Offer more choices by having insurers share common panel of specialists

The seven insurers providing coverage for Integrated Shield Plans (IPs) have been working hard to increase the number of doctors on their panels to give policyholders more choice.

Four have promised to have more than 500 specialists on their panels by the end of this year, while two have committed to at least 450 and one, 250.

According to the Ministry of Health (MOH), these changes will result in 79 per cent of the 1,235 eligible specialists in private practice being on at least one insurance panel, up from 70 per cent at the start of the year.

While any increase is useful to patients, one still needs to ask if this is enough.

There are 2.85 million people in Singapore with IPs that cover them for serious private medical treatments - subject to an annual deductible and the co-payment portion mandated by MOH.

About 1.71 million people out of those with IPs have also bought riders to cover part of their bills. MOH has mandated that riders bought since March 8, 2018, can no longer cover the entire portion of the patient's bill - as data showed that people with full riders have bills that were 60 per cent higher than those without riders.

However, MOH allows insurers to provide a cap on the amount a patient has to pay each year. Most insurers apply this cap - set at $3,000 a year - only if the policyholders use doctors on their panels or those practising in public hospitals.

This is because they have prior agreements with these doctors, and are assured that fees would be reasonable.

Doctors in private practice may charge any amount they want as long as it is considered reasonable. The difference in charges between two specialists for the same procedure could be huge.

But the small number of specialists on these panels led to complaints about limited choices by patients and their referring doctors. This number ranged from 190 to 409 doctors per panel at the start of this year. So increasing the pool of doctors is a step in the right direction.

But while having 79 per cent of eligible private sector specialists on insurance panels may seem like a lot, they are spread across seven panels, so no IP policyholder will have access to all of them.

In fact, no insurer has committed to having even half the available private sector specialists on their panels by the end of this year. And one insurer has committed to having only at least 250 doctors on its panel - less than 20 per cent of those available.

So the question is whether having 500 specialists on a panel out of the 1,235 who are eligible is really good enough.

In real terms, patients will have a choice of fewer than half the specialists in private practice should they want to have their bills capped. There is no limit only if they forgo the cap.

Forgoing the cap is not really as bad as it might sound, since they need to have bills that total more than $60,000 a year to top the cap.

Fewer than 3 per cent of patients have bills that high - but insurance is for "what ifs", as in what if my bills top $60,000 a year? Hence most would opt for specialists on the insurer's panel.

As these specialists are attached to different hospitals, the choice is further reduced. A patient being treated at a particular private hospital will need to get a specialist on his insurer's panel who is based there.

Since 79 per cent of private sector specialists are already on at least one insurer's panel, perhaps the Life Insurance Association of Singapore, together with MOH, may want to consider having a common panel of specialists that is shared by all seven insurers.

This will enable the 1.71 million policyholders with riders to choose from a far wider pool of doctors. Insurers could also share data that would improve the overall quality of private healthcare in Singapore.

The patients will be the big winners.