Ensuring the right products and options for patients

THIS WEEK'S TOPIC: How far would the Health Insurance Task Force's proposals go to rein in rising healthcare costs?

Bob White President, Asia-Pacific Medtronic

THE Health Insurance Task Force's proposals will bring alignment to the overall system - the first step towards rethinking how we should pay for healthcare. In particular, consistent guidelines for the care of costly, chronic conditions would promote integration across a patient's care continuum. Healthcare systems need to shift from volume to value in order to manage costs more effectively. Stakeholders have to think beyond episodic care and focus on value-based initiatives that take into account clinical, economic and patient outcomes. Value-based healthcare, re-architecting healthcare delivery and payment systems to better reward improved patient outcomes should be our aim.

Victor Mills Chief Executive Singapore International Chamber of Commerce

THE proposals are clear, sensible and timely. All of us - whether we are consumers or medical practitioners - need to change our behaviour to keep healthcare costs and insurance premiums affordable. Consumers need to take responsibility for their health before they lose it, by taking care of their diets and exercising sensibly. More doctors in the private sector need to stop treating patients and their insurers like cash cows. They need to stop asking patients how much insurance they have and stop charging to the limit. Instead, they should focus on holistic care and tests relevant to the patients' conditions.

Yeoh Oon Jin Executive Chairman PwC Singapore

THE Task Force recommendations will help with transparency of healthcare costs. Having diversity and "choice" as part of the healthcare provider panels will provide Singaporeans with the ability to make more informed and personal decisions about their healthcare choices.

A hybrid system that involves co-payment has many benefits, including patients taking greater ownership of their health. Clarification of the process through which insurers can raise issues such as inappropriate or excessive treatment to the authorities increases patient advocacy which is good moving forward. Prevention is always better than cure with raising awareness being key.

Educating consumers on the healthcare options available addresses just this.

Dileep Nair Independent Director Keppel DC Reit Management Pte Ltd

RISING healthcare costs seem a certainty in today's world. But these can be tempered by having people take more responsibility for their health and making better lifestyle choices. Employers have a vested interest in having a healthier workforce that is more productive. Incentives should, therefore, be given to employees who, say, enrol in gyms and meets BMI targets.

Similarly, health insurance companies should give discounts to people who, like safe drivers, take steps to ensure their wellness. For that matter, even Medisave should be allowed to be used for regular multiphasic health screening so that there can be early detection of any chronic disease and corrective action taken. An ounce of prevention is indeed worth more than a pound of cure.

Karl Hamann Chief Executive Officer QBE Insurance (Singapore) Pte Ltd

THE Task Force's proposals are a welcome step towards ensuring healthcare costs are kept affordable for the public. While Singapore has done its part for all citizens, the insurance sector also has an important role to play in keeping healthcare costs down. Rising claims put pressure on insurers to increase premiums, thereby lowering affordability. I think the recommendations put forth represent a holistic, multi-faceted approach that minimises potential abuse of the healthcare system and ensures citizens have access to the right insurance products and treatment options. In the long run, this promises sustainable and reasonably-priced healthcare for generations to come.

Dr S Nasim Group Executive Chairman Meinhardt Singapore Pte Ltd

JUDICIOUS implementation of the Medical Insurance Scheme is a challenge in most countries. Measures to control the rising costs of Integrated Shield Plans (IPs) need to be carefully calibrated.

While there is an inherent risk of hospitals prescribing unnecessary diagnostics tests and/or expensive treatment, where costs are covered by IPs, there is equal danger of the insurance companies (ICs) placing too many restrictions on hospitals to curtail even the necessary investigation and/or treatment simply to reduce costs.

Prudent measures to strike a reasonable balance may include:

The measures will need to be fine-tuned from time to time, once we have had the chance to track their efficacy.

Ronald Lee Managing Director PrimeStaff

IT is indeed worrying that Singapore's healthcare expenditure has more than doubled from S$4.7 billion in 2012 to S$11 billion this year.

Our ageing population is the key factor contributing to rising healthcare costs.

Another contributing factor is inappropriate or excessive treatment. This tends to occur due to the prevalence of IPs - private insurance plans for hospitalisation - with many people buying "riders" that may cover the entire hospital bill without the patient needing to pay anything for the treatments.

Hence, there may be a tendency for patients to undergo more tests and treatments than absolutely necessary. This pushes up healthcare costs for everyone, including insurance premiums.

The Task Force's proposal to include a co-insurance and/or deductibles (currently covered by riders) to ensure some co-payment by the insured should help to moderate rising costs in theory. However, with costs already so high, the public may not react well to this proposal as they will have to fork out upfront cash payments that might otherwise have been covered by their insurance plans.

The proposal to educate consumers on healthcare options to reduce the occurrence of excessive treatment seems a more palatable option and this should go in tandem with the authorities continuing to promote active lifestyles. With a healthier population, there will be less strain on the healthcare system.

