Deep Dive Podcast: Great Eastern suspends Mount Elizabeth pre-authorisation - time to relook how health insurance is managed?

CNA

9 hours ago

When insurer Great Eastern suspended pre-authorisation for admission to Mount Elizabeth hospitals, it raised questions about the way health insurance is managed in Singapore. With increased medical bills and insurance premiums, who is paying for what and where are the gaps?
Steven Chia and Otelli Edwards speak with Associate Professor Jeremy Lim of Saw Swee Hock School of Public Health and Dr Yoong Siew Lee, a health services consultant.
Here is an excerpt from the conversation:
Otelli Edwards, host:
Why are hospitals charging differently for the same treatment?
Dr Yoong Siew Lee, a health services consultant:
Different hospitals have different charges and Great Eastern will have access to the data on those charges, so the detailed bills actually show the differences.
So you have surgeon fees that can be standardised with fee benchmarks. But you also have occupational therapy facility fees, you have bed charges, which vary between the hospitals.
Otelli:
Like a five-star bed versus a three-star bed?
Dr Yoong:
Versus a six-star.
So the facilities are all different and that attracts different price points. Some insurers have actually dealt with that by tiering the insurance.
So if you choose a certain tier of insurance, you can go to all the hospitals. Or if you choose a sub-tier, you can go to some of the hospitals and you pay a lower premium.
If they pool all the hospitals, then naturally the premium will go up if everybody chooses the most expensive hospitals.
Steven Chia, host:
But right now we don't (pool all the hospitals), right? If you choose to adopt the private one, will you have access to all the private hospitals?
Dr Yoong:
No, not all insurers are like that. Insurers have different schemes for customers with different pockets.
Otelli:
What's the difference between choosing public versus private (hospitals)? Because in public, you can choose the class A ward or the premium as well, right? So what would you say is the main difference there?
Associate Professor Jeremy Lim, Saw Swee Hock School of Public Health:
Generally, the insurers don't impose a pre-authorisation on public hospitals and this includes the private wards of public hospitals, because there's a high degree of predictability in the public hospitals.
Doctors' fees are pretty much set, the hospital charges for room and other services are very, very predictable and they're well within the range of what the insurers are prepared to pay.
So policyholders who go to a public hospital generally find the experience pretty fuss-free, because there is a high degree of conviction amongst the insurers that the fees are going to be reasonable.
Steven:
Versus the private hospitals, which, you seem to be suggesting – are a bit more volatile?
Assoc Prof Lim:
There is much more variability (in private hospitals) because the doctors price differently, as Dr Yoong mentioned, has been attenuated by the fee benchmarks and by the negotiations that the insurers have had with the doctors.