Managed Health Care scheme - the sad truth

Categories: Singapore

Today newspaper highlighted the Managed Health Care scheme in Singapore in today's edition. In the report, it highlighted the danger of unprofessional conduct by general practitioners under the scheme and the need to regulate the industry. The main concerned highlighted is that doctors may compromise on the medication prescribed for maximum profit.

To the uninitiated, Managed Health Care is a scheme akin to an insurance policy taken out by employers for their employees. Employees either do not have to pay for their consult and medication when they see their doctor or pay a minimum sum of usually S$5 in the co-pay scheme. In return the employees are restricted to see only a panel of doctors covered by the scheme in order to enjoy this privilege. For the doctors, they have a ready potential pool of patients from the scheme. The downside being a cap on the charges that the doctor can charged. Sometimes, certain scheme even place restrictions on the type of medication that can be prescribed for the purposes of reimbursement. In short the company that carry out the Managed Health Care (MHC) scheme acts a middleman between the employer and the doctor.

Do employees benefit from the scheme? Yes and no. If the employee is seeing the doctor for simple everyday cough and cold, then he does benefit from the scheme. This is because the medication prescribed are rather standard and the cost of such medications are manageable for the doctor. Hence his medical care is not compromised as similar medication would be prescribed whether a patient is under the scheme or not. The only downside in this instance is the trouble of having to seek out the doctor under the scheme.

If a problem is more complicated, then the problem may arise depending on the MHC scheme. Some MHC does not limit the type of medication that can be prescribed. Others restrict to a certain approved list, some give leeway but only if given prior approval. In practice, many MHC restrict the type of medication to an approved list. As a result a more prolonged sickness which may need for a change of medication maybe compromised by the restriction placed on the doctor; or a better medication but one not approved by the MHC scheme may not be able to be prescribed by the doctor without the patient paying it himself. In such instances medical care is necessarily compromised.

To the doctors, MHC schemes also presented with a double-edged sword. On one hand it gives a potential ready pool of patient. On the other hand, he does not have a free hand to manage the patient in the best possible ways because of the restriction imposed by the scheme.

To the companies, MHC is a boon for them. Where previously they have to bear the cost of medical care, now they can 'outsource' to another company. In this way they may be able to save on the healthcare cost as they can shop around for the cheapest MHC. In addition to that, estimates of running cost for the company becomes easier as healthcare cost is now fix yearly.

The employees unfortunately have no say in the MHC scheme. The doctors have a choice, and if the MHC scheme is so restrictive, why do they want to join the scheme in the first place? The choice is very limited, especially for those stand-alone practice. In this day where the big will eat the small, if they do not take up such scheme, how are they going to compete with the big players - company that runs a chain of clinics. Because their chain of clinics are dispersed around the island, they are at an advantage because employees do not have to travel far to see an approved doctor. However once they signed up the scheme, their hands are tied. They cannot practise the same way their are accustomed to. Medication given has to be limited in duration, the type of medication has to be limited to an approved list.

The call by the Singapore Medical Association for the Ministry of Health to regulate the MHC industry is therefore timely. A benchmark and guideline should be set up so that health care received by members of such scheme do not get short-changed; even as the MHC companies try to tweak the price they charge to employers and give the doctors unrealistic reimbursements in their quests to improve their business. The benchmark is the most important because it will serve as a guide for the minimum acceptable level of care expected by the patient. As the members of the scheme has no choice or say in these scheme, only the benchmark will be able to protect their interest. And as doctors, we should "vote with our feet" and shun those schemes that give unrealistics reimbursements, so that our conscience can be clear when we treat our patients and so that our patients can have the best treatment with the given restricted conditions.

I would like to share my own experience. I was running a high fever of 40 degrees. Unfortunately, the nearest clinic that covers my MHC scheme was in the next township. In order to save the trouble and time I decided to see a doctor in my neighbourhood whose fee have to be borne by myself. I was given a medical leave but unfortunately the medical leave was not accepted by my company because "it was not part of the panel doctors". In frustrations, I told the HR to convert the medical leave to my annual leave instead! To the cynical, that was my first medical leave in two years.

So who benefits from the MHC scheme? Of course the MHC companies themselves!


P/S: Read the novel Unmanaged Care by K E Schields which touch on this issue in the US. A movie by the same name was recently shown on HBO.