Latest news with #GreatEastern
CNA
10 hours ago
- Health
- CNA
Commentary: This health insurance clash is a chance to fix issues in Singapore's healthcare system
SINGAPORE: Tensions had been simmering for months, with insurer Great Eastern encouraging its panel doctors and agents to avoid Mount Elizabeth and Mount Elizabeth Novena hospitals and instead seek care elsewhere. Things came to a sudden head on Jun 17 when the insurer announced it was suspending pre-authorisation certificates at both hospitals, citing higher charges with no discernible differences in clinical outcomes. This was unprecedented in the decades-long history between healthcare payers and providers. It is a game-changing salvo in Singapore's healthcare landscape. Now, social media is awash with accusations of 'greedy' insurers and 'predatory' hospitals. Doctors and patients scramble to shift care to other facilities for fear of rejected claims later on. IHH, the operator of the two hospitals and by far the largest private healthcare group in Singapore, argued that the Mount Elizabeth Hospitals 'house facilities and equipment that allow specialists to manage patients and perform surgeries that are not available at other hospitals' and catered to more complex patients, thus justifying higher charges. The Ministry of Health (MOH) stated it was seeking clarification from Great Eastern, cautioning that the insurer must ensure 'policyholders continue to be able to access the full benefits of their policies in accordance with the terms and conditions for claims, as stated in their policy contracts'. What should we make of all this? There are two realities to recognise and two next steps to consider. HARD REALITIES OF SINGAPORE'S HEALTHCARE LANDSCAPE The first reality is the clear mutual dependence between insurers and private healthcare providers. Without private providers, there would be no need for private health insurance. Without private health insurance, many may not be able to afford private healthcare. That said, mutual dependence does not mean mutual interests. Insurers pool risk by collecting premiums from many to cover the claims of a smaller subset, but they cannot simply be passive conduits of our money without value-adding. They seek to optimise value for claims paid out, and managing the fees charged would be expected. Conversely, private sector doctors and facilities would seek to maximise fees and charges – within ethical boundaries – for example in opportunities to sell branded drugs instead of generics or use the latest equipment when the conventional would suffice for a good outcome. Doctors' fees, traditionally 50 per cent of the total bill, have been moderated after years of insurer interventions, such as encouraging use of panel doctors with pre-agreed fees or imposing fee guidelines. Facility fees, on the other hand, have largely escaped scrutiny and today can make up two-thirds of the total bill. It is unsurprising that insurers have now turned their attention to these. The second reality is that healthcare costs are rising unsustainably and left unchecked, this will be bad for everyone. The cost of healthcare insurance benefits – which is a useful proxy for private healthcare spending – has increased in Singapore by about 12 to 13 per cent every year in the last three years. Minister for Health Ong Ye Kung has stated that the government healthcare budget doubled in the last decade, jumping from S$9 billion in 2015 to S$21 billion this year and is projected to reach more than S$30 billion by 2030. BETTER PROTECTION FOR HEALTHCARE CONSUMERS Two actions taken in unison might help with the way forward. First, strengthen consumer protection. In the ongoing saga, it's surprising that policyholders have not publicly sought more reassurance from the insurer. While Great Eastern has said policyholders 'can still receive treatment and submit claims as usual with no impact to their benefits', customers may need to pay upfront and be reimbursed some time after receiving care in the affected hospitals. But they will be hardly reassured of their benefits, without knowing if there could be disputes over services rendered and fees. There should be, at least on an exceptional basis, an appeal process and mechanisms to enable pre-authorisation for patients with more complex needs, so the affected hospitals would still be accessible without worries about advance payments. Should people be allowed to freely switch insurers? Due to underwriting at enrolment, this is fraught with challenges (particularly if one has been diagnosed with a health condition) and is not realistic in practice. MOH said in November 2024 that it ' does not believe that mandating full portability for IPs is the right solution '. This leaves customers effectively captive with only two options: exiting private insurance with relying only on MediShield Life, or accepting new policy terms and premium increases, no matter how unjust these are perceived to be. Both are poor alternatives. The former further stresses an already stretched public healthcare system and increases current and future funding commitments by the government which it may struggle to honour in prolonged economic downturns. The latter worsens public frustration with 'Big Business' and risks fomenting the perception of an elitist