Redesigning guidelines on health insurance costs, forum news and current affairs

I refer to the article “The installer of the insurance panel: what do the specialists want?” (May 28) by Salma Khalik, Straits Times Senior Health Correspondent.

The current phase two (heightened alert) exposes a loophole in the current panel system – it restricts the free flow of elective surgery patients to private specialists at a time when public hospitals must conserve resources for Covid-19.

In addition, most private specialists are not part of the panel.

A new committee has been formed and I hope the committee will consider the following:

• An opt-in panel: ideally, there should be no panel. Alternatively, the panel of doctors should be an opt-in panel, so that all specialists who are willing to agree to the terms and conditions are allowed to be part of the panel, instead of the current system appointed by the insurer. A committee appointed by the Department of Health (MOH) involving bodies such as the Singapore Academy of Medicine, the Singapore College of Family Physicians, the Singapore Medical Association and insurance companies can review the various candidates for misconduct rendering them inappropriate.

• Simplified Fee Guidelines: There is currently disagreement on the range of fees, which are within the permitted ranges. An alternative would be to have a fixed fee replacing a range for all procedures, using the 50th percentile as a guide. Certainly, some operations of the same nature will be technically more difficult, but there are others which will be relatively easier, and the loads should work on average.

• Incorporate inflation into fee guidelines: such a feature will be forward looking and satisfy all parties concerned as to whether future costs will be factored into the benchmark prices. An alternative is to conduct annual reviews of the fee guidelines.

• The MOH should play a bigger role: As a ministry directly involved in the health and well-being of the nation, the MOH should play an active role in the formulation of costs and pricing of health care. As ideal as it is to leave it to market forces, health care does not fall squarely within a free market economy system.

• Portability: Current Integrated Shield (IP) plans fail the portability test, and the panel concept has further contributed to IPs becoming silos. The committee should strive not to rule out pre-existing coverage conditions when people change insurers – which will certainly improve the competitiveness of insurance offerings.

• The MAS has a role to play: the Monetary Authority of Singapore (MAS) should be part of the current IP deliberating committee, as only the MAS can regulate insurance companies, just as the competence of the MOH cannot. extends only to doctors in their professional capacity.

Tan Jee Lim (Dr)

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