, the panel of doctors should be an opt-in panel, such that all specialists who are willing to accept the terms and conditions will be allowed onto the panel, instead of the current insurer-appointed system. A committee appointed by the Ministry of Health (MOH) involving bodies such as the Academy of Medicine, Singapore, College of Family Physicians Singapore, Singapore Medical Association and insurance companies can vet the different applicants for misconduct that render them unsuitable.

• Simplified fee guidelines: There is currently disagreement on the range of charges, which fall within permitted bands. An alternative would be to have a fixed fee replacing a band for all procedures, using the 50th percentile as a guide. Granted, some operations of a similar nature will be technically more difficult, but there are others that will be relatively easier, and the charges should work out on average.

• Incorporate inflation into fee guidelines: Such a feature will be forward-looking and satisfy all parties concerned about whether future costs will be factored into fee benchmarks. An alternative is to have yearly reviews of fee guidelines.

• MOH should play a bigger role: As the ministry directly involved in the health and well-being of the nation, MOH should play an active role in the formulation of costs and pricing of healthcare. Ideal as it may be to leave it to market forces, healthcare does not fall squarely into a free market economy system.

• Portability: The current Integrated Shield Plans (IPs) fail the portability test and the panel concept has further contributed to IPs becoming silos. The committee should work towards not excluding pre-existing conditions for coverage when people change insurers - which will definitely improve the competitiveness of insurance offerings.

• MAS has a role to play: The Monetary Authority of Singapore (MAS) should be part of the current committee deliberating on IPs, as only MAS can regulate insurance companies, just like how MOH's jurisdiction extends only to doctors in their professional capacity.

Tan Jee Lim (Dr)

A version of this article appeared in the print edition of The Straits Times on June 01, 2021, with the headline 'Relook fee guidelines in healthcare insurance'. Subscribe