Integrated Shield: More transparency is needed on doctors' panels

THE unhappiness and controversy which have erupted just prior to the transition of policyholders to co-pay arrangements under the Integrated Shield (IP) health insurance schemes raise a number of thorny issues.

One is transparency over the criteria for admission onto insurers' medical panels. Two, there is a perception of unfair treatment by insurers of policyholders and non-panel doctors. And of course, there is the perennial tug of war between long-term plan sustainability and policyholders' expectations of the best and often costly treatment. To be sure, this tug of war is weighted on one side: Insurers have the right to adjust terms of contract and premiums at any time, subject to oversight by the regulator. At the same time it serves no one - not the insurer nor the policyholder - to have unsustainable benefits and claims that saddle policyholders with premium rises and eventually cause insurers to withdraw their plans.

To recap, years of underwriting losses prompted the Health Insurance Task Force to recommend measures some years ago to address IP sustainability. These include co-payments to encourage prudent use of healthcare; fee benchmarks; pre-authorisation of treatment; and "preferred'' doctor panels to ensure costs stay within reasonable limits. Co-payments are a major plank in these efforts. Previously, riders to cover the deductible and co-payment portions made it possible to claim 100 per cent of hospital bills, which were blamed for a "buffet syndrome'' or over-consumption of healthcare. In 2019, insurers rolled out riders requiring policyholders to co-pay 5 per cent of bills. In April this year, most insurers will ask policyholders on older riders to transition to 5 per cent co-pay riders.