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ZHUN BO? Insurers Want Patients To Pay Part Of Hospital Bills

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TL;DR- Insurers want patients to pay part of hospital bills

A recent Straits Times article has been circulating online, and it is going to have a great impact on Singaporeans’ lives.

Editor’s Note: This is a summary of the Straits Times article since they made it a “Premium” article.

  • Six companies selling MediShield Life-linked health insurance have appealed to the Ministry of Health (MOH) to make it compulsory for existing and new policyholders to foot a portion of their hospital bills
  • This is even if they buy riders that now cover the entire amount.
  • It is said that patients who have full coverage of their hospital bills are claiming more frequently with bills 20%-25% higher than the rest.
  • This pushes up premiums for everyone.
  • It is believed that patients may be looking to pay 5%-8% of the bill, capped at a maximum yearly amount he needs to pay.
  • The Ministry Of Health supports the recommendations and a task force was set up to address the cost of medical insurance.


Here’s how the insurance companies believe can help curb medical cost.

  • Private hospitals and doctors are usually the culprits, by overcharging certain components of bills and unbundling certain routine laboratory tests just to charge higher and maximize profits.
  • Patients who do not pay a cent of their medical bills are believed to lack the incentive to check and manage their medical costs, resulting in higher insurance claims.
  • Patients who have to pay would likely question such charges.
  • In the year 2015, 32% of Singaporeans had riders, with 75% of such having the most expensive, private hospital insurance plans.


  • Anyone buying new rider will need to pay at least 5% of his hospital bill, with total amount capped at $3,000 per year as announced on 7 March 2018.
  • Insurers have until 1 April 2019 to come up with new riders
  • Anyone buying a rider from 8 March 2018 onwards will switch to the new scheme by 1 April 2021.


Further reading: Questionable claims of patients with riders, who received treatment in a private hospital

Editor’s Note: The examples are from the Straits Times article. We are putting it here for the convenience of our readers

  • 37-year-old woman stayed 7 days in the hospital for abdominal hernia repair.
    Of the $46,000 bill, the surgeon’s share was $31,900 (5 times the norm). It transpired that while in hospital, she also had her breast augmented, and a tummy tuck with the fat transferred to her buttocks, but since these are not covered by insurance, none of this was stated in the bill.
  • Another patient who needed cataract surgery opted to be admitted to the hospital, instead of having it done as a day procedure, which would have taken no more than an hour or so. His one-day stay each time for each eye amounted to a total bill of $21,000. The median private hospital bill for cataract surgery of one eye? $5,000.
  • A patient with fungal growth in her nail stubbed her toe, causing the nail to fall out. She was admitted for two days and was billed $6,000.
  • A patient complaining of stomach and chest pains was admitted to the hospital, and underwent gastroscopy and colonoscopy procedures to check his stomach and intestines. He was also referred to a heart doctor, a dermatologist for skin rash and an ophthalmologist for blurred vision. The total bill for his one-day stay was $14,000.
  • A patient was admitted for 16 hours for inflammation of the gallbladder. The tests showed no inflammation and no treatment was needed. However, the patient was given a series of unrelated screening tests, including an electrocardiogram, a magnetic resonance imaging scan, and a computerized tomography scan. Screening is not covered by insurance. The bill came to $11,000.
  • A woman was warded for 42 days for cervical sprain and strain (or pain in the neck) but received treatment only on seven days. She was given physiotherapy and painkillers for the other 35 days, something that could have been done as outpatient treatment. The bill was $84,000.
  • A 40-year-old man was warded for four days for pain and swelling in his big toe, chalking up a bill of close to $6,000. The bill was rejected after the insurer checked with the doctor, who said the patient was admitted at his own request and that the treatment would otherwise normally be done in the clinic.



Seedly’s 2 Cents

We once wrote an article on the increasing cost of medical cost in Singapore.

To put the whole saga into perspective, this is a growing concern which resulted from moral hazard of 4 parties:

Private hospitals

For the longest time, private hospitals might have gotten they way out easy in this rather loosely regulated space.

  • To maximise profit, private hospitals might have deliberately overcharged or bundled in optional services to max out claims from every patient’s treatment.


It is common to hear insurance agents use our ever-rising healthcare cost as their best sales pitch to convince people into getting healthcare coverage.

  • Insurers were hungry for market shares, resulting in them producing policies that may well, be bigger than what they can handle.
  • The rest of the insurers follow suit in order to not lose market shares.
  • The math that goes into managing the risk of such policies got lost in the process due to greed.
  • The insurers now suffer the repercussions of their greed but are not willing to bear it.
  • They ultimately wish to pass down the costs of their actions to the consumers.


Sometimes we just need a small group of consumers to do the extremely wrong things, and the whole entire population suffers.

  • Moral hazard occurs when one gets insured.
  • Insured parties tend to behave in a more risky manner resulting in more negative consequences, or in this case, overclaim the necessary medical services.


The situation could have been avoided should regulators kept a close watch on how the situation unfolds. Now that the shit has hit the fan, the regulators are taking the possible convenient approach of agreeing to whatever the insurers are proposing. Ultimately, the consumers suffer.

What Singaporeans think of this? (If the voice of Singaporeans even matter)

The above article was shared onto our Seedly Personal Finance Community, and here are some of the comments:

I Am So Angry!