government pandering to commercial ahead of citizens' interests. HELP PATIENTS MAKE BETTER DECISIONS Second, focus on data and transparency for decision-making. No two patients are the same. Hence to fairly compare across doctors and facilities, multiple other data points are collected for risk adjustment. Consider two surgeons each with a patient undergoing gallbladder removal surgery: One patient has kidney and heart issues and the other an otherwise healthy marathon runner. They would have very different care protocols and journeys, such as the need for post-operative intensive care, despite going through the same surgery. With appropriate risk adjustments, policymakers, insurers and healthcare providers can assess and compare the quality and cost-effectiveness of the surgeons and facilities despite them having very different patient profiles. Customers would really prioritise only three factors for healthcare services: clinical outcome, patient experience such as waiting time and service hospitality, and price. In choosing insurance products, beyond the current terms offered, customers would want to know the historic rates of declining claims, the number of disputes between insurer and policy holder as well as the patterns of premium adjustments over the years. MOH already puts out comparisons of insurers' lifetime premiums, sample contracts, claims processing duration and pre-authorisation turnaround times. Combining these with clinical data is necessary now. Surely in a Smart Nation, all this data could be collected, analysed and made available so that all stakeholders can make better decisions. We all want the best available for the lowest costs, and in finding value, such data would greatly aid customer selection of the insurers that best meet their needs and budgets. Different facilities do have different sophistication and expertise and these should be aligned to the needs of the specific patients. GOVERNMENT'S ROLE IN TRANSPARENCY The role of the government deserves re-examination. Singapore traditionally prefers light-touch regulation, opting for market mechanisms instead. Former health minister Khaw Boon Wan used to describe healthcare as the classic case of market failure and said that when the healthcare market fails, the government should explore how to step in to make the market work better as a first step. One condition for a perfect market is typically information transparency and the government has a role in enabling meaningful public availability of information. Strong government encouragement of both insurers and providers (doctors and facilities) to collect data in standardised manners and make it available is essential. Any data framework and analytics won't be perfect – especially when we first start, but anything would be better than the current 'he says, she says' situation with customers caught in the middle with no way of understanding whose arguments are founded. Facilitated negotiations would also help tremendously. MOH already has a regular platform to facilitate discussion across insurers, facilities and doctors on industry-wide issues. It is timely to ask how this can be made more effective, perhaps by involving the insurance regulator, the Monetary Authority of Singapore (MAS). A combined MOH-MAS team with expert knowledge and regulatory powers could convene the stakeholders to find effective solutions, without resorting to heavy-handed policy that could crush innovation and compel the industry into a downward spiral with only pricing as the differentiator. DON'T WASTE A 'GOOD CRISIS' The dispute between Great Eastern and IHH is a harbinger of worse things to come if this degenerates into a cesspool of misinformation and wild accusations. Yes, healthcare costs are escalating beyond society's ability to cope and effective solutions are needed. Yes, all parties seek and will need a fair profit to continue. But the public interest must be paramount. Insurers and healthcare providers need to recognise the mutual dependence despite divergent interests, and work together. Customer rights must also be better and more forcefully represented to balance the power of the insurers and providers. The government should step in to bring the disputing parties together in constructive dialogue and actionable solutions starting with better data, better analytics and better decision-making. The pragmatic Singapore way is not to waste a 'good crisis', but seize the opportunity to correct long-festering perversions in the current system. Else, patients and policyholders could get hurt while public confidence in both the healthcare and insurance sectors erodes, to the ultimate detriment of all of us. Jeremy Lim is a public health physician and author of Myth or Magic - The Singapore Healthcare System. Taufeeq Wahab is a doctor and senior preventive medicine resident with the National University Health System (NUHS).
CNA
a day ago
- Health
- CNA
Deep Dive Podcast: Great Eastern suspends Mount Elizabeth pre-authorisation - time to relook how health insurance is managed?
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.
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CNA
a day ago
- Business
- CNA
Deep Dive - Great Eastern suspends Mount Elizabeth pre-authorisation - time to relook how health insurance is managed?
