Expand fee benchmarks and IP panels to safeguard patients' interests: WP MP Gerald Giam

SINGAPORE – Providing fee benchmarks for more procedures and expanding the Integrated Shield Plan (IP) are some ways to improve the healthcare system to better safeguard patients’ interests, said Workers’ Party MP Gerald Giam (Aljunied GRC).

Addressing the trend of what he called overservicing and overcharging is also key to curbing rising healthcare costs in Singapore, he said in Parliament on Monday (May 10).

Speaking at the close of Monday’s sitting, Mr Giam said that in putting forth these proposals, the WP had consulted insurers, hospital administrators, insurance agents, doctors in both private and public practice, and their constituents to better understand their concerns and hear their perspectives on the issues.

Fee benchmarks have an outsize influence on the fees doctors charge, as well as the premiums, payouts and coverage of health insurance, Mr Giam said. He added that they provide more transparency on doctors’ fees and can help narrow the problem of information asymmetry between patients, doctors and insurers.

However, Mr Giam said only about 9 per cent of the 2,300 procedures listed in the comprehensive Table of Surgical Procedures (TOSP) are listed in the benchmarks.

Mr Giam suggested that MOH provide fee benchmarks for all the rest of the procedures as well.

He also suggested narrowing the benchmark range, which is now set at the 25th and 75th percentile of the fees for a given procedure.

He said: “Based on feedback I gathered from doctors and insurers, this may be too wide a range to take effective reference from. It may be more useful to set the fee benchmarks to a narrower 40th to 60th percentile of each fee range.”

On IP panels, Mr Giam said panels should be expanded to admit all doctors who wish to be on the panel.

This is so patients will not feel pressured to switch away from their preferred doctor just because that doctor is not on the panel, he added.

All insurers should also use the fee benchmarks to determine their payouts instead of their own panel doctors’ fee schedules, Mr Giam said.

He added that if doctors charge more than the upper end of the fee benchmarks for a procedure, they should have to provide a written justification or inform their patients of potential out-of-pocket expenses beforehand.

“The Government has to take the lead in introducing these changes across the board for all doctors and insurers. No insurer will be willing to be the first mover on this because of competitive pressures. Insurers cannot coordinate these changes among themselves, lest it be deemed anti-competitive,” he said.

Mr Giam also took aim at doctors who overcharge their patients or push them into undergoing unnecessary procedures.

Although what constitutes overservicing and overcharging is not clear-cut, Mr Giam said these are important issues to address as they contribute to rising healthcare costs.

He said: “We can address concerns about overcharging and overservicing by instituting greater price transparency in billing. Doctors and hospitals should be required to provide detailed itemisation of the charges on their bills by default.”

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In response, Senior Minister of State for Health Koh Poh Koon said fee benchmarks have been published for about 200 procedures. These are the most common ones, making up 85 per cent of cases and 75 per cent of professional fees for procedures in the private sector, he added.

“This approach we have taken allows us to set the fee benchmarks for the most common procedures to achieve the intended outcome without the unnecessary administrative burden and costs of curating very limited data sets for less commonly performed procedures,” he said.

Dr Koh also said the size of IP panels has increased by 40 per cent in the last six months to a year and up to 70 per cent of private specialities are already on at least one panel.

Rather than expanding panels further, Dr Koh said a better way to improve patients’ access to care is through pre-authorisation – a service where an IP insurer gives prior approval for hospitalisation or medical treatment and their costs before the patient receives the treatment.

Dr Koh added that his ministry will continue to work closely with stakeholders and facilitate close collaboration between them to ensure that measures and solutions are put in place to uphold patients’ interest in healthcare.

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