I read with interest this rather long opinion piece by an ex-ST journalist in The Straits Times “Some practical ways to rein in rising healthcare costs, premiums” (Claire Huang, 21 May 25, The Straits Times)
In particular, one section highlighting Integrated Plan (IP) insurer Great Eastern Life deserves scrutiny.
Let’s reproduce the section here,
“What an insurer can do”
“IP insurers are constantly looking for ways to sieve out doctors and hospitals that like to maximise profits.
In this area, Great Eastern Life might have found an achievable and pragmatic way out.
In October 2024, the insurer launched its own medical care concierge, where its in-house officers help match patients to doctors, based on their IPs.
These 10 officers, who are experienced in handling patients or are medically trained, are employed by the insurer and receive a fixed salary.
They first determine what benefits apply based on the policy the patient has, then they recommend specialists who are on Great Eastern’s panel.
Patients can also choose to seek treatment from specialists who might not be on Great Eastern’s panel.
In such an instance, the co-payment amount will logically be higher and some benefits may be moderated if the specialist is not on the panel.
The cost estimates and differences will be made known to the patient.
Those who opt for panel doctors will receive pre-authorised certificates and their claims will be guaranteed by the insurer.
Already, the scheme has worked for Great Eastern, whose concierge team has processed more than 1,100 policyholders so far.
Besides preferred doctors, insurers also have their preferred hospitals.
The preferred hospitals approach functions on the basis of the insurers’ bargaining power, which has grown as medical tourism here dries up.
Some insurers secure bill discounts for patients by agreeing to send these patients to preferred hospitals.”
Let this hobbit now comment and offer another perspective on this subject in addition to this piece of awkward journalism.
In particular this statement, “IP insurers are constantly looking for ways to sieve out doctors and hospitals that like to maximise profits”.
This is true to a certain extent. But then, to be fair to both doctors and hospitals, aren’t the insurers, as companies responsible for maximising shareholder value, almost always trying to maximise profits too? Why only focus only on doctors and hospitals? Should IP insurers also be sieved out when they maximise profits?
Anyway, in this hobbit’s opinion, let us look at some past behaviour and practices as well as the track record of GE to see if it is as good as it is made out to be by this article.
In the 2022 IP Providers’ Ranking Survey conducted by SMA which was published in the SMA News June 2023 Issue, GE did not do so well: (https://www.sma.org.sg/news/1953/June/SMA-Integrated-Shield-Plan-Providers-Ranking-Survey-2022).
In fact, of the 4 largest IP insurers, (Income, AIA, Prudential and GE), it regularly came in last on many fronts. The Survey involved respondents who were doctors. Out of a scale of 1 to 5 (5 being the best), it achieved an overall score of 2.5, which was only higher than the two smallest IP insurers: Singlife and Raffles (which has an employee-physician model). Overall, it was placed 5th out of 7 IP insurers.
In terms of doctor-panel management, GE did pretty well in the 2022 Survey, in terms of inclusiveness and transparency of criteria for doctor selection, scoring 2nd out 7.
But for 5 out of the remaining 6 questions asked, it ranked a poor and consistent 5th place out of 7 insurers, above Singlife and Raffles but consistently below Income, AIA or Prudential. These 5 questions are: ease and timeliness of pre-authorisation, timely payment to doctors and appropriateness of fee scales and putting up obstacles to dissuade policyholders to see non-panel doctors.
Of course, one may say well, this is all about doctors’ perspective which may be biased. Well, let’s look at MOH data then.
Lest we think that panel management is something that GE is good at, and maybe that is the case in 2022, latest and official MOH data suggests otherwise: (https://www.moh.gov.sg/managing-expenses/schemes-and-subsidies/integrated-shield-plans/about-integrated-shield-plans/)
Let’s look at what happened in 2024 for the Big 4 IP insurers according to MOH data
| Panel | No. of Private Specialists (Total) | No. of Private Specialists Who Left | No. of Private Specialists who Joined |
| AIA | 594 | 25 | 12 |
| GE | 779 | 126 | 74 |
| Income | 807 | 37 | 93 |
| Prudential | 814 | 16 | 154 |
The data provided by MOH claim with this footnote/disclaimer:
“The higher private specialist attrition in 2024 was due to Great Eastern Singapore’s planned panel review. Great Eastern Singapore continues to maintain a large pool of private specialists on its panel”.
I would hazard a guess that this footnote was inserted at the insistence of GE but to be fair, one does not really know who wanted it to be there. But the MOH numbers speak for themselves.
Adding on new specialists is always a good thing for policyholders because it gives them more choice. But removing specialists may not be a good thing. It leads to loss of choice and more importantly, continuity of care probably suffers. 126 out of 779 is a turnover rate of 16%. The footnote only states that it was due to a “planned panel review”. The statement doesn’t state how often such planned panel reviews occur. Could it be yearly, or more frequently or less frequently? Anyway, if you remove 16% of specialists each year, you can effectively turn over the entire panel in 6.25 years, and that is assuming you top up each year with the same number of new specialists that you remove, which is not even the case here. The panel size actually shrank in 2024, because GE only added 74 private specialists while it removed 126. The panel size of GE for 2022, 2023 and 2024 were 764, 831 and 779 private specialists respectively.
