Life Insurance Association warns of trade-offs in widening insurers' panel of doctors

INCLUDING all private specialists on insurers' panel of doctors may drive up costs and premiums, said the Life Insurance Association (LIA) in a statement on Monday.

It was responding to the report by the Singapore Medical Association (SMA) on Friday, which urged insurers to be more transparent about the selection criteria for their lists of accredited doctors and specialists and for a more inclusive panel.

The use of Integrated Shield Plan (IP) panels was among measures recommended by the Health Insurance Task Force (HITF) in 2016 "to bring down the rate of claims cost inflation so that premium increases can be moderated and kept sustainable", said LIA.

But SMA had in its report said that with the Ministry of Health (MOH) fee benchmarks in place, there is no "reasonable justification for highly exclusive panels".

Panels, if needed, should be inclusive in the first instance and private-sector specialists should be excluded only if they have a poor track record," said the SMA.

"Since there are Ministry of Health (MOH) fee benchmarks in place now to address overcharging, there is no reasonable justification for highly exclusive panels. Panels, if needed, should be inclusive in the first instance and private-sector specialists should be excluded only if they have a poor track record," said the SMA in its report.

The LIA pointed out, however, that such a move may come with trade-offs. It said that the upper bound of the MOH fee benchmark range for a procedure can be up to five times that of the lower-bound one.

MOH fee benchmarks have been published for the most common 222 procedures since late 2018. Each benchmark for a procedure comes with a lower and an upper limit.

"As such, proceeding per SMA's suggestion without calibration may lead to substantial cost increases and further premium increases for policyholders," it said.

"Striking this balance is critical, and we invite SMA for a discussion on how this can be done in a way that will not disproportionately burden policy-holders with higher premiums."

It has, however, agreed that greater transparency from all stakeholders will provide more clarity on issues surrounding panel doctors.

As such, it recently concluded an update of the guidelines on panel management, which is available on the website. This includes guidance that IP insurers should explain the criteria for selection of panel doctors.

In return, the LIA is urging the SMA to respond to calls for measures and guidelines to oversee clinical quality in order to prevent over-treatment.

"Clinical quality measures will enable insurers to make better, evidence-based decisions on admitting doctors into panels. Policy-holders will ultimately benefit because they will receive better care," said LIA.

In response to queries from The Business Times (BT), Great Eastern's managing director of group operations Patrick Kok said: "The well-being of our customers is our top priority. As a leading insurer, we have a responsibility to partner with our customers to manage rising healthcare costs and ensure they receive comprehensive and affordable medical insurance throughout their lifetime."

AIA Singapore told BT that even with the implementation of panel doctors, it sees value in engaging with the broader healthcare provider ecosystem, including non-panel doctors, public hospitals, private hospitals and day-surgery centres to explore ways to work together to better manage healthcare costs.

It had, for instance, made pre-authorisation available for all non-panel doctors.

Insurers also told BT that they are continually expanding their panels to offer customers wider options.

Prudential Singapore said that it has, over the past few years, ensured a good representation of specialists in fields related to ailments of the heart, digestive system, eyes and cancers, in view of increasing claims for treatments in these areas.

A formation of a trilateral committee, comprising the LIA, SMA and the Academy of Medicine had been set up by MOH to discuss and resolve IP-related related issues, and to refine the implementation of Health Insurance Task Force (HITF) recommendations.

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