Sunday, March 11, 2018

A messy and inefficient health insurance system

Hi Mr Tan,
Your post on the over consumption of medical services is very good and to the point. Unfortunately, as we know by now, the government will not retract its stand even when it is clearly wrong.

For the shield plans issue, I have a few comments :

1) This point I have raised many times but MOH seems to be brushed under the carpet. I believe that majority of the policyholders are working adults. As company medical insurance is compulsory and shield plans are on last payout status, why has the insurer not put on action on getting policyholders to claim from their company insurance? I believe it is a paradox problem as most of the shield plan insurers are also corporate insurance providers. If the policyholders claim from the corporate insurance, they will have to increase the premiums for the companies. Hence, it maybe easier to not do too much and when claims raises they can show MOH the stats and increase the premiums accordingly. As it is mandated for shield plans to be last payor, all policyholders should do their part to claim from their corporate insurance.

2) MOH point on over servicing. Singapore has always pride itself to be comparable to the best in medical treatments in the world. Is MOH saying that the services is too much? Should we convert the a class to c class facilities at all restructured hospitals?

3) Over charging by doctors and medical establishments. By stating this point MOH should have already identified which doctors and medical establishments are over charging. Has MOH taken any action against them. Highly unlikely. By penalizing the patients for the over charging by doctors is similar to punishing by the victim of a bully so that he will be more careful in the future. Will the bully still continue to bully in the future? Yes because he is never punished and will think that what he is doing is right. Hence, will doctors stop over charging because of this change. I don't think so.

4) Overconsumption of medical services. Besides the points raised. One important point is that if there is no medical condition and if the tests and surgeries are done purely as preventive measures. The claims assessors should have rejected the claims according to the policy contracts and this will not have been a point to be raised. If the insurers are incapable of processing the claims according to the policy contract terms and conditions, why penalise all the other policyholders? Processing of claims is not just about speed but the accuracy of the claim. I used to train my claims assessors based on the value of FAIR.

F - Fast processing of all claims
A -Accurate processing of all claims with minimum errors
I - Integrity and unbiased processing of all claims
R - Reliability. All claims assessor must be knowledgeable and able to respond to any queries that clients may have.


Dear X
Thank you for your comments. I see that you are a health insurance practitioner.

Let me answer your questions briefly.

1) I do not know whether the medishield insurers do or do not exercise their right to be the payer of last resort, i.e. insist that the patient claim first under the company's plan. Some working adults are covered under their company's plans but they are many who are not covered under their company's plan, or their coverage under the company's plan is limited in scope.

2) I believe that it is better for all restructured hospitals to serve only the subsidised patients (B2 and C). But it would be very difficult to make this change now.

3) MOH has the data to identify the hospitals and doctors that are overcharging and overservicing. But I suspect that they are not doing it. They like the patients to do it through the co-payment. But this strategy has not worked for three decades. This strategy has to change.

4) I agree with your point about rejecting of claims due to negative test results.

Let me make this summary. We have a messy and inefficient health insurance system. It is very costly to administer. They is confusion about the over lapping coverage and exclusions. I am quite disappointed about our 3M system (medisave, medishield, medifund).

I hope that the health minister has the wisdom to recognize the problem and the courage to take the correct steps to change the system. I am willing to help them, if they find my service to be useful.

Tan Kin Lian

1 comment:

Unknown said...

1. Majority of workers (including civil servants) here don't have corporate healthcare coverage, at least not for organic diseases & illnesses. Only those in large private organisations, MNCs.

2. Most of the "over servicing" is by private hospitals/specialists. Restructured hospitals have audit & best practises committees to review high cost cases or those over 75th percentile. I may be wrong but don't think private hospitals do this rigorously.

3. I suspect MOH talking to private hospitals behind the scene, especially on how they can adopt similar measures as govt hospitals in controlling costs. Not nice for pro-biz govt to be seen dictating how private enterprises to conduct their biz.

Blog Archive