MediShield Life review: Proposed cap on claims may make some avoid private hospitals, say doctors

Doctors in private practice are concerned that some patients may be reluctant to seek treatment in a private hospital because of a change proposed in MediShield Life earlier this week.

The MediShield Life Council, which was set up to review the national health insurance plan, among other things, recommended on Tuesday that the cap on claims for private hospital bills be cut from 35 per cent to 25 per cent from early next year. If implemented, the change may affect the private integrated plans (IPs) offered by seven insurers which incorporate MediShield Life.

As a result, the insurers may increase their IP premiums, and policyholders will have to pay more for treatment in private hospitals, the private doctors told The Straits Times.

“Increased IP premiums will force patients, especially the middle class and heartlanders, to abandon their current IPs and move to lower-tier plans, and seek treatment at public hospitals,” said Dr Desmond Wai, a gastroenterologist at Mount Elizabeth Novena Specialist Centre.

The doctors also said that if more patients shift to public hospitals, there would be a greater burden on restructured hospitals and patients may not be able to get timely treatment.

Dr Chuang Hsuan-Hung, a cardiologist and medical director of the Asian Heart and Vascular Centre, said: “Both the public and private healthcare sectors have a part to play in serving the needs of the community. It’s not an argument on which system is better or cheaper, but it is a recognition that the public healthcare system is more overwhelmed.”

Dr Christopher Chong, an obstetrician and gynaecologist at Gleneagles Hospital, added: “This is especially so during the Covid-19 period as public hospitals are the first line of defence.”

Dr Chuang cited the case of a patient who went to the emergency department of a public hospital for chest pain recently, and was given a follow-up appointment in November.

“After consulting his family and looking at insurance, he decided to see us quickly. His main artery had a 90 per cent blockage,” the cardiologist added, and he was given “timely” treatment.

The MediShield Life Council proposed the change in payouts because it said that at 35 per cent pro-ration, a private hospital bill is more expensive than the same procedure in a subsidised ward.

Poorer patients getting subsidised care are therefore underwriting the more expensive, private care of wealthier patients in private hospitals.

Farrer Park Hospital said it is too early to ascertain the impact of the proposed changes.

“We endeavour to do what’s best and right for the patients, and within the council’s guidelines,” the private hospital said, in response to questions from ST.

Assistant Professor Zhu Wenjun from Nanyang Technological University’s business school said the economic rationale behind the lower cap is for more efficient utilisation of government transfer payments, so that all Singaporeans can have access to affordable and high-quality healthcare.

Patients who opt for private A or B1 class treatment in public hospitals will continue to get 35 per cent of their bills covered by MediShield Life.

Prof Zhu also said it is unclear for now if the reduction will lead to significant shifts in patient behaviour.

“We will need to wait and see responses from the market.”

Cost may not be the only consideration when patients opt for treatment at a private hospital, said Dr Daryl Tan, a haematologist at Mount Elizabeth Novena Specialist Centre.

Shorter waiting times, frequent personalised attention and care, direct access to primary doctors during emergencies, and ease of admission due to lower in-patient occupancy rates are other reasons, he said.

Dr Wai said private doctors could become more prudent and consider more cost-effective treatment plans with lower payouts.

“Hopefully, this helps weed out unnecessary procedures and surgeries,” he said.

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