Can you really blame the consumers for the increasing cost of health shields?

Ok, perhaps I am a bit late to the party, since this has been widely covered in the mainstream press, as well as various other bloggers and sites.

As many of our readers would know from our monthly updates, one part of the fixed expense would be our insurance premiums. This also include the partial cost of the shield plans of my parents.

We had recently renewed the shield plan for them, and because of their age (hitting the new age band) and my mum’s history of making a claim about 10 months back,  the premiums has also (exponentially) increased. I am splitting the cost of the premiums with my sibling, but collectively for this year, it seems like we will need to pay about $8314, which means $4317 on my part.

And as I was lamenting over the atrocious increment of the premiums, we were slapped with another appalling news that a 5% co-payment will be introduced to help address the overconsumption of medical services.

That really got me riled up.

Of course, the proponents for this scheme did mention that by implementing a co-payment feature, it will also help to “reduce” and “mitigate” some of the moral hazard of the individuals who are “overclaiming”, and indirectly causing losses to the insurance company companies.

Well the article did quote some examples by Mr. Chee Hong Tat, Senior Minister of Health, including an individual claiming for 12 nose scopes a year, even though there was no medical need and a few other examples which got people to question whether it has transcended into a “buffet syndrome”, where people are just undergoing these procedures because they are covered by insurance, adopting a since-I-am-covered-by-insurance-might-as-well-go-through-all-the-tests mentality.

Having said that, I would like to think that these are the minority. After all, these are medical procedures (which means there are certain risks involved) and there were also no statistics shared (percentage of individuals who are “overclaiming”, etc), so we don’t really know how many people are really abusing the system.

In a separate scenario, it might be true that there are some individuals or Singaporeans who are overinsured, and this has been discussed previously by other articles.  In fact, it could be due to our “kiasi” personality —- better get ourselves insured just in case… … In Singapore, there is also a popular saying that goes, ” one can die, but cannot fall sick“,  in part referring to the high and astronomical medical costs incurred if you require medical help (especially so for chronic conditions). Having said that, with the introduction of medishield life, I think this has helped mitigate some of those issues (although it is still debatable…).

Anyway, back to the earlier point.

Personally, I do not deny that I might fall under the “kiasi” category. In fact, I had purchased my H&S plan immediately after I got my first job, in my early 20s. I just wanted to make sure that I was covered, in case I needed medical attention for anything (touchwood!), and premiums are also cheaper when you buy it when you are younger, with a clean bill of health.

In addition, with the trend that people are getting all sorts of weird diseases and illnesses at a younger age compared to a hundred years ago, be it due to our lifestyle or diet, you never know what is going to happen. A good friend of mine is a physiotherapist in a local hospital and she has shared with me on various occasions that that there is an increasing trend of younger patients who come to her for post-stroke therapy, some even as young as 18! And yes, they were also wondering how and why they got it.

When I was in my late 20s, I developed a certain condition which would require surgical intervention. Even though it was just a minor surgery, and considered a simple one, it was still a surgery nevertheless and definitely, there were some risks involved. I dreaded it and after discussing with my mother, we decided to seek a second opinion to find out whether surgery was indeed necessary.

After oral medication yielded no positive results, under the professional suggestion of this second specialist physician that I was seeing, I finally took the plunge and underwent the surgery.  I could still remembered when I was wheeled into the operating theatre, feeling really scared and nervous, and the lights in the operating theatre didn’t help either. Before I realised, the anesthesia had taken its effect and I felt into a deep sleep. When I woke up, the surgery was over and I was already back in the ward.

To be honest, unless absolutely required, I will absolutely not want to go through that again. It wasn’t a heart bypass nor a brain surgery. But it was daunting nevertheless. 

Unless I am the odd one out, I do not think that many would want to undergo something like that either.

Many of these procedures, be it a surgery (major or minor), or simpler checkups like a scope etc., can be pretty uncomfortable. And risks are involved as well (even though it might be just a measly 0.1% risk). Yes call me a skeptic but the thing is, you never know. And there are real life stories of these procedures gone wrong, some perhaps in Singapore, some perhaps not.