Play 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. Deep Dive - Great Eastern suspends Mount Elizabeth pre-authorisation - time to relook how health insurance is managed? 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. 25 mins Deep Dive - Jetstar Asia closure: Are the days of cheap fares over? Jetstar Asia will cease operations on Jul 31, a move unsurprising to experts because the low-cost carrier was struggling to turn a profit in a tough aviation market. Otelli Edwards speaks to Shukor Yusof from aviation consultancy Endau Analytics and Dr Nitin Pangarkar from NUS Business School to find out what the future holds. 20 mins Deep Dive - Is Singapore's electric vehicle infrastructure catching up with demand? Electric vehicle sales hit a new high in the first three months of 2025, accounting for 40 per cent of total car registrations. Yet concerns about charging networks and capacity remain. Steven Chia and Otelli Edwards speak with transport economist Walter Theseira and Stephanie Tan, CEO of EV-Electric Charging. 25 mins Deep Dive - Calling 995? You may be rerouted to the NurseFirst helpline instead – here's how it works Non-life-threatening 995 calls will be directed to NurseFirst, a triage helpline, under a six-month nationwide trial aimed at easing the burden on emergency services. How exactly does it work, and will the public adapt? Steven Chia and Otelli Edwards find out from Col Dr David Pflug, chief medical officer of the Singapore Civil Defence Force and Dr Jade Kua, clinical lead for the NurseFirst helpline and senior consultant at the emergency medicine department in Woodlands Health. 18 mins
CNA
a day ago
- Health
- CNA
Medical body president concerned over Great Eastern pausing pre-authorisation for Mount Elizabeth admissions
SINGAPORE: Great Eastern's suspension of pre-authorisation certificates for policyholders admitted to Mount Elizabeth hospitals could disrupt 'continuity of care' for patients, the president of the Singapore Medical Association (SMA) said. Dr Ng Chee Kwan told CNA that the insurer's move limits its policyholders' choice of doctors and discourages them from using the two hospitals. Other doctors with clinics in the two affected hospitals also voiced concerns about Great Eastern's decision. Last Tuesday (Jun 17), the insurer halted pre-authorisation certificates for admissions to Mount Elizabeth hospitals in Orchard and Novena, citing 'efforts to manage rising healthcare costs and ensure long-term affordability for all policyholders'. According to Great Eastern, it had observed certain private hospitals charging 'significantly more for similar treatment' over the past few years. Pre-authorisation refers to an insurer's approval of coverage for medical costs before treatment. It minimises the upfront cash deposit needed for certain costs, such as hospitalisation and surgical expenses, doctors' fees, tests conducted in hospital and certain outpatient treatments. These pre-approved bills are settled directly by the insurer with the hospital. Without pre-authorisation, patients have to pay for their treatments first, before filing their claims for assessment. Dr Ng, who is on Great Eastern's specialists panel and whose clinic is at Mount Elizabeth Novena, said: 'Because integrated shield plans are not portable, many policyholders may not be able to change insurers even if they are unhappy.' According to him, the insurer 'entered into partnerships with some hospitals' this year. 'Although I can admit patients to (Great Eastern's) preferred hospitals, for major cases it is not so ideal,' he said. He added that one of the insurer's preferred facilities does not have the necessary equipment for some of the major surgeries he performs. Dr Tan Yung Khan, a urologist who has clinics in both Mount Elizabeth hospitals and Mount Alvernia Hospital, said the insurer's move meant less certainty for patients as to whether their claims would go through. 'The lack of certainty will weigh on patients' minds and discourage them from certain hospitals,' he added. Dr Tan, who is also on Great Eastern's specialist panel, pointed out that private doctors are often accredited in different facilities and can operate in them. 'For example, I can see a patient in Mount Elizabeth Novena, and I often do, and I end up doing cases in (Mount) Alvernia, or even certain day surgery centres,' he added. However, he noted that certain factors would make doctors keen to use the same location. The benefits of using their usual facility are that the doctors and staff know each other's usual practices, and this may lead to 'more efficiency and possibly fewer errors', he said. 'If let's say you're doing a major surgery, you would rather be in a location that has facilities, in a sense, that you trust,' he added. 'Oftentimes, if you practise somewhere before, you have the confidence that they can support you.' COMPLICATES DECISIONS FOR PATIENTS Dr Peter Ang, an oncologist at OncoCare Cancer Centre, said he 'felt dismayed' after hearing about Great Eastern's decision. 'It does complicate the decisions our cancer patients need to make for their health care,' he said. 'On top of medical decisions when patients are unwell, they need to navigate the financial aspects, which they often have difficulty finding answers to.' Dr Ang is also on Great Eastern's specialist panel, but said last Friday that he had not had any patients who were Great Eastern policyholders since the announcement. When asked about how the move could affect his clinic, he said some of their patients might need to be admitted to various hospital locations for tests, investigations or treatment. 