Not So Merry A Season

It’s that time of the year when practically everyone you know is on holiday overseas. They are taking full advantage of the almost almighty Singapore dollar and standing up for Singapore by chirping “cheap, cheap” from Tokyo to Tasmania and from Seoul to Sao Paulo. Of course, most people do not realise that there are zero-sum games in this world after all – if we find everywhere else cheap, then everyone else also probably finds us expensive. Which probably explains why Orchard Road is rather quiet nowadays, when compared to other shopping districts in the major cities of Asia. But it’s OK, in the meantime, just enjoy the almost almighty Singapore dollar and almost all-conquering Singapore passport.

It’s the season to be merry, after all. But not for quite a few folks

The first group of folks would be the board of directors, management, shareholders and customers of Cordlife Group Limited. In a shocking revelation, several storage tanks in its Singapore operations for stem cells were found to have been exposed to temperatures exceeding that which is deemed allowable. This calls into question if the cells and tissues stored therein are still viable should they be needed. In any case, an accreditation body called FACT (Foundation for the Accreditation of Cell Therapies) has suspended their accreditation of the bank. Most if not all reputable hospitals who can perform stem cell transplants will only take samples that have been stored in cord blood banks that are accredited with internationally reputable accreditation agencies – FACT is one of them. In other words, even if the cells stored are viable, they may not be deemed usable because the accreditation status is now suspended.

Anyway, the incident calls into question a few things, including

• When and how much did the management and board know about the shortcomings?
• What was done to uncover the full extent of these incidents to get a full picture of the number of incidents in tank(s) were exposed to higher than allowed temperatures?
• What were the reasons for these failures in operations, escalation and disclosure?

This will entail probably the Mother of all RCAs (Root Cause Analysis)…..And we haven’t even talked about how this incident affects Singapore’s reputation as a healthcare hub.

The next unmerry thing on the radar is the alleged corruption of the AON Singapore CEO, who has been accused of taking a bribe amounting to $240,000 from Fullerton Healthcare. At first glance, two things are interesting about this case. First, this hobbit doesn’t know how much an insurance broker like AON pays their Singapore CEO, but it is probably well in excess of $240,000 a year. The fact that he was willing to risk his entire well-paid job and possibly end up as a criminal for $240,000 defies common sense. Also no present or past employee or director of Fullerton Healthcare has been charged yet by CPIB. Watch this space carefully.

We move onto something else pretty interesting developing in the Third Party Administrator (TPA) Scene. An unnamed TPA was said to have offered new fee scales to its panel of ophthalmologists. These new scales are so low that they fall well below that of the MOH Fee Benchmarks. In fact, an older ophthalmologist was said to have remarked that the new fee scales are even below what he was offered more than 10 years ago by the same company. Apparently, in 2011 a Table 4A operation was reimbursed at ~$2800. In 2024, the same Table 4A was to be paid ~$2200.

This hobbit is also hoping his bowl of Bak Chor Mee in 2024 will be cheaper than what he paid for in 2011, but that is wishful thinking bordering on the mythical, like Santa coming down the chimney bearing gifts.

But myths and wishful thinking will remain just what they are. Reality, on the other hand, bites. Apparently, more than 90% of the original ophthalmologists who were on this TPA’s panel came to their independent and individual conclusions that it was unwise to remain on this panel for reasons best known only to them and they then quit one by one; leaving just a handful left on the panel. It’s a free world and a market economy we live in. Payers have a right to offer fee scales as they see fit and service providers have a right to independently reject them for whatever reasons. But if I were this TPA’s clients, I would ask why did my panel of ophthalmologists shrink by more than half in 2024 when compared to 2023?

Finally, its squeaky-bum time for the Integrated Shield Plan (IP) providers. On 9 Dec 23, Mr Han Fook Kwang wrote in ChannelnewsAsia (CNA) this commentary titled, “Amid ever-raising premiums, let’s make for no-claim individuals to switch private health insurers”. Now Mr Han is the Michael Owen-equivalent of Singapore journalism. He was the Editor of The Straits Times for many years but now writes for CNA, not unlike how Michael Owen played for Liverpool before playing for Manchester United, both periods to wide acclaim.

In this commentary, Mr Han has come to the conclusion that:

1. The IP providers want to collect premiums when you are young but are happy for you not to be covered by them when you are old (i.e. the concept of cherry-picking or adverse selection)
2. There is no real competition between IP providers once a person has chosen to stay with one IP provider due to pre-existing diseases
3. Smaller IP providers charge higher premiums and also make financial losses

He then recommends:

1. (More) government supervision and action
2. Beyond ensuring the financial viability of insurers, there should be someone (or some government agency) out there to look after the interests of the customers
3. There should be “closer oversight of the premiums charged and what they cover”.
4. Allowing for “portability for those who have not made any claims for a certain number of years”.
5. So as to facilitate “a gradual migration to more efficient companies charging lower premiums”
6. Three to four IP providers will suffice for a relatively small market like Singapore so that real competition exists, instead of seven providers

Many of the above points have also been covered by this Hobbit previously in this Blog over many posts but of course nobody pays attention to mythical me. Hopefully the guys in MAS, the stated regulators of insurers, will pay more attention to what Mr Han is saying. Even though going by the past record of MAS, this is most likely going to remain a hope and nothing more. But’s it is Christmas and Christmas is the season of hope. The hope that MAS will do more than pay attention to financial viability or health of insurers, but also do what Mr Han said about looking after “the interests of customers”.

Finally, we move on to the ongoing Public Consultation of the Health Information Bill (HIB). It’s interesting how this Consultation is carried out – which is in the form of a survey or a questionnaire. The survey consists of a number of questions that demands the respondent to answer in a binary-outcome fashion, either a “yes” or a “no”. Each question is followed by an optional free-text box for you to elaborate, should you so wish.

I think whoever designed this survey should be sent either to the Civil Service College or the Saw Swee Hock School of Public Health for a short course in survey or questionnaire design, because enforcing a binary outcome does not lend itself well to understanding and analysing the nuances in attitudes of diverse stakeholders in what is now usually a complex policy environment. Many respondents may not use the free-text box provided and even if they do, the free text cannot supersede the “yes” or “no” response.

You are conducting a consultation to receive feedback so as to draft bills and fine-tune policies. You are not conducting a referendum like in the Scottish Referendum of 2014, when the Scots were asked whether they wanted to be an independent country or not, in which case a “yes” or a “no” answer is fit for purpose.

Indeed, a “yes” or “no” answer makes for easy analysis later when the consultation process is over. But what will be the quality of the analysis of the survey outcomes that can possibly come out of such a blunt approach?