  • Gabriel Tham
    The most important part: Are my premiums for the rider going to go down?
    If I am to pay part of the bill, I expect premiums to go down significantly. I hope that any changes will not affect existing policies. Otherwise, a full refund of my past premiums should take place, given that I have not made a single claim. Not very fair to be paying so much for a reduced future benefit.
  • Terrence Long
    Insurers feeling the heat of overcharging from the private hospitals and doctors, which is the root of all the problems.
  • Louise Low
    Insurers should appeal to Ministry Of Health and regulate the private hospitals from all the overcharging instead.
  • Jian Lin
    Why punish insurers instead of private hospitals?
    They should employ more people to stop questionable claims instead of throwing the problem back to the consumer, which is dumb.
  • HC Tang
    The point is why authority did not try to regular and keep surgery and hospital and equipment cost down?
    I believe that the problem lies on the upper stream. As a consumer, there is no way one can bear the rising cost be it from premium or medical cost. Hence, the problem lies with the supply side. We can try all kind of measures today, but an average salaried worker will never be able to afford and keep up with the ever-rising cost from the supply side if nothing is done about it.
  • Christopher How
    Insurers were greedy and offered riders to cover every cent of the bill. Now, they are complaining and trying to U-turn when their plans fail. If that is the case, both parties including insurers need to be penalized too. They were part of the problem.
  • Alan Kor
    Both consumers and private hospitals are at fault.
    Consumers abusing “buffet syndrome”, heading to the private hospital with any little ailments, and Private hospitals charging ridiculous bills knowing that the patients are fully covered by insurance.
  • Kenneth Lee
    I read everything that’s been said, and here’s the broken logic:
    Doctors, and Hospitals are charging exorbitant amounts for procedures. They are also the ones who do not regulate and say no to the patient, especially with the abdominal hernia lady who ended up doing plastic surgery as well.
    If there’s anyone that is to be punished for lapses and outsized claims, it is the Hospitals, not the rest of us.
  • Jiehuai Foo
    The issue seems to be mainly from the private hospital which doesn’t seem to be regulated the same way as the government hospital. Maybe insurance companies can have more Terms and conditions for the claim from the private hospital? Government hospital normally just treat and ask you go home, overstaying is also not common.
  • Kexin Chen
    Angry, as a consumer who paid for the rider hoping to absorb exorbitant hospital fees in later years. I still do not understand why I’m being penalized by greedy Private medical services and people ask for a buffet of non-required service.
  • Jiehuai Foo
    Just wondering whether the insurance companies propose this to have a higher profit margin? I doubt the premium will go down much but rise again in a few years, but the co-payment will help them to cover some cost to increase profit.
  • Winston Ong
    In industrial economics, if it is no longer profitable for the next margin of operation, you shut down. The fact that insurers keep ranting and not pull out from the market shows that they want to maintain market share and profitability but don’t want to compromise. I suggest that MOH ignores them.
  • Royston Cheng
    My personal take is that private doctors also need to be taken to task. Patients also depend on the doctors’ recommendations. I am sure some of these ridiculous claims are due to doctors recommending the patients to stay in the hospital.
    There should be tighter framework regarding whether the patient does need the required treatment/ hospitalization.
  • Ang Boon Yuan
    So the aim of the appeal?
    If greed is the issue then whether the patient pay or the insurers pay is not going to matter. Why wasn’t the medical board consulted in event of discrepancies? Shouldn’t there be punitive actions against Hospitals/Doctors fallen foul or have they become too big for the regulators to come in? It is quite salient that the insurers preferred to take on the commoners that their “partners”. There are a lot of other tangibles and intangibles relationships between the insurers and medical professionals.
  • Megan Tay
    I don’t know very much about insurance, so just wanted to clarify – is there a prerequisite that the patient be hospitalized before they can be allowed to claim?
    Apart from the tummy tuck lady and the big toe gentleman, the rest of it looks like procedures that any layman might be convinced to carry out or take up based on the doctor’s advice.
    Patients just want solutions to their medical problems. I can imagine people taking up riders so they don’t have to worry about having to balance their medical bills against their treatment. Shouldn’t the focus be on enforcement of SMC policies against overcharging, and limitation of the coverage to “necessary procedures” only? Or is this somehow less practical in the long term?

I agree!

  • Raymond Ng
    I agree with the proposal. The patient should pay part of the medical bill. The ‘As Charge’ is a “kiasu” mentality and will inflate the medical bill, and as a result, our insurance premium goes up with time.
  • Soon Xiaohui
    Recent years why the plan keeps increasing premium? Even people who have no medical issues, claims frequently at private hospitals. Some even prolonged their admission, for things such as appendicitis (no rupture).
    Personally, I think is better for the implementation to be at private Hospitals. Since the major cost/abuse is there. And it should be work on a case by case basis.
    Not all doctors at private hospitals are bad though.
  • Chen Zhirong
    This should have been done from the get-go lol. Thought it was weird we have the 100% payment rider when Medishield was created with the idea that co-payment is necessary and ideal for any healthcare system.
    Well, at least they tried…
  • Jax Tan Jin Xian
    Overall, it makes logical sense for insurers to come up with that proposal. After all, they are all businesses and wouldn’t want to be making losses.
    From another perspective, shouldn’t the guideline for private healthcare be stepped up, even more, to reduce such malpractices by the private doctors and hospital? I understand that Singapore’s private healthcare structure is made in a profit-driven way but I look at the above real-life examples by Alan, I can’t help but feel that something needs to be done for the private healthcare sector.

Well, here are some solutions

  • Lim Chun Long Jimmy
    More reasons to start earning addition (passive) income to keep up with the rising costs.
  • Terrence Long
    I wonder if there is a Tripartite arrangement between Private hospitals, Insurers and MOH to regulate this runaway overcharging.
    With Smart Nation initiatives, it can even be automated to raise any red flags during the estimated bill counseling sessions with the patients.
  • Chong Shing Ann
    Some insurers have taken the initiative to launch pre-authorisation for treatment at private hospitals based on estimated bill size.
    This will help to minimize claim dispute, and any additional charges may be further investigated to prevent overcharging.
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