Recommendations

Impact on Stakeholders

Introducing Medical Fee Benchmarks or Guidelines

- To have a set of medical fee benchmarks or guidelines to provide a range of professional fees. Benchmarks or guidelines should be calibrated to ensure the appropriate involvement and adoption by stakeholders

- To address the issue of information asymmetry by providing stakeholders access to information on appropriate charges

- To mitigate cases of over-charging by providers

Consumers (or Patients)

� Provides an approximation of charges and allows consumers to manage their personal healthcare financing

Healthcare Providers

� Enhances the financial counselling process conducted by healthcare providers as consumers are aware of the possible charges

� Provides greater transparency on charges to promote trust and to improve the patient-doctor relationship

Payers (IP insurers)

� Provides a reference for insurers to review size of claims and develop appropriate product features (e.g. charges are within claim limits)

� Addresses cases of inflated claims

Clarification on Existing Process to Surface Inappropriate Medical Treatment

- To clarify the existing escalation process which allows insurers to raise cases of inappropriate and excessive medical intervention to the relevant authorities

- To clarify on the practices amongst insurers when dealing with such claims so as to minimise the impact on policyholders whose cases are subject to investigation

- To increase awareness of the existing avenue for insurers to raise cases of inappropriate and excessive medical intervention noted in their review of claims

Consumers (or Patients)

� Ensures impact on policyholders' claims is managed by insurers

� Provides assurance of a robust and accountable process when claims are denied on the basis that treatments were not medically necessary

Healthcare Providers

� Emphasises the importance of providing medically necessary treatment and discourages medical professionals from malpractices

Payers (IP insurers)

� Provides greater clarity and awareness of the escalation process

� Allows insurers to play a more active role in supporting medically necessary treatments

Enhancing Insurance Procedures and Product Features

� Panel of Preferred Healthcare Providers

- To suggest that insurers consider the use of preferred healthcare provider panels, where appropriate, to manage medical costs through fee agreements. IP insurers should make clear to their customers that their choice of healthcare providers is not restricted by the existence of the panels, although the coverage may be affected

- To enhance and ensure transparency of the arrangement (e.g. disclosures on the healthcare provider selection process)

- To suggest that insurers consider, during the appointment of preferred healthcare providers, TPAs, and intermediaries, whether their fee arrangements are in line with SMC's ECEG

Consumers (or Patients)

� Provides assurance that charges by panel healthcare providers are appropriate and correspondingly, out-of-pocket costs in the form of deductible and co-insurance are appropriate

� Provides clarity on the potential implications of using a non-panel healthcare provider in terms of making insurance claims

Healthcare Providers

� Emphasises the importance of providing required standard of care to patients and discourages medical professionals from fee arrangements that may influence the objectivity of their clinical judgement in their management of patients

Payers (IP insurers)

� Encourages insurers to influence their preferred healthcare providers, TPAs, and intermediaries to have fee arrangements with medical professionals that are in line with SMC's ECEG

� Ensures leakage of claims costs is minimised as claims are based on agreed medical fee charges and treatment

Enhancing Insurance Procedures and Product Features

� Co-insurance & Deductibles

- To encourage insurers to include co-insurance and/or deductible features in product design to ensure consumers' interest are aligned with managing healthcare costs

- To address the risks of overconsumption due to poor product features

Consumers (or Patients)

� Encourages consumers to play a more active role in managing their medical care costs

� Encourages consumers to be more responsible for their lifestyle habits

Healthcare Providers

� Increases pressure to provide medically effective and cost efficient treatment

� Encourages communication between consumer and healthcare provider on type and cost of medical care recommended and, improves the patient-doctor relationship

Payers (IP insurers)

� Aligns product features with consumers' interest for long term sustainability of IP premiums

� Ensures better claims cost management

Enhancing Insurance Procedures and Product Features

� Pre-approval of Medical Treatment

- To encourage insurers to approve claims for medical treatment and estimated bill size prior to the actual procedure, which provides certainty to patients on what can be claimed from their insurance policy

- To address the risks of inappropriate treatment and high medical charges

Consumers (or Patients)

� Provides a peace of mind as policyholders know their procedure is within insurance coverage when actual treatment is sought

� Protects consumers as insurers would not endorse and providers are unlikely to recommend procedures that are not medically necessary

Healthcare Providers

� Decreases disputes with payers and consumers over medical treatment and bills

� Encourages greater communication between payer and provider

Payers (IP insurers)

� Provides greater control over cost of medical bills

Educating Consumers

- To educate the public on the available options, such as the types of hospitals and wards, and the corresponding costs of their medical treatments

- To address the issue of information asymmetry by ensuring information on medical charges is readily accessible and easily comprehensible by consumers

Consumers (or Patients)

� Educates consumers to assess the available information and make informed healthcare choices

Name

Designation

Ms Mimi Ho

(Chairman)

Principal, Regulatory Professionals Pte Ltd

Dr Khoo Kah Siang

President, Life Insurance Association, Singapore

Mr Richard Wyber

Deputy Convenor, Health Insurance Subcommittee, Life Insurance Association, Singapore

Mr Lim Biow Chuan

President, Consumers Association of Singapore

Mr Seah Seng Choon

Executive Director, Consumers Association of Singapore

Dr Wong Tien Hua

President, Singapore Medical Association

Dr Wong Chiang Yin

Council Member, Singapore Medical Association

Mr Chin Chee Kiat

Director (Finance Policy), Ministry of Health, Singapore

Ms Jasmin Lau

Deputy Director (Finance Policy), Ministry of Health, Singapore

Ms Lee Keng Yi

Director & Department Head (Insurance), Monetary Authority of Singapore

Ms Tan Siew Yen

Director & Division Head (Insurance), Monetary Authority of Singapore

Name

Designation

Dr Leow Yung Khee

Head of Group Insurance and Claims, The Great Eastern Life Assurance Company Limited and The Overseas Assurance Corporation Limited

Mr Martin Ho

Chief Administrator, Singapore Medical Association