In addition, they are often done under the recommendation of the specialist doctor. If there is no medical need, more often than not, they will not recommend that.

However, in the case of the individual who underwent 12 nose scopes a year with no medical need, perhaps, the specialist should raise the alarm bell for another condition, for instance, hypochondria? And shouldn’t this be flagged when the insurer was processing the claim? Well, I guess it did ultimately and that is why it was reported.

I do not deny the fact that there might be some errand doctors who perhaps suggest certain procedures that the patient might not require. Yes, perhaps there’s another cheaper and useful procedure that could help to alleviate the condition, but yet the specialist suggested the more expensive one so as to charge more. This, however, would most probably constitute medical malpractice and should be seriously dealt with. 

You see, many of us are not medically trained. The reason why we see a specialist or physician for these ailments, is because we want to get cured (well, unless one is suffering from some kind of hypochondria perhaps, but even such cases should seek medical help!). Moreover, we are highly dependent on the recommendation of these physicians to let us know and tell us what is happening to our body, as well as their professional discretion on the best course of treatment.

If the physicians were to sell us the procedures such that the more expensive one is better for us, I bet that most would go for that option (especially since we are insured and do not have to worry about the cost. After all, we just want to get cured right?). If the cheaper one works as well, it’s up to the physician to recommend as well. I will not choose a treatment based on the cost, but based on one that suits my condition, and less risks etc. Cost will not be the key point of consideration (since I am covered by insurance.) I just want to get well and at the end of the day, that’s why we are INSURED right?  

As such, is it right to blame consumers entirely that they would choose a more expensive option? That is highly debatable really.

One might argue, you could choose not to opt for the atas private hospital either. The government hospitals would offer pretty good options as well. Which is true erm …. …. to a certain extent. Unfortunately, yours truly never quite had a good experience with them.

Disclaimer – not that I have personally sought for medical treatment with them. But my mother had, and that experience was quite lousy. Of course, this is just our family experience, and I have heard from some of my friends, whose parents had seeked help at the restructured hospitals, and had their treatments managed rather well.

Anyways, back to my mother. For the longest time, my mother has an eye ailment which she has been seeking consultation at a restructured hospital.

For three years, she has been heading back for follow-up appointments every couple of months. But there has never been a clear cut explanation and follow up treatment. Each appointment was simply a scan of her eyes and they would fix another appointment for her to go back again.

This went on for three years, until one day, we all wondered if we should seek a second opinion from a specialist in private practice. Coincidentally, a neighbour has also sought treatment for an eye ailment from a private practioner and she highly recommended the physician to us.

The day she went for consultation, they had recommended her to undergo surgery.

Everything was fast, and fixed. An we were glad that we had insurance coverage for that, because the fees were rather pricey.

And she recovered well, and her eyes are giving her less problems these days, which is great.

Should we had continued at the restructured hospital, I wasn’t sure whether she was getting the proper treatment.

One might argue that for private practitioners, the doctors are more profit driven, and as such “take the opportunity” to sell these procedures to patients.

They might be right. And if so, that would also possibly constitute medical malpractice.

But if not, they would have significantly improve the quality of life of the individual by providing the timely and appropriate treatment required for them.

So far, from our cases, we think that our quality of life has improved after our surgeries and we are glad that we have our shield plans to cover the cost of the surgeries.

Having said that, I can understand the benefit of introducing a co-payment feature within the shield plans.

However, at the same time, I think it is rather irresponsible to just blame the consumers lynching on the supposedly “buffet syndrome”.

After all, there are many parties at play.

Kyith from investment moats has recently written an article about it, which I largely agree with.

Perhaps it is also timely for  a regulating body to look into the fee system of the private practice, for they are the ones, who are rendering the treatment, charging the fees, and causing some of these treatments to be astronomically high. Even though this is an open market, but healthcare should be an area where there should be a delicate balance between profit-driving and affordable care.

And as for the insurers, seriously, did you not see this coming?