Ministry of Health Sustainable healthcare financing: Whose outcomes are at stake?
I refer to AIA Singapore medical director Alan Ong's commentary (The coming healthcare crisis: Unsustainable financing, March 7).

I concur that healthcare financing has to be sustainable, and that there is a need to deliver optimal health outcomes.

However, Dr Ong's views do not present a balanced and full disclosure of factors currently in play in healthcare financing.

First, it should be pointed out that insurers offering Integrated MediShield Life plans were the ones who introduced full riders but have since been compelled to withdraw such provisions because of underwriting losses.

In this instance, one needs to question whether insurers are primarily concerned with the health outcomes of the insured, or the financial outcomes of the insurers, since AIA Singapore reported last year that its operating profit rose by 7 per cent to US$558 million (S$775 million) for the 12 months to Dec 31, 2018.

Second, it was stated that problems may arise when patients demand excessive treatment.

In the current climate where patient autonomy takes a central role, there is a need for clarity from the health authorities and the courts regarding liability should a diagnosis be missed if doctors decline to offer what patients demand because of limits set by insurers.

Third, Dr Ong suggested that the appointment of preferred provider panels serves to enhance insurance benefits, mitigate the risk of abuse, and benefit panel doctors by virtue of the fact that insurers will steer patients to them.

I would counter that such panels limit patient autonomy, pay no heed to clinical outcomes and work primarily to benefit the financial bottom lines of insurers.

Also, appointment to such panels requires doctors to charge, for the majority of local health insurers, within the lower range of fees set by the Ministry of Health fee guidelines, with little regard for the complexity of procedures or the expertise of the doctors.

The Montgomery standard of disclosure requires that material information be communicated to patients, and that such information be understood, so as to allow informed decisions to be made.

The actions of health insurers to entice patients to switch to preferred providers as a means of reducing costs, without clear explanation as to the possible impact on care outcomes and patient autonomy, breach the Montgomery standard.

Our patients deserve better.

Sitoh Yih Yiow (Dr)

Source: https://www.straitstimes.com/forum/sustainable-healthcare-financing-whose-outcomes-are-at-stake

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