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Forum: Insurance company making it hard for policyholders to have continuity of care​

APR 07, 2024

I have been a loyal policyholder of Income Insurance for decades, with six policies with the company. However, Income Insurance has introduced new terms and conditions regarding panel and non-panel specialist doctors in its Integrated Shield Plans.
I had a long-established patient-doctor relationship with my specialist doctor A. When I needed an operation, I was informed that I would need to pay a $2,000 non-panel deductible if I continued treatment with doctor A, as she is not on Income Insurance’s panel. I was advised to see another specialist, doctor B, who was on Income Insurance’s panel, to avoid paying the deductible.
Now, I have learnt that doctor B has left Income Insurance’s panel, and I would have to find a new doctor to continue my care.
Some of my friends have faced similar issues, needing to change their specialist doctors due to Income Insurance’s mandate to use panel doctors, or pay the deductible, which is up to $2,000 in each policy year.
This policy may affect patient autonomy, and continuity of care. It also increases healthcare costs, as new doctors may need to repeat previous tests and procedures and re-evaluate the previous treatment plan.
Continuity of care is essential for managing chronic conditions, ensuring accurate diagnoses, and fostering trust between patients and their healthcare providers.
This policy does not seem to be in line with the Ministry of Health’s Healthier SG programme that encourages us to stay with one doctor to develop and enjoy a long-term trusted relationship.

I hope Income Insurance will reconsider this policy and uphold the principles of patient-centred care and fairness that prioritise the well-being of policyholders.

Ng Sout San

Forum: Insurance companies should be transparent about how they pay doctors​

APR 10, 2024

I refer to Ms Ng Sout San’s letter “Insurance company making it hard for policyholders to have continuity of care” (April 8).
As doctors and insurers continue to debate over remuneration amounts and the role of panels, we sometimes forget the people we are serving –our patients. As a breast surgeon myself, whenever I speak up on such matters, I might be perceived by some as self-serving. Therefore, I am glad members of the public are speaking up about what they need.
All of us need access to healthcare at some point in our lives. We must take an active interest in open discussion to better shape policy.
Patients should have access to any doctor of their choice. I have heard ad nauseum the same old arguments of how panels help to reduce costs, and accusations of overcharging by doctors and hospitals. The Ministry of Health has stepped up efforts to rein in these costs. I call for transparency in how insurance companies remunerate doctors. Currently, contracts with non-disclosure clauses are signed between doctor and insurer when they enter a panel, with all the caveats and limitations to adhere to.
Just as common procedure and hospital fee benchmarks are listed in public domains, I propose that insurers should also let their policyholders (or even the public) know about their fee schedules for common procedures.
In addition, I propose that a modified reimbursement be considered–where a company offers a certain fee, but patients can choose to top up the difference for a highly skilled and experienced doctor that they choose. This has multiple benefits where doctors will be mindful of fees and charge appropriately, and patients will be truly empowered to decide where they go for treatment.
Every month, new doctors join the private sector. Are insurers keeping up with reviewing and expanding their panels to include these doctors who can bring new skill sets and knowledge to help patients?

I fully respect the work and necessity of insurers in paying for healthcare bills. I am committed to creating a fair ecosystem, and for always putting patients first. Let all the stakeholders collaborate in educating patients, so that they can make an informed choice in which insurer they use, which doctor they choose and which hospital they go to.

Tan Yia Swam (Dr)

 

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How the high cost of living is hitting Singapore's poor​

31 January 2022
By Mariko Oi,Asia business correspondent

OK Chicken Rice
Chicken rice stalls have seen higher costs of ingredients, electricity and labour
In South East Asia you don't get much more of a staple food than chicken rice. Found in almost every food court and hawker centre, it is considered one of Singapore's national dishes.

Daniel Tan, who owns six chicken rice stalls, has previously charged $2.20 (£1.60) for a small portion. But Covid has seen the cost of his ingredients rise sharply.

The price of chicken has gone up by 50% and vegetable costs have more than doubled since January 2020, he says.

"We've been absorbing the costs for a significant period of time," he tells me as we meet at one of his OK Chicken Rice stalls in the north of Singapore.

"When the pandemic hit our first thought was this was a short-term emergency - six months, maybe a year - so we held [prices] for as long as we can because we were hoping for the whole thing to be over."

Getty Images
Lower rice prices mean that inflation has been more muted across Asia than elsewhere in the world
But when his electricity bills also jumped, Mr Tan decided it was time to raise prices. "A thousand dollar electrical bill for a chicken rice store really is not sustainable," he says.