JY Pook Senior Vice President, Asia-Pacific Tableau

THE Health Insurance Task Force is working to manage medical costs and improve insurance coverage processes in Singapore. Underlying this issue is the need for the government, healthcare sector, and insurers to come together and work smarter. But just like any other industry today, healthcare and insurance service providers need to take full advantage of the data that's available to them, and understand it, to improve patient experiences and operational processes. Consumers too need to make more informed healthcare choices by tapping on data. Data analytics allows all these stakeholders to visualise and understand costs, needs, and outcomes to make the most of resources. This will be the main enabler that identifies cost drivers and trends, and improves the quality and cost of healthcare in Singapore in the long run.

Daniel CF Ng Senior Director of Marketing, APAC Cloudera

HEALTHCARE costs in Singapore will predictably rise and cause a strain as the population ages. Healthcare policymakers globally are increasingly tapping on the science of data analytics to understand disease and recovery patterns, and drive care planning as well as policy making. Data can also help planners identify areas where there is excess, need or wastage. Already, healthcare institutions are among the world's biggest aggregators of data. I am sure data-backed policymaking will go a long way in addressing the key concerns raised by the taskforce to achieve a more effective healthcare cost structure.

Lim Soon Hock Managing Director PLAN-B ICAG Pte Ltd

IF the Health Insurance Task Force's proposals to rein in rising healthcare costs are to achieve the desired outcomes, more individuals must take personal ownership of their lifestyle and health. This is more so for those with chronic ailments such as diabetes. The demand side of the insurance costs equation must be managed. This means that those with chronic illnesses, who were previously not insurable and are now insured, must be required to commit to a regime of treatment of their chronic conditions, for example through telehealth consulting. Telehealth services - which offer triage management, chronic disease management and wellness management - have proven that costs associated with chronic conditions can be contained, if not reduced.

Patrick Liew Managing Partner Greenpro Capital

MY concern is whether enhancing healthcare affordability will induce artificial demand for such services. Therefore, the Health Insurance Task Force should look at ways to help consumers be more self-reliant, take responsible ownership for their health, and be more proactive to improve their health.

It's also important to promote preventative and anti-ageing healthcare services as they can be just as important as mainstream medical practices in contributing to overall wellness. These services include educating consumers about health-related issues and motivating them to adopt a healthy lifestyle.

Consumers should also be encouraged to look after their mental, emotional, social and environmental health as these factors can also affect physical health. In addition, health checks should also be made more accessible and affordable to them.

With rising healthcare costs, there's a need to look at how to capitalise on healthcare facilities on a regional scale, beyond Singapore. For instance, we can leverage on cost advantages of healthcare services in Iskandar Malaysia to strengthen our current healthcare ecosystem.

Zaheer K Merchant Regional Director (Singapore and Europe) Qi Group of Companies

FEE guidelines are useful for comparisons and decision-making purposes. But an overriding concern is balancing curbs on rising healthcare costs with ensuring no compromise in the quality of healthcare while catering to the varied healthcare needs across society. The Task Force must check this, especially with an ageing population. It's paradoxical that measures aimed at reining in rising healthcare costs can actually translate to a hike in premiums for certain age groups (especially older folks) due to insurance providers having to cut premiums while concurrently having to recoup their "losses" from the broader public. Hopefully in reining in costs, some form of broader subsidy and slight socialism in the form of more government subsidies can apply. If this would be done, perhaps we're on the right path.

David Leong Managing Director PeopleWorldwide Consulting Pte Ltd

THE dilemma stems largely from rising claims on IPs in recent years which have sharply squeezed underwriting profit margins. With an ageing population, healthcare costs are bound to rise. Medical claims are unlikely to come down. Hence, are hikes in premiums of IPs and IP riders to allow insurance companies to maintain a fair profit margin in any case? It's hard when policymakers need to balance the commercial interests of private insurance companies and the healthcare needs of Singaporeans and residents.

The real question to ask is not how to curb healthcare expenses but how to ensure people do not seek to game the system for selfish reasons. The Task Force should go all out to safeguard the healthcare interests of the public, with a strong bias towards keeping a lid on costs.

Robin C Lee Group COO Bok Seng Group

MEDICAL insurance claims in Singapore have escalated over the decade, coupled, unfortunately, with prominent cases of unethical over-charging and excessive servicing surfacing a little too often. Clearly, insurance riders are an open invitation for self-justified excessive treatment, medication and claims, all of which lead no doubt to a hike in insurance premiums for all. Therefore, co-insuring and levying excess, along with requiring pre-approval for certain treatments, should be encouraged even if it's all a bit tedious.

Fee guidelines should be published not just for benchmarking but to curb inflated and unexpected charges. More importantly, more information sources should be made available to educate policyholders on their medical conditions and treatment options, price-wise and prescription-wise, so that they can flag instances of inappropriate or excessive treatment.

Goh Yang Chye Managing Director GYC Financial Advisory Pte Ltd

PRESCRIPTION before diagnosis is malpractice!

Before one prescribes any solutions, it would be good to first investigate the spike in medical claims in recent years. Are these claims legitimate? Are medical costs really high? Were alternative, less costly, medical solutions explored? What's the profile of the people making these claims?

I would suggest that we conduct a data analytics exercise on claimants, insurance providers and medical service providers over the last three to five years. This will ensure that we have a good understanding of what is involved before prescribing solutions to reduce wastage. One cannot rule out the fact that the increased costs may be legitimate in the first place.