With integrated shield plans now requiring a five per cent co-payment, should you opt for treatment from a panel or non-panel doctor? Read this to find out which option to pick before you make a trip to the hospital.
Panels for integrated shield plans (IP) have been around for a few years and are therefore not entirely new to the market.
However, the requirement for IPs to offer riders with co-payment from April 1, 2021 has triggered a debate over panel versus non-panel specialist doctors.
While this is a problem for the Singapore Medical Association (SMA) and Life Insurance Association (LIA), with the Ministry of Health (MOH) playing a part, consumers are paying close attention as it could have implications on our insurance premiums and healthcare standards.
As the saga drags on, what matters most to consumers is this: Should you be choosing a panel or non-panel doctor?
Here, we’ll look at reasons for and against choosing either option, as well as the potential implications.
Why choose a panel doctor?
A panel doctor is one that’s listed on the insurance company’s list of approved doctors. This could be a medical practitioner, specialist, hospital or medical institution. Each IP provider has their own panel of preferred doctors that their policyholders can seek treatment from.
Here’s what the panel of doctors for each IP provider looks like:
|Panel of specialists|
|AIA||More than 380 AIA Quality Healthcare Partners (AQHP) specialists where each of them has at least five years of specialist experience and a clean professional track record|
|Aviva||More than 300 medical specialists across various disciplines|
|AXA||More than 300 medical specialists across various disciplines|
|Great Eastern||More than 4,000 specialists of over 25 different medical specialties, including relevant specialists in restructured hospitals and more than 300 private specialists|
|NTUC Income||More than 400 specialists across various specialties and subspecialties|
|Prudential||More than 700 specialists with more than 50 medical specialities represented. Most of the PRUPanel Connect Partners are specialists that have been practising in their respective specialities for at least five years.|
|Raffles Health Insurance||More than 150 specialists across more than 30 disciplines|
The idea to have panel doctors stemmed from the measures recommended by the Health Insurance Task Force in 2016, with the aim to help avoid overcharging, over-servicing and over-consumption of healthcare services.
Although there are MOH fee benchmarks in place, it is not sufficient to guide prices. For example, the upper end of fee benchmarks is 1.8 times higher than the lower end.
The doctors on IP panels sign enforceable contracts and must therefore charge within the agreed fee range, ensuring that claims can be kept within a reasonable range, while providing policyholders with assurance that their claims will be covered and capped.
|Co-payment for bills capped at $3,000 per policy year||A smaller pool of doctors to choose from|
|Fees and charges are supposed to be reasonable, as doctors on the list need to pass stringent criteria||Might not be your preferred doctor|
|Assurance that the specialist doctor has at least five years of specialist experience and a clean professional track record|
|Receive pre-approval for medical expenses, even before any medical procedure or hospital admission is carried out|
|Higher Letter of Guarantee (LOG) — the insurer guaranteeing to pay on your behalf, in order to waive the upfront payment required by the hospital|
The main draw of receiving treatment from a panel doctor is that your out-of-pocket expenses will be capped at $3,000 a year when you have an additional rider.
However, having to choose from a panel of doctors from the many doctors in Singapore could mean that your go-to doctor or preferred doctor might not be on that list.
Why choose a non-panel doctor?
A non-panel doctor is a doctor that’s not on the insurers’ list of preferred doctors. However, a non-panel doctor is by no means a poorer doctor than a panel doctor.
These non-panel doctors are still professionals in their field that simply aren’t on the exclusive panels insurers have established.
|Flexibility and option to choose any doctor you prefer (e.g. one that’s more convenient, or a doctor recommended by a friend or relative)||Co-payment could be more than $3,000 per policy year (no cap), unless it is pre-authorised by the insurer|
|An established trust and rapport with the doctor that can give you additional peace of mind||Doctors might not have passed the insurer’s stringent criteria|
|Continue to seek medical advice from your family doctor who is aware of your medical history||Pre-authorisation by the insurer could be required to see a non-panel doctor, in order to ensure that your claims will be capped at $3,000 per policy year|
Choosing a non-panel doctor could be a decision that gives you greater peace of mind, particularly if the doctor is one who’s aware of your condition and has been the one providing the treatment all this while.
However, the downside to choosing a non-panel doctor is that you could incur a five per cent co-payment of the bill with no cap, as the $3,000 cap only applies to panel doctors and specialists at restructured hospitals.
The tug-of-war between SMA & LIA, and how this affects you
Once you’ve understood both the good and the bad of going for panel and non-panel doctors, you’ll start to see the problem between SMA and LIA.
Doctors have questioned why they’re excluded from the insurers’ panels when they also have a good track record while charging fees that are within the benchmarks given by the MOH.
|SMA’s stance||LIA’s stance|
|IP panels are “highly exclusive”, with private specialists accounting for just 21 per cent of all doctors on the panels of many IP insurers||
Having more doctors on IP panels is on the cards.
However, doctors cannot expect the defaults fees to be at the upper end of the fee benchmarks set by MOH, as this could result in higher claims cost and in turn, premiums.
|The criteria and selection process of choosing panel doctors is not transparent, noting that most IP insurers reimburse doctors at rates that are “clustered around the lower limit only”, rather than also including those in the higher range of the fee benchmarks.||
Insurers look at a prospective panel doctor’s past claims, reputation, records, credentials and whether there are any disciplinary issues with the Singapore Medical Council.
However, LIA agrees that greater transparency will be provided. For example, the selection criteria could be made publicly available on the LIA Singapore website.
Insurers have increasing expense ratios (operating expenses of the fund) and management fees that contribute to the IP sector being loss-making or unsustainable, rather than higher claims by policyholders.
For example, the growth in management expenses (56.6 per cent) and commissions (50.4 per cent) outstrip the 35.9 per cent growth of gross claims.
|While insurers’ costs went up in the short term, this may not reflect the long-term trend of increasing claims — the main driver behind premium increases.|
|IP panels are unfair to specialists as it incentivises policyholders to use the insurers’ panel of doctors in order to be assured of lower fees||
This is done as there are many specialists charging higher fees (e.g. closer to the higher range on the MOH fee benchmark) than the ones on the IP panels.
This could in turn lead to higher premiums for policyholders.
As a result of this, a 12-member committee has recently been appointed by MOH to look into managing rising healthcare insurance costs, address complaints arising from claims and ultimately improve Singapore’s healthcare insurance system.
This Multilateral Healthcare Insurance Committee (MHIC) comprises of representatives from:
- Ministry of Health
- Academy of Medicine, Singapore (AMS)
- Consumers Association of Singapore (CASE)
- Fee Benchmarks Advisory Committee (FBAC)
- Private Hospitals
Both parties have also made recommendations to work towards resolving this issue, including carefully increasing the number of doctors on the panels and also greater transparency in information sharing between the two parties.
While this debate on healthcare is largely fought by SMA and LIA, the conclusion of this tug-of-war has implications on all consumers.
As this debate goes on, we can only hope that the final outcome will be favourable to consumers and have the healthcare of Singapore citizens at heart.
This article was first published in SingSaver.com.sg.