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.
Policyholders are likely to accept the rationale of a co-payment, particularly when this is capped at S$3,000 a year. But to avail of this cap, they must comply with conditions, such as use of the insurer's panel of doctors. Those who insist on their own doctors may have to bear the full co-payment of 10 per cent. These terms put policyholders - especially those who suffer serious conditions - between a rock and a hard place. Healthcare isn't a one-size-fits-all. What if a comparable specialist cannot be found in an insurer's panel?
In fact, preferred doctor panels have become something of a minefield. In a letter to The Straits Times, the Singapore Medical Association's 1st vice-president Ng Chee Kwan contended that as of late last year, private specialists comprised only 20 per cent of each IP panel.
SMA's survey of private specialists found that 34 per cent could not join insurers' panels when they tried. Fifty-three per cent reported that more than a quarter of their patients needed to change doctors because of panel issues; and 57 per cent were unable to refer patients to an appropriate panel specialist. The Life Insurance Association in its published reply said IP insurers continue to expand their panels to ensure they are comprehensive.
LIA has indicated that the Ministry of Health would form a trilateral committee comprising the LIA, SMA and Academy of Medicine to discuss IP issues. This is surely welcome. Meanwhile more transparency on the criteria to admit doctors into insurers' panels is needed. Better still, since reasonable fees appear to be a key criteria, insurers could consider Dr Ng's call that panels be open to all specialists as long as charges are reasonable. This would go a long way to meet policyholders' needs and still remain sustainable.
READ MORE: Insurers, doctors at odds over how panel practitioners are selected
