Did shortcomings in public policy contribute to the Great Eastern versus Mount Elizabeth saga?

One thing I really don’t like about the Singapore government is that they don’t really acknowledge shortcomings or limitations. Unless they are the perfect government, there must be something they can do better right? The second thing I don’t like is that there are no published action steps in terms of what they will do to improve the situation.

I get that no problems can be solved immediately and it’s impossible to know what solutions would eventually work. That much is true. But it would be nice to hear more about what are the steps that would be taken, and preferably the timeline.

We are great with this when it comes to building MRT, so why not just apply the same to healthcare policy?

Are private health insurers and private hospitals really tied up in a knot?

Minister Ong Ye Kung has finally responded to Great Eastern suspending Mount Elizabeth Hospital pre-authorisation.

The health minister claimed on his Facebook post two days ago that private health insurers and private hospitals are tied up in a knot. But what does that even mean? I get that there are conflicts between them, that makes sense. The more money private hospitals make, the more insurers have to pay out. It hurts their bottom line. I get that.

But so what?

Great Eastern is by no means poor or unattractive as a company. OCBC has been trying to takeover Great Eastern for two decades! Just last month, OCBC offered $900 million for less than 7% of Great Easter shares in their attempt to delist the insurer.

According to their website, Great Eastern’s full year profit for 2024 increased by 28% to $995.3 million. They definitely make money.

The group that owns Mount Elizabeth Orchard and Novena, aka the IHH Healthcare, net profit for last year was RM $1.9b or SGD $573m. They make money too!

In my opinion, the ones tied up in the knots are Singaporeans with integrated shield plans! Premiums are ever increasing to up to over $10,000 per year but what the additional benefits?

Public policy can address issues before they become a problem

The Tampines medical clinic rental at 52k per month is definitely a clear indicator that our healthcare policies are not working well. Remember Ong Ye Kung being dismayed? But how can he be! He has been the minister of health since 2021.

There was mentioned of how a new tender system was being used at Bartley Beacon GP clinic, which awards tenders not based on rental alone. They make it sound like the government has proactive at dealing with issues before they become problems. But the Price-Quality evaluation Model (PQM) framework has been introduced by HDB since 2018. It was just seven years too late at being applied to medical clinics!

So ya, I do think that our public policies have their shortcomings.

If insurance design is big factor (i.e., problem?) why was it not addressed?

One of the things Minister Ong Ye Kung mentioned on his Facebook post was that insurance design is a big factor leading to the current suspension of pre-authorisation certificates for Mount Elizabeth Orchard and Novena hospitals. But, um, insurance design has not changed for decades?

Insurers know that policyholders are worried about incurring an unexpected huge hospital bill, so they launch insurance products that offer generous coverage to win customers and market share. These include ‘as-charged’ or no limit coverage, and riders that will protect almost to the last dollar.

Sure, the ministry of health did introduce copayment. This effectively forces Singaporeans to pay out-of-pocket for their hospitalisation fees. The people who is tanking the burden are the people. Remember, insurers are still (very) profitable!

Yes, there is a now a fees benchmark from Ministry of Health.  This guides how much doctors should charge. Who is affected by this policy? Specialists. Sure, the greater society does benefit. But only the 10% who opt for procedures and surgeries at private hospitals.

My question is, if insurance design is the big factor and contributing to the knot, what are the measures taken to address the rising healthcare costs on the insurer’s end?

I cannot reiterate this enough. Insurers are (very) profitable. Why are they allowed to continue to enjoy increasing profits at the expense of the people? D:

Is not for profit hospitals the solution to the problem?

I don’t think people are choosing to go Mount Elizabeth Orchard and Mount Elizabeth Novena because there are no cheaper hospital options. Sure, a not-for-profit hospital could potential offer cheaper fees but that still doesn’t address insurance design, does it?

The issue here is that Mount Elizabeth Orchard and Mount Elizabeth Novena are charging above industry norms, and that Great Eastern is fed up with bearing these costs. From a patient perspective, the premium I pay would cover both cheaper and more expensive private hospitals. Why then would I as a patient choose a cheaper hospital just cos there is cheaper is an option?

Help me understand that please.

Regulation on both insurance companies and private hospitals can be beneficial

Not-for-profit organisations are also allowed to charge whatever they want to charge. The crux of the issue here is increasing healthcare fees that are already skyhigh. What we need is price control, and that can apply to all private hospitals. Regardless of their profit status!

I don’t know much about the Australia situation. What I do know is the Australian Competition and Consumer Commission (ACCC) regulates competition in Australia and consumer rights. They recently sued health insurer Bupa and Bupa now faces a $35 million fine. I feel like we can do with some similar watchdog to ensure companies do not keep profiting hundreds of millions at the expense of consumers.

Not-for-profit does not guarantee price control

Furthermore, not for profit does not mean prices cannot go up. I am not a finance person or an economist so I have no grand theories or case studies to share. But I can share my own personal experience with Singapore Symphony Orchestra.

For subscription concerts in 2024, the fee for a balcony B ticket is $48. Back then, these seats are category three tickets. Today, the same seat for a subscription concert will cost me $75. They are now re-zone as category two tickets. That is a sneaky 56% increase in ticket price.

And, um, SSO is a charity and a not-for-profit organisation. From my very limited understanding of financial statements, their endowment fund is a whopping $66+ million.

The sneaky 56% increase in ticket fee over a year for the exact same seat has left such a bad taste for me. I am not sure if they are a music group I will continue to support with my own money. Thankfully, SG60 vouchers comes with a SG Culture Pass, so maybe you will still see me at a SSO concert.

Why would a chiropractor care about private hospital fees?

In my work as a chiropractor, I see people in pain. Most of these pain is chronic in nature, but there are some that are acute. There have been cases where I would suggest clients visit the hospital for further investigation or pain management.

When you have a disc herniation that is aggravate and in an acute flare up, it is extremely painful. Even the pope was not spared. In 2020, the then Pope Francis skipped New Year’s Eve and New Year’s Day services due to sciatica pain.

I once had a patient who made it to my chiropractic clinic but could not sit, stand, or lie down because of his back pain. He was wailing in pain every two to three minutes because there was no single position he could find that was bearable. There was literally nothing I could do! I advised him to seek pain management at the emergency department.

There is 100% a place for private hospital treatments for pain management. There are some instances where a NSAID or even tramadol injection could give you the relief you need to have some semblance of basic living.