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Working out a standard Integrated Shield Plan for B1 patients

One in five Integrated Shield Plan (IP) holders in Singapore were on B1 plans last year. Analysts say knowing how much to expect for premium increases and what procedures should be covered, should form the basis for a standard IP to cover them.

SINGAPORE: The MediShield Life Review Committee recently recommended that the Singapore Government work with the insurance industry to develop key features for a standard Integrated Shield Plan (IP) covering Class B1 wards.

Some of the key advantages patients under Class B1 wards in public hospitals have are being able to choose one's doctor, and having a wider range of access to medication.

Of the 2.34 million IP policyholders in Singapore, 21 per cent were on B1 plans as of last year. However, observers say health technology assessments need to be conducted for the standard Integrated Shield Plan to be cost-effective. 

"The doctors have to come together to decide on cutting-edge technologies or drugs that should be in this basic package. That is the first order of the day. Then the insurance companies will say, okay, these procedures will be covered, this method or this drug will be covered under this package," said Associate Professor of Health Policy and Management Phua Kai Hong, of the Lee Kuan Yew School of Public Policy.

Health analysts also say that predictability in premium rates is critical, given that IP policyholders often see volatility in their premiums.

"It's always the balance between premiums and benefits. If we determine that predictability in the pricing of premiums is important, then the trade-off would need to be what is the scope of benefits. Let's say we hypothetically agree that a premium rise should not exceed 5 to 10 per cent. The benefits would have to be commensurately sized to fit within this 5 to 10 per cent increase," said Dr Jeremy Lim, Health and Life Science partner at consulting firm Oliver Wyman.

Dr Chia Shi-Lu, Chairman of the Government Parliamentary Committee for Health, is not in favour of extending the standard Integrated Shield Plan to cover Class A wards or private hospitals.

"I think that using the B1 as a benchmark which is actually the lowest level of care that the IP give you, it is the lowest level of private care, it's fair. We do not want to peg it to the highest level," said Dr Chia.

The MediShield Life Review Committee also recommends allowing private IP insurers to risk load, or charge higher premiums, for those with pre-existing conditions. Observers say there may be initial challenges with this, due to a lack of data.

However, they have welcomed the committee's recommendation that the Government consider improvements to the regulatory framework for IPs and IP insurers such as in the selling of the plans as well as enhancing responsible selling requirements.

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