"If I go on any further, either my staff are not paid or I have to close down some stores and that's not what we want to do."

Due to border closures and new employment regulations, Mr Tan has faced staff shortages and higher salaries, which all feed into rising costs for his business.

The Food and Agriculture Organization (FAO) says global food prices rose 28% in 2021.


"The last time food prices were this high was in 2011, when policymakers were actually warning about a global food crisis," says Dr Abdul Abiad of the Asian Development Bank (ADB).

These latest price rises are due to higher energy costs, which affect food and fertiliser production, with global supply chain issues compounding the problem.

Even in a wealthy nation like Singapore, it means that the number of families seeking help has increased.


"What we have seen when we make the door-to-door deliveries is that young families [with] both husband and wife working a part-time job or in the gig economy - these were the families that got impacted when Covid hit and all the part-time work dried up," says Nichol Ng, co-founder of Food Bank Singapore.

It is not just the poorest 10% of the population who now need help, she says: "It has slowly crept to maybe 20% of the population including middle income families that might not even know where to get help in the first place."

And it is also not just higher food prices that are affecting those in need. "Due to Covid, everybody's self-awareness about looking after themselves in terms of hygiene has increased," says Ms Ng.

Nichol Ng of the Food Bank Singapore says she has seen a rise in people asking for help
But higher palm oil prices mean that shampoos, hand soaps and sanitisers have also become a lot more expensive.


"Up to 20% of our requests thus far, especially starting from the second half of last year, has been pivoting towards personal hygiene products," she adds.

Ms Ng is also concerned that the current wave of inflation does not seem to be temporary. "In the past, at certain times of the year, you might see these price surges but it seems that this inflation is going to be persistent - and none of us really have that crystal ball to understand when it is going to end," she says.

Elsewhere in the region the impact of higher prices is even more severe. The latest FAO report shows more than 375 million people in Asia faced hunger in 2020, an increase of 54 million from the previous year.

In 2020, the Global Food Banking Network saw the number of people needing help increase by more than 130% to 40m, with half of them living in Asia.

This is despite the fact that food price increases in Asia have been more muted than in the US or Europe, where inflation has soared to levels not seen in decades.

There are several reasons for this, including a good rice harvest in 2021, says the ADB's Dr Abiad. While maize prices rose 44% last year and wheat by 31% , rice prices dropped 4% . "So rice being the main staple in many Asian economies contributed to a food price inflation being lower in the region," he says.

Asian nations also produce a lot of their own food, which has been sold in domestic markets rather than being exported. Governments have also been working to ensure that food supplies have been stable, says Dr Abiad.

In the Philippines, for example, liberalisation of rice imports has allowed the supply of rice to improve which has kept prices low.


Meanwhile, China has been stockpiling various important food products, which has resulted in it bucking the trend, with the country's food prices falling in 2021.

But it has also led to criticism that the world's second biggest economy, which accounts for 20% of global population, is hoarding supplies as it is estimated to hold 69% of the world's corn reserves, 60% of its rice and 51% of its wheat by mid-2022, according to the US Department of Agriculture.

Getty Images
Global food prices are expected to remain high in 2022
Singapore imports the majority of its foodstuffs, but so far big supermarket chains like NTUC FairPrice have decided not to pass on higher prices to consumers.

To keep the prices of key products stable, the firm says it is employing various strategies including "stockpiling of daily essentials, forward buying and diversifying our import sources to over 100 countries".


NTUC FairPrice also has more than 2,000 own-brand products such as rice, oil, toiletries and cleaning products that it says are at least 10% cheaper than comparable popular brands.

Mr Tan of OK Chicken Rice, who also owns three mini supermarkets, says smaller retailers tend to take their cue from larger rivals when pricing goods.

"They act like a central bank to the rest of the grocery players in Singapore. The good thing about it is that inflation doesn't spike up as much during a crisis but the bad side effect is that entrepreneurship is stifled and only semi-government players can survive," he says.

Daniel Tan
Daniel Tan also owns minimarts which have also seen higher costs
"The question is, after the whole thing is over how many smaller players are left?" asks Mr Tan.


Global food prices are expected to remain high this year and the FAO's David Dawe says this is of concern for Asian governments because price hikes have not yet worked their way through the system.

"If global prices continue to rise, there will be an impact, especially for lower income families who spend bigger proportion of their income on food."

Economists like Mr Dawe and Dr Abiad remain optimistic that Asian countries will continue to be shielded from double-digit food inflation.

