Keeping insurance premiums affordable

Health Minister Gan Kim Yong says the medical fee benchmarks could help insurers know what are the reasonable reimbursement rates for treatments. The sharp rise in claims is a major driver of healthcare costs here.
Health Minister Gan Kim Yong says the medical fee benchmarks could help insurers know what are the reasonable reimbursement rates for treatments. The sharp rise in claims is a major driver of healthcare costs here.PHOTO: LIANHE ZAOBAO

The Ministry of Health (MOH) will work with insurance companies to "improve and strengthen their claims process" so people will not end up paying high premiums.

Health Minister Gan Kim Yong said the ministry is seeing how it can implement some of the recommendations from the Health Insurance Task Force report released last year, which highlighted the sharp rise in claims - a major driver of healthcare costs here.

Said Mr Gan: "We want to give the assurance and ensure that premiums are sustainable in the long term and don't result in excessive claims."

One of the task force recommendations is to provide benchmarks for professional fees, "given the urgency to manage escalation of healthcare costs".

Mr Gan said in an interview with the local media this week that MOH will come up with benchmarks of what are reasonable fees for doctors to charge.

The fee benchmarks, which will be available next year, would help patients know how much they are expected to pay, and help doctors decide on what are reasonable fees to charge.

Mr Gan said the benchmarks could also help insurers know what are the reasonable reimbursement rates for treatments.

  • Strategy for healthcare

  • The Ministry of Health (MOH) has come up with a strategy to keep healthcare here both good and affordable. It calls it the "3 Beyonds":

    BEYOND HEALTHCARE TO HEALTH

    A healthier nation requires less of the healthcare system. In recent years, the Health Promotion Board (HPB) has stepped up efforts, such as by getting people to opt for healthier meals. The authorities have also launched a "war" against diabetes, as well as highly subsidised health screening for those aged 40 and older.

    Some heartening results:

    • Sales of the HPB Healthier Dining Programme's lower-calorie meals rose from 7.5 million in 2014 to 26 million last year.

    • More than 4,000 stalls in 70 hawker centres and 600 coffee shops now offer at least one healthier option.

    • More than 300,000 had signed up for the National Steps Challenge by the end of October. The target is 500,000 this year.


    BEYOND HOSPITAL TO COMMUNITY

    Care for patients goes beyond hospitals. The idea is to let them receive appropriate care in the community or at home, so they can stay well and avoid frequent hospital admissions.

    This includes post-discharge visits to patients' homes by nurses and care workers to ensure that they remain well. This is done for patients who are deemed at risk of frequent re-admission to hospital.

    This is better for the patient in terms of health and convenience, and for the healthcare system too, as hospital care is very expensive.


    BEYOND QUALITY TO VALUE

    This is an effort to retain or increase quality of care while ensuring value for money.

    The Agency for Care Effectiveness was set up in 2015 to research treatments that provide the best value for money. For example, three drugs may offer the same results, but have very different prices. Or a drug may be more expensive, but offer outcomes that are far better than cheaper alternative drugs. Such information is disseminated in detail to doctors who may not have the time to do their own research. It will also be adopted in the public sector.

    The introduction of fee benchmarks is another effort to keep a lid on spiralling healthcare costs. This recommended fee structure will be decided together with doctors, hospitals and other stakeholders. Such benchmarks not only give doctors a yardstick against which to measure their prices, but also give patients an idea of what is justified cost.

    Salma Khalik

The introduction of the benchmarks is one part of a three-pronged strategy by MOH to ensure people continue to receive quality healthcare here that is sustainable.

The strategy includes continued care for patients once they are discharged from hospital, ensuring good value for quality care, and programmes for people to stay healthier for longer.

Mr Gan hopes the strategy would help slow down spiralling healthcare costs that are expected to soar as new and expensive medical treatments hit the market amid greater demand for elective treatments, with better access to healthcare, and an ageing population.

More hospitals, nursing homes and polyclinics are coming online within the next few years. New hospitals, like the one in Sengkang that opens next year, will work closely with general practice clinics and polyclinics to ensure that discharged patients continue to get the care they need.

The Agency for Integrated Care works closely with social agencies and welfare organisations, when help goes beyond healthcare.

Said Mr Gan: "From the patient's point of view, it doesn't matter whether it is social or healthcare. They just need support."

To get the best value for money, the Agency for Care Effectiveness - the national health technology assessment agency under MOH - will study what drugs are available on the market, check out how well they work and how much they cost.

The third arm of keeping healthcare affordable is keeping people healthy, which includes the heavily subsidised health screening programme launched this year, as well as the "War on Diabetes".

The strategy builds on other initiatives introduced earlier to manage healthcare costs, including MediShield Life and higher drug subsidies at polyclinics and public hospital specialist outpatient clinics.

Salma Khalik

A version of this article appeared in the print edition of The Straits Times on December 01, 2017, with the headline 'Keeping insurance premiums affordable'. Print Edition | Subscribe