As a policyholder, one should assess an IP insurer’s panel management not just on the absolute number of specialists and whether the panel size is increasing, but also the amount of turnover (number of specialists leaving and joining). The worst scenario is when panel size decreases and at the same time the panel experiences high turnover. You have less choice and continuity of care suffers as your preferred doctor is removed from the panel.
One can easily access MOH data from the link given above and see for yourself and come to your own conclusions as to which IP insurer is better managing their panels for the benefit of policyholders and not just for other reasons, e.g. profit maximisation.
Next, we come to look at some examples of how GE (or rather their appointed third party administrator, Adept Health) communicates with some of their panel specialists. Several specialists have surfaced essential copies of the same letter to this hobbit sent out in Aug 24. An excerpt from this letter reads
“XXH Privileges, Great Eastern (GE) is pleased to announce that XX Hospital (XXH) has been designated as the priority and preferred hospital for Great Eastern Life customers. This selection is based on XXH’s commitment to delivering exceptional care, which aligns with the goal of providing the best possible healthcare experience for the customers”
If the panel doctor does not play ball and admit GE policyholders to XXH, then they may receive another letter several months later. Excerpts from this letter (which this hobbit received with the doctor’s name redacted, so the doctor’s identity is unknown even to this hobbit):
“We have recently noticed that the clinic has not been prioritizing admissions to GE preferred hospitals, such as the XXH. This may result in non-compliance with our guidelines.
As a result, Dr. YYY name is currently removed from the Health Connect website.
If you are accredited, we kindly request that you prioritize admitting patients to GE preferred hospitals during this 3-month observation period.
Should you have any questions or require clarification, please do not hesitate to contact us.
Dr YYY, apparently appealed, because a month later, the TPA replied with an email. Again, excerpts from this email,
“Thank you for allowing us the time to review this matter.
Based on our PAC issuance data of Year 2024, we do observe there are patient admission from Dr YYY mostly at ZZ Hospital (You can refer to the PAC data captured at DA Adept records for your reference). As we are also informed by GE side of data (for non PAC cases) it was observed with similar trend as well.
We are open to understand more from Dr YYY if there are any challenges or concerns in supporting this initiative.
Please note that despite the temporary removal of Dr. YYY’s name from the website, Dr YYY still remains as a panel specialist under GE Shield. This change will not impact Dr. YYY’s PAC requests”.
Finally, Dr YYY was terminated from the panel recently by email:
“We regret to inform you that we’re serving this termination notice on our Health Connect Provider Agreement”. No specific reasons were given for the termination, but one can reasonably come to your own conclusions from the sequence of events and previous communication the reasons for the termination.
A few points are worth discussing here. As an insurer, it is free to source for the best deal from private hospitals, generally speaking. But as a doctor, I can tell you, there are hospitals and then there are hospitals. This is the same for restructured hospitals. There are things that SGH can do, that well, Sengkang General cannot support well as a hospital. There are complicated stuff that NUH can do, that NTFGH cannot. MOH acknowledges this as much – different restructured hospitals have different levels of capability.
And so it is too with the private sector. There are complicated procedures that XXH cannot support, that another private hospital can. Of course these better equipped and staffed hospitals are often more expensive. To simply say that one must admit their patients to a certain hospital just because an insurer has a special arrangement with that hospital ignores the complicated nature of medical practice and hospital capabilities, and may even promote unsafe clinical practice just to satisfy an IP insurer’s commercial interests.
Please also note in the above correspondence that the TPA did not once claim Dr YYY was expensive and did not follow GE’s fees schedules. The professional fees charged by Dr YYY was never highlighted as an issue.
More importantly is the whole idea of transparency. Has GE informed its policyholders in the first instance that panel doctors who don’t use their preferred XXH hospital will be penalised? And perhaps even eventually removed from the panel? One must tell the good news with the bad news. One should not only tell policyholders that they will get free parking and a free fruit basket etc if they go to XXH. They should also tell them that there is a risk of their preferred panel doctors being removed from the panel if they do not agree to being admitted to XXH, leading to a loss in the continuity of care.
In fact, the IP insurer should tell potential customers of their IP plans upfront that their choice of care is largely limited to certain preferred hospitals, or rather private specialists admitting to these preselected hospitals before IP policies are sold or purchased. Then folks shopping for an IP policy can then make an informed choice of which IP insurer to use or buy their IP policies from. What GE is doing is essentially selling a “bundled” IP product, with preferred specialists and preferred private hospital(s) bundled together. Nothing wrong with that, but they need to tell everyone upfront, including existing policyholders and potential customers who are seriously considering buying their IP policies. They can then compare the price of a bundled product with the price of another IP product that gives them more choice of not just doctors, but hospitals as well.
Back to the subtitle in the opinion piece in The Straits Times, “What an insurer can do”. There are many things that an insurer can do. Perhaps too many. This is because the clinical aspects of the IP sector are largely unregulated while the assigned regulator, the Monetary Authority of Singapore (MAS) is interested mainly in ensuring that an insurer is financially viable and does not go bust. Indeed, the insurer can do many things legally. But should they?
Now, based on the above information, would a hypothetical construct called “the reasonable lay-person” still buy an IP policy from GE? Perhaps he will, perhaps he won’t. This hobbit doesn’t know. Perhaps Ms Claire Huang may know and you can ask her.
hobbitsma 