But for those on the ground, like Mr Tan and Ms Ng, the issue feels more acute. They wonder whether higher prices, rather than being transitory, will linger on just as the pandemic has.

 

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Forum: Address power imbalance between IP insurers and policyholders​

APR 27, 2024

Numerous letters to the Forum have highlighted the issues of Integrated Shield Plan (IP) panels, from the perspective of policyholders and doctors. This was followed by an Opinion piece “How to fix S’pore’s healthcare insurance and preserve care continuity for patients” (April 25).
Policyholders with private IPs are steered towards panel specialists to get benefits, or to avoid incurring extra out-of-pocket costs.
The enrolment and removal of panel specialists are entirely at the discretion of the insurers. Many specialists, especially those new to private practice, continue to have difficulty getting onto panels.
Long-term policyholders have been adversely affected by panel restrictions, but are unable to change insurers (Insurer making it hard for policyholders to have continuity of care, April 7).
Doctors have pointed out that steering patients to panel doctors may affect the timeliness of urgent care, and disrupt existing patient-doctor relationships. (Abolish medical panels – they negatively impact patient care, stifle competition, April 12; and Should patient-doctor relationship be cornerstone of healthcare system? April 17).
There has also been increased scrutiny of claims, which may delay claims settlement.
There is a power imbalance between IP insurers and their policyholders. Insurers are free to vary the terms and conditions of the policy by serving notice to policyholders.

Even if policyholders disagree with changes in terms and conditions, they may feel compelled to accept them, as any medical condition they have developed over the years would be considered as pre-existing conditions by other insurers.
Other insurers may impose premium loading, exclude coverage of pre-existing conditions, or reject coverage altogether.
Panels were implemented by IP insurers to mitigate healthcare inflation.
The Singapore Medical Association feels that doctor fee inflation has been adequately addressed through the Ministry of Health (MOH) fee benchmarks, as well as efforts by the MOH claims management office to reduce inappropriate claims.
We continue to recommend that IP panels be open to all specialists who undertake to charge reasonably, or alternatively to have panels abolished.
To address the issue of power imbalance, stakeholders and regulators could look into whether changes in insurance design, such as the portability of IPs, would be beneficial. If policyholders can change their IPs without losing coverage for pre-existing conditions, it could promote healthy competition among insurers and ensure that policyholders get a fair deal.

Ng Chee Kwan (Dr)
President
Singapore Medical Association

 

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Singtel flags $3.1 billion impairment hit, net loss in second half of FY2024​

About $2 billion of the impairment provisions originate from its Australian unit Optus’ goodwill, Singtel said. PHOTO: ST FILE
UPDATED

APR 29, 2024

BENGALURU - Singtel on April 29 forecast non-cash impairment provisions of $3.1 billion for the second half of financial year 2024 which would lead to the telecom giant reporting a net loss for the period.
The company also warned that it would report a lower net profit for the full year ended March 31, 2024.
About $2 billion of the total impairment provision originates from its Australian unit Optus’ goodwill, Singtel said in its bourse filing.
An “impending deal” for Optus was recently ruled out by Singtel following reports that talks for a potential stake divestment had fallen off.
Singtel added that Optus expects a non-cash impairment provisions of $470 million on its enterprise fixed access network assets, mainly due to weaker prospects, increased cost of capital and a bleak macroeconomic outlook.
After conducting a strategic review of its enterprise business, Optus found that it was reporting steep declines in fixed carriage revenue, in-line with an overall market decline in Australia, the Singtel filing stated.
Among other units, the Asia Pacific cyber security business is expected to report non-cash impairment provision for goodwill of $340 million, with $280 million of the same expected from IT service provider NCS Australia.

Singtel said the impairment provisions will not impact the payment of dividends. “Singtel is on track to pay at the upper end of its dividend policy for the financial year ended 31 March 2024,” it said in the filing.
The company is scheduled to report results for the financial year ended March 31 on May 23.
In a separate announcement on April 29, Singtel said its unit Optus struck a deal with local rival TPG Telecom to provide access to its local radio network in regional Australia.
As a part of the agreement, TPG will increase its mobile network in regional Australia to 2,444 network sites, with Optus providing TPG Telecom access to its regional radio access network and sharing spectrum in regional Australia.
“The agreement will reduce combined 5G network rollout costs in regional Australia, which will enable the rollout of 5G infrastructure to be completed two years earlier than previously planned,” said Optus interim chief executive Michael Venter.
The agreement is expected to be operational by early 2025 and has an initial term of 11 years with an option for TPG to extend it for five more years. REUTERS