Two private hospitals were recently de-listed from an insurer's panel of healthcare service providers, leading a committee of doctors to cry foul and call for insurers to be "more patient-centered and less profit-driven."

Last month, ING Insurance Bhd made the decision to take Sunway Medical Centre in Petaling Jaya and the Pantai Medical Centre in Bangsar off its panel 'managed care organisation' (MCO) network of hospitals and specialists.

ING is the country's largest buyer of private healthcare - the second largest buyer of healthcare overall after the government - with about one million corporate employees and retail members as its policy holders.

The move, therefore, meant a fairly large number of the two medical centres' patients under ING's corporate employee benefits' scheme would from now on be 'forced' to seek treatment elsewhere.

According to the Joint Inter-Hospital Healthcare Committee (JIHC), the de-listing was due to a dispute over discounts that ING had allegedly sought to "coerce" the doctors into giving when billing ING for medical services extended to its policy-holders.

These discounts were included by ING in the Healthcare Service Provider Agreement (HSPA) it had proposed to the Sunway Medical Centre and Pantai Medical Centre.

Unethical terms

JIHC, whose stand on the matter is backed by the Association of Specialists in Private Medical Practice, is said to represent about 500 specialists from eight hospitals in the Klang Valley.

Its spokesperson Dr Steven KW Chow said the discounts would result in medical practitioners not being properly reimbursed for their services.

"The terms are unethical (as) it will lower the standard of healthcare (and) limit the treatment services that can be made available to patients seeking private healthcare," he said at a press conference at the Pantai Medical Centre yesterday.

The Private Healthcare Facilities and Services Act (PHFSA) 1998 already prescribes a schedule of fees designed to safeguard medical costs to the patient, said Chow, who advised "all parties" to strictly adhere to the schedule.

"This commercial pressure by ING to squeeze doctors for more while giving less will set the stage for downward spiral in the ability of patients to access quality medical care," he added.

"For many patients, who have been seeing a particular doctor, they may be forced (after the de-listing) to seek treatment from other healthcare providers who may be located further away and are not fully aware of their medical history," he said further.

Another concern is the possibility that the hospitals' concession to ING's demands for discounts may land them in legal trouble for contravening the PHFSA's provisions against 'fee-splitting'.

Fee splitting occurs when one healthcare service provider seeks to induce another healthcare provider to refer or receive a patient in return for certain benefits.

"We have been advised by our legal counsel to refrain from any arrangement that can be construed to be fee-splitting.

"We do not find it proper for any managed care organization to demand for discounts in order for doctors and hospital to be listed on their panel of providers," said Chow.

"We want all MCOs to come up (with) a HSPA that is more patient-centered and less profit-driven," he said.

A petition on the matter would be submitted to the Health Ministry seeking its intervention on the matter, Chow added.

Different version

ING, however, presented a different perspective of the issue.

Its senior vice-president in charge of employee benefits division, Phoon Yew Seng, said the reason it had requested the discounts was in order to achieve a patient-centred HSPA.

"The hospital discount cannot be anything but patient-centred," said Phoon when met at ING's headquarters in Kuala Lumpur today.

The reason for this is that its policy-holders directly benefit from any discounts ING succeeds in extracting from the hospitals, said Phoon.

"There are other hospitals who are prepared to give us discounts and with all these discounts, it translates to a lower bill for the customer, because the bills are coming from their (insurance policy) limits.

"If my coverage is RM8,000 per year, for example, and the bill comes out as RMRM10,000 without discount, I pay RM2,000 in excess. But if there are discounts of, say, 20% or 15%, I get the lower bill, the bill comes out cheaper, my limit is still intact

"Each of us have limits and entitlements. When the bill comes in for us, they are matched off against the limit. These discounts are simply to stretch your dollar further," he said.

Secondly, neither Sunway Medical Centre or Pantai Medical Centre have been taken off the panel of ING's network hospitals completely. They have only been taken out of its list of 'cash-less facility' healthcare providers that policy-holders can go to.

"Our member policy-holders can still go (to these hospitals). There's just no cash-less facility, that's it. As these hospitals are not in the panel, policy-holders if they still want to go to them merely have to their claims after their treatment, and we reimburse the customary and reasonable charges," said Phoon.

"The patient has still the choice to go (to the hospital), whether cash-less or otherwise," he added.

