MOH steps in to appoint committee for resolution of insurer-doctor conflict

THE Ministry of Health will appoint a committee to look into issues raised by both insurers and doctors on the topic of medical panels linked to Integrated Shield Plans (IPs).

Both sides have made valid points while also expressing views that misrepresented the trade-offs and balance required for sustainable insurance premiums and cost-effective healthcare, Senior Minister of State for Health Koh Poh Koon said on Saturday.

"Candid discussions between the stakeholders to identify the issues and work on the solutions or trade-offs needed to improve the system are the right way forward," said Dr Koh in a Facebook post. He had on March 31 met with representatives from the Singapore Medical Association (SMA), Life Insurance Association (LIA) and the Academy of Medicine (AMS) to discuss improvements to the way IP panels are set up and administered.

Discussion topics included expanding insurers' panel of doctors with clear and transparent criteria, as well as improving the claims pre-authorisation process for treatment - particularly by doctors who were not on panels.

To improve public awareness and processes to deal with unfair behaviour, ideas on on improving transparency on doctors' fees and outcomes and insurers' performance were also brought up during the meeting. Dr Koh said the existing pro-tem committee that had been looking into issues related to IPs will be formalised into a committee appointed by the Ministry of Health (MOH).

"The committee will take the work forward, and work in the public's and patients' interest to deliberate and implement changes for quality, safe, cost effective and affordable care for all," said Dr Koh.

More details on the committee and proposed recommendations will be released when ready. The use of IP panels was recommended by the Health Insurance Task Force (HITF) in 2016, but has come under the spotlight lately as policyholders make the transition into co-pay arrangements. Such arrangements encourage seeking treatment from their insurers' accredited specialists or doctors.

Doctors responded with a call for IP panels that are more inclusive, and the SMA recently introduced an initiative to rank IP insurers on an annual basis as well as to set up a complaints committee for patients and doctors to flag issues related to IPs and health insurance. The LIA said that panels serve as an enforcement mechanism to keep fees of healthcare practitioners in check, and warned that including all private specialists on panels may drive up costs and premiums.

Dr Koh said the SMA's intent to set up a complaints committee and the LIA's plan to create an IT platform to streamline data-sharing and claims process are both "positive and helpful steps in the right direction". "Ultimately, both doctors and insurers must remember that they should serve the best interests of a common customer - patients who are policyholders," he added.

With MOH helming talks between LIA, AMS and SMA, there has been some "clarification and the beginning of a journey of understanding and collaboration", said an SMA spokesperson. Still, a lot more work lies ahead as various stakeholders need to hold "honest and sometimes painful discussions" on existing problems, potential solutions and trade-offs, said the spokesperson.

"Like-minded people from all industries should be aligned in protecting patients' interests. There has to be mutual trust and we will all have to work together to build a sustainable healthcare system, (and) support a robust subsidised system, and a fair private practice," the spokesperson added. In response to Dr Koh's Facebook post, LIA said in a statement that it looks forward to collaboration between all parties with the formalisation of the trilateral committee.

"Ensuring accessibility and affordability of quality healthcare for Singaporeans remains the LIA Singapore's foremost priority. Open and constructive dialogue is essential in addressing IP-related issues and refining how HITF recommendations are implemented," said LIA.

Source: Business Times