'So that would mean some logistical arrangement among our group of doctors,' he said. OncoCare Cancer Centre has clinics at the two affected hospitals, as well as Mount Alvernia and Gleneagles. Dr Tan said the move had no impact on his clinic for now, likely because they did not have any Great Eastern policyholders scheduled for surgery at the two hospitals at the moment. 'But, of course, moving down the road, things may be different because of the uncertainty,' he said. 'Patients may rather choose somewhere where they have more certainty on their claims … fees have gone up quite a lot, and if there's no certainty, there's a risk that there is no payment,' he said. While he was 'a bit shocked' at Great Eastern's move, Dr Tan said he could understand the decision as healthcare costs have been rising. 'I think if we can control overall costs in some way, I think it's a good thing because everyone benefits out of the whole system,' he said. 'I buy insurance, too. I don't want my premiums to keep rising either.' GREAT EASTERN RESPONDS In response to CNA's queries, Great Eastern said on Thursday that the suspension does not impact its policyholders' coverage or benefits. 'Customers can still choose to visit these two hospitals,' it said. For planned procedures or surgeries, the affected hospitals can issue an electronic letter of guarantee, which will be used to request a waiver of deposit on admission, added the insurer. A letter of guarantee reduces or waives the upfront cash deposit required for treatment and provides assurance of payment to hospitals for part of the bill. It is different from a pre-authorisation certificate. Great Eastern said customers can continue to file claims to be assessed, and that all eligible and covered claims would be paid. The insurer still issues pre-authorised certificates for treatments at other private hospitals, such as Mount Alvernia, Farrer Park, Gleneagles and Raffles. The insurer's medical care concierge will provide customers with 'various options' for treatment, including suggesting private and public hospitals where they can seek treatment. REMOVAL OF PANEL SPECIALISTS Dr Ng noted that Great Eastern removed more specialists from its panel in 2024 than any other insurer. In response to CNA's question about the drop in its panel specialists, Great Eastern said it does an annual review of its panel to ensure that doctors provide quality service to its patients and 'offer reasonable fees aligned to MOH (Ministry of Health) guidelines'. According to data from the Ministry of Health (MOH), Great Eastern and AIA were the only insurers that saw net decreases in the number of specialists on their panels last year. While AIA saw its panel shrink by 13 specialists, the drop in Great Eastern's specialists was four times this, at 52. This meant the number of specialists on Great Eastern's panel fell by about 15 per cent. Despite this, Great Eastern still had the third highest number of panel specialists, with 779. Dr Ng said the partnerships Great Eastern entered into with some hospitals this year could explain why he had not seen any of the insurer's policyholders in a while. 'I hope that Great Eastern and the affected hospitals will come to an agreement soon and restore the pre-authorisation arrangement,' he added.
Singapore Law Watch
3 days ago
- Health
- Singapore Law Watch
Some good may come out of uproar over health insurance pre-authorisation: Opinion
Some good may come out of uproar over health insurance pre-authorisation: Opinion Source: Straits Times Article Date: 24 Jun 2025 Author: Salma Khalik Great Eastern's move to suspend issuing of certificates for admission to Mount Elizabeth hospitals has created an opportunity to sort out sources of rising healthcare costs. Great Eastern has decided to suspend pre-authorisation of treatments for policyholders using Mount Elizabeth Hospital (MEH) and Mount Elizabeth Novena Hospital (MNH). The reactions seem to have been a bit over the top when, in fact, the move could pave the way for much-needed discussion on healthcare costs. Some doctors and patients have claimed that GE's move restricts their choices, despite the high premiums they pay for treatment at private hospitals. Even the Ministry of Health (MOH) has chipped in to say that it is engaging GE to better understand the impact of its decision. But let's be clear. GE's decision to stop pre-authorising treatments does not mean that the insurer will stop covering patients who choose to get treatment at these hospitals. It merely means that it is not giving blanket approval for those treatments, but rather, will reimburse valid claims when they are submitted. So patients are still free to choose whichever hospital they prefer. It's not even the case that GE has done something unprecedented. In fact, two of the seven insurers offering Integrated Shield Plans (IPs) – Income and Singlife – do not pre-authorise treatments for policyholders. So why the disquiet over GE's move? One reason is that many are reacting without fully understanding the situation on the ground. Another is possibly because GE's move affects only two private hospitals, which it claims are significantly more expensive than the rest. First, let's look at what pre-authorisation serves. The practice surfaced here less than a decade ago, following recommendations in 2016 by the Health Insurance Task Force. Pre-authorising a treatment lets insurers assess the cost and medical necessity of treatments before they are carried out; it gives patients peace of mind knowing their treatment will be covered; and it offers greater clarity to hospitals and doctors on insurance coverage. In 2019, Life Insurance Association Singapore came up with a standard form for the pre-authorisation of hospital and surgical bills. It is also worth noting that pre-authorisation is different from getting a letter of guarantee (LOG), where the insurer tells the hospital it promises to pay the full, partial or a set amount for the treatment of its policyholders. Having an LOG means patients will not need to place a deposit on admission. GE has assured that the two hospitals can still request electronic letters of guarantee for their patients, 'ensuring that there is no upfront cash deposit of up to $50,000'. Reasons behind the move So if GE is willing to provide LOGs, why stop pre-authorisation? One reason could be that GE wants to steer its policyholders towards the other seven private hospitals where total bills tend to be lower. The insurer said it has been tracking bills for procedures done at MEH and MNH and found that, for similar procedures, the charges are typically 20 per cent to 30 per cent higher than at other private hospitals. Perhaps GE hopes that the fear of losing patients might lead the two hospitals to lower their total bill sizes. The move also gives GE more wiggle room, when disputing claims. The Straits Times understands that often, in applying for pre-authorisation, hospitals just give a broad estimate of the potential charges. It is only when claims are made that a breakdown surfaces. But having pre-authorised the treatment makes it difficult for insurers to dispute the claim. Pre-authorisation, after all, is meant to give patients peace of mind and the assurance that their bill will be paid. Although Mr Yong Yih Ming, chief operating officer of IHH Healthcare Singapore, said that there are occasions where insurers may still dispute claims despite pre-authorisation, insurers enter these negotiations at a disadvantage if they had given prior approval. Without it, they can more easily scrutinise bills and query charges that appear higher than the norm. GE told The Straits Times: 'In the last few years we have observed that certain private hospitals have been charging significantly more than others for the same treatment, same clinical outcome, similar level of complexity, as well as for procedures that are less complex.' The GE spokesman added that the higher total bills arise not because doctors at these hospitals are charging higher fees, but rather because of charges by the hospital, such as for the use of its operating theatres and wards, as well as for consumables. He said: 'Doctor fees are unlikely to be the cause for the increase in the total bill size as it is consistent across the board and benchmarked to MOH fees benchmark. We have observed that the same doctors providing the same treatment at different hospitals can result in different bill sizes, which could imply that it is resulting from hospital charges.' Another major IP provider, Prudential Singapore, gave similar views: 'Generally, private hospital charges are higher than public hospitals. At the same time, we also observe that the median claim costs at certain private hospitals are higher than others for similar procedures.' It, too, tries to steer policyholders to certain hospitals and doctors by offering no claims-based increase in premiums for riders for those who choose one of the 1,700 specialists (including all in the public sector) on its panels, and have the procedure done at its partner hospitals in the private sector, which does not include any IHH hospital. What happens next? Associate Professor Jeremy Lim of the Saw Swee Hock School of Public Health said he was disappointed by GE's move, as 'unilateral, arbitrary decisions announced at short notice' are unhelpful. He said: 'Payers and providers are mutually dependent and work in a partnership of mutual respect and open communication. Without private providers, there would be no need for private health insurance, and without private health insurance, many of us would not be able to afford private healthcare.' However, in fairness to GE, Prof Lim added that it's understandable that the payer – in this case, the insurer – seeks to maximise the value of the money it pays out. He said: 'Whilst doctors' fees have been moderated as a share of total bill size, facility fees have escalated. Every effort should be made to manage down this portion of the fees.' According to both GE and IHH Healthcare Singapore, which owns four private hospitals here including MEH and MNH, the two parties have been in discussion for some months. Where they differ is that IHH said it had been given no inkling of GE's move, while GE said it had informed IHH of its decision and rationale. Perhaps GE moving so quickly to cut off pre-authorisation could have been handled better. On the other hand, if it manages to get the two hospitals to align their charges with others in the private sector, it can only be a good thing for patients, while moderating overall healthcare costs. Now that the problem has been spelt out and made the headlines, perhaps MOH should engage not just GE, but also all the IP insurers as well as private hospitals in a discussion on their charges. IHH would then have the opportunity to either show that the charges at the two hospitals are not excessive, or justify why they are. If it can't do this, it may have to rein in the charges. Escalating healthcare cost is a major concern, and the current brouhaha opens the way to possibly nipping some of the push factors in the bud. Salma Khalik has been covering health issues for over 20 years. Source: The Straits Times © SPH Media Limited. Permission required for reproduction. Print
