Insurance Coverage for Obstetricians

MOH's Reply

The Straits Times, 23 April 2015

Insurance for obstetricians: MOH replies

We refer to the letters by Dr Wong Mun Tat ("Private obstetricians contribute a lot to healthcare"; last Thursday), Dr Yik Keng Yeong ("Open up docs' insurance to more players"; last Friday) and Dr Chew Shing Chai ("Not reasonable for Govt to provide blanket cover"; Forum Online, last Friday), concerning the insurance coverage for obstetricians in private practice, in response to the report on April 13 ("MOH to cover obstetricians in retirement").

Our public healthcare institutions have already been covering the medical indemnity insurance of all doctors under their employment as part of their provision of medical services to the public.

With the change in terms for insurance coverage for obstetricians offered by the Medical Protection Society (MPS), the public healthcare institutions will continue to ensure that doctors under their employment remain covered, and are in the process of working out the administrative details.

This has been communicated by the respective hospitals' management to their obstetricians, and should enable obstetricians in the public hospitals to practise without the anxiety of future indemnity cover once they retire.

Doctors in private practicecan opt to be covered under the terms offered by the MPS or NTUC Income, the two main insurers in Singapore for medical indemnity.

While the MPS cover for obstetrics practice has changed from occurrence-based to claims-made, the NTUC Income scheme remains occurrence-based.

There is still indemnity cover, even though the terms going forward have been changed for one insurer.

MOH will continue to work with the obstetrics fraternity, including the Obstetrical and Gynaecological Society, of Singapore to address the issues for both private and public institutions.

We appreciate the important and responsible role of our obstetricians in pregnancy care and childbirth in Singapore.

We will need to work together to ensure that Singaporeans have access to appropriate and affordable maternity care.

Lim Bee Khim (Ms)
Director, Corporate Communications
Ministry of Health

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Forum Letters

The Straits Times, 16 April 2015

Private obstetricians contribute a lot to healthcare

The Ministry of Health's (MOH) decision to insure only government obstetricians has naturally drawn the ire of private sector obstetricians ("MOH to cover obstetricians in retirement"; Monday).

There are more obstetricians in private practice than in the public institutions, and the private sector sees more patients and delivers more babies than the public sector.

The private sector also handles many complex cases, relieving some of the public institutions' burden.

The private sector contributes significantly to Singapore's healthcare system, so many private obstetricians have taken umbrage at the MOH's decision to insure only doctors under their employment, considering this discriminatory and unfair.

At the core of the matter, obstetrics is the study of abnormal pregnancies, since normal pregnancies were, in the past, attended to by midwives; so obstetricians should not be doing a lot of business out of normal pregnancies.

However, with the way the field is practised in the private sector today all over the world,

it is the only discipline in medicine where the practitioner profits lucratively from a largely benign and natural event.

And it has been market forces that have shaped and supported this practice.

The ministry is still sorting out some details of the insurance coverage, such as what happens should the obstetrician move to the private sector instead of working until retirement in public hospitals.

I hope coverage will be extended to those in private practice.

Wong Mun Tat (Dr)

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The Straits Times, 17 April 2015

Open up docs' insurance to more players

The proposal for the Government to provide insurance cover related to deliveries for obstetricians in the private sector after they have retired from practice will engender great resistance and resentment from the paying public ("Private obstetricians contribute a lot to healthcare" by Dr Wong Mun Tat; yesterday).

While nobody will dispute the fact that obstetricians provide an essential service in the private sector, the essence of the service is not altruistic but mainly for monetary gain.

It is understandable that the Government continues to pay for tail-end insurance coverage for public-service obstetricians who have operated under the aegis of public health institutions ("MOH to cover obstetricians in retirement"; Monday).

For private-sector obstetricians to ask for this similar privilege is akin to having one's cake and eating it too.

While they are productive, private obstetricians can prudently put aside a bigger portion of their lucrative takings into a pot for insurance, to be dipped into when they retire, and hope the authorities put in a contributory share, too, in recognition of the essential delivery services that the profession offers.

Almost all doctors in Singapore have medical insurance coverage through NTUC Income or the London-based Medical Protection Society. There is little competition, and doctors are held hostage.

In the United States, there are insurers specialising in providing only tail insurance for retiring doctors. Our market is very small but, perhaps, we could entice such boutique insurance providers to offer their services at more friendly rates here.

Yik Keng Yeong (Dr)

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The Straits Times Forum Online, 17 April 2015

Not reasonable for Govt to provide blanket cover

It is true that private obstetricians contribute a lot to private healthcare ("Private obstetricians contribute a lot to healthcare" by Dr Wong Mun Tat; yesterday).

It is also true that the private sector delivers more babies than public institutions. This is because with increasing affluence since the 1980s, more and more people have gravitated towards private hospitals, where care is personalised for a procedure that is natural and usually uneventful.

But obstetrics, by definition, is not the study of abnormal pregnancies. Neither is it the only discipline in medicine where the practitioner profits lucratively from a benign and natural event - that honour is firmly in the hands of aesthetic medicine practitioners.

Those who have practised obstetrics have encountered sudden, unforeseen and serious problems that account for the litigation.

The actuaries have decided that "occurrence-based" policies for obstetricians are no longer viable; therefore, we must scramble to meet the challenge of dealing with reduced protection ("Obstetricians up in arms over new protection limits"; Feb 17).

Some obstetricians will stop practising, and others will look for alternatives, almost certainly by increasing their delivery fees and putting defensive measures in place.

The Government has a role in protecting doctors, but to look to them to provide blanket cover is not reasonable ("MOH to cover obstetricians in retirement"; Monday)

The future is uncertain, but neither Singapore nor obstetrics will remain the only victims of the litigation tsunami that will sweep the rest of the world in future ("SMA chief: Docs need protection against excessive patient claims"; yesterday).

Chew Shing Chai (Dr)