The recent letters regarding empanelling of doctors in Integrated Shield Plans (IPs) by insurers can be summarised into how two different and often conflicting relationships are striving for primacy when private healthcare is organised and delivered (Insurance company making it hard for policyholders to have continuity of care, April 7, and Income Insurance supports continuity of care, April 13, among others).

On the one hand, there is the patient-doctor relationship, described in the Hippocratic Oath, which has existed for millennia. The patient is free to choose his doctor and the doctor’s obligations to the patient can persist for a long time, often till the death of one party; this facilitates the important “continuity of care” mentioned.

On the other hand, there is now the insurer-policyholder relationship, which is contractual and only annual, since IPs are annual insurance contracts. The insurer-policyholder relationship has primacy over the patient-doctor relationship. The insurer wants the policyholder to pay a deductible when non-panel doctors are used, even when a patient-doctor relationship already exists.

The Health Insurance Task Force in 2016 recommended that panels may be used, and that insurers should disclose how health providers are selected, so as “to enhance and ensure transparency of the arrangement (of empanelling)”. Eight years on, no IP insurer has publicly disclosed what the inclusion criteria for empanelling are.

It is thus difficult for other parties, besides the insurer, to understand the “related benefits” (as mentioned by Income Insurance) of empanelling. However, the detriment herein, such as the added cost of a deductible to ensure continuity of care, is evident.

It is also hard to envisage how policyholders are encouraged “to play an active role in choosing medical providers for their healthcare” when they are unaware of the selection criteria for empanelling doctors, other than to acquiesce to the preferences of the insurers by selecting a panel doctor.

Ultimately, IP regulators will have to listen to what the patient/policyholder is saying and decide what is best for Singapore –whether the patient-doctor relationship remains the cornerstone of our healthcare system or if it should be subjugated to the insurers’ management of the insurer-policyholder relationship. Co-existence of the two relationships as equal and harmonious partners is probably difficult, if not impossible, now.

Wong Chiang Yin (Dr)

The recent spate of letters regarding empanelling of doctors in Integrated Shield Plans (IPs) by insurers can be summarised into how two different and often conflicting relationships are striving for primacy when private healthcare is organised and delivered.

On one hand, there is the patient-doctor relationship, which has been described in the Hippocratic Oath; and has been in existence for two millennia. All doctors in Singapore take the Singapore Medical Council’s Physician’s Pledge, which has derived much content from the Oath. The patient is free to choose his doctor and the doctor’s obligations to the patient can persist for a long time, often till one of the two parties has passed on; this facilitates the very important “continuity of care” that has been mentioned.

On the other hand, there is now the insurer-policyholder relationship, which is contractual and only annual, since IPs are annual insurance contracts. The insurer-policyholder relationship has primacy over the patient-doctor relationship: the insurer now wants the policyholder to pay a deductible when non-panel doctors are used, even when a patient-doctor relationship already exists beforehand with this doctor.

The Health Insurance Task Force in 2016 recommended that panels may be used, and that insurers should disclose how health providers are selected, so as “to enhance and ensure transparency of the arrangement (of empanelling)”. Eight years on, no IP insurer has publicly disclosed what is the inclusion criteria for empanelling. Empanelling remains a black box exercise.

Because it is a black box exercise, it is difficult for other parties, besides the insurer, to understand the “related benefits” (as mentioned by Income Insurance) of empanelling. However, the detriment herein, such as the added cost of a deductible to ensure continuity of care, is evident. It is also hard to envisage how policyholders are encouraged “to play an active role in choosing medical providers for their healthcare” when they are unaware of the selection criteria for empanelling doctors, other than to acquiesce to the preferences of the insurers by selecting a panel doctor.

Ultimately, IP regulators will have to listen to what the patient/policyholder is saying and decide what is best for Singapore - whether the patient-doctor relationship remains the cornerstone of our healthcare system or that it should be subjugated to the insurers’ management of the insurer-policyholder relationship. Co-existence of the two relationships as equal and harmonious partners is probably difficult if not impossible now.

Wong Chiang Yin (Dr)