Need for regulations that put patient care ahead of commercial decisions by insurers: Forum

In Parliament on Sept 24, questions were raised on the need for regulations to prevent insurers from influencing healthcare decisions against the best interests of policyholders. While Integrated Shield Plans are private commercial products, they are built on the national MediShield Life scheme, making arguments for their regulation a delicate but important consideration.

There are clear circumstances where decisions made by IP insurers may adversely affect the care of policyholders, which call for regulation to put patient care ahead of commercial decisions. 

Removing specialists from panels without clear justification affects the continuity of patient care. Last year, a particular IP insurer removed 126 specialists which amounted to 15 per cent of the specialists on its panel. As a result, patients stand to face potential disruptions in treatment.

While policyholders can still see non-panel doctors, they risk incurring higher out-of-pocket expenses because certain benefits, like co-payment caps, may not apply. This can pressure patients to switch to an unfamiliar doctor to avoid additional costs. Such situations can be avoided if there is a specific measure that is imposed upon insurers to limit the turnover (the rate of removal) of specialists on their panels.

Regulation would in this instance increase transparency and ensure greater continuity of care. The Singapore Medical Association has previously suggested that all specialists with good track records should be able to join IP panels without restriction. 

When IP insurers place obligations upon panel specialists to use preferred hospitals, it effectively limits the choice of hospitals that policyholders have access to, and policyholders may be unaware of such underlying arrangements.

Obligations on panel specialists to use preferred medical institutions could result in policyholders being admitted to hospitals which may not be ideal for them. A specific measure could be imposed to compel insurers to disclose the insurers’ commercial arrangements with facility providers, and penalties, if any, to policyholders and panel doctors for not using such facilities. This would allow the public to make informed decisions on their choice of IP insurer.

When IP insurers change administrative arrangements without adequate notice, these may disrupt the care of patients who have already been scheduled for treatment, cause significant stress for patients and create uncertainty, making it difficult for patients to plan their finances. An example of this would be when Great Eastern abruptly announced that it would suspend pre-authorisation arrangements for policyholders admitted to Mount Elizabeth hospitals.

Enforcing specific rules for communicating any changes that affect coverage or the claims process would protect patients from unexpected disruptions, especially when they need care. 

We fail to see how these, and perhaps other well-considered regulatory measures, could possibly affect the sustainability of IP insurance. In fact, they would simply treat insured patients in a fairer way. 

Ng Chee Kwan (Dr)
President 
Singapore Medical Association

Source: The Straits Times © SPH Media Limited. Permission required for reproduction.

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