Multilateral Healthcare Insurance Committee to look at patient interests, cost issues

We thank Dr Tan Jee Lim for his suggestions (Relook fee guidelines in healthcare insurance, June 1).

Market failure occurs in the healthcare sector because of information asymmetry through lack of knowledge or transparency, and when insurance leads to a buffet syndrome.

The Ministry of Health (MOH) therefore plays an active role in ensuring that appropriate and cost-effective healthcare continues to be accessible and affordable to Singaporeans.

MOH has been publishing fee benchmarks since 2018. This is presented as a range, to allow for varying complexity across cases even for the same procedure.

The fee benchmarks should be reviewed regularly to remain relevant, and the review by the Fee Benchmarks Advisory Committee is ongoing.

As a matter of fundamental medical ethics, a patient's access to appropriate care should not be compromised.

A combination of wider insurance panels and a functioning pre-authorisation system would enable patients to gain access to more choice and benefits offered by their insurers.

Greater portability of Integrated Shield Plans (IPs) could further enhance choice and competitiveness of insurance offerings, but it requires closer study as insurers may raise their premiums to factor in risks of covering pre-existing conditions.

This is why MediShield Life is designed to cover all Singaporeans for life with no exclusions, to give reassurance to all Singaporeans should they chose to relinquish their private IPs.

MOH has appointed the Multilateral Healthcare Insurance Committee to address these issues holistically. The Monetary Authority of Singapore is an observer in the committee and has given useful input to the process.

The committee will consider the suggestions received in formulating its recommendations.

Real improvements can come about only when doctors, insurers, regulators and patients work together.

Cham Dao Song

Director (Finance Policy)

Healthcare Finance Division

Ministry of Health

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Forum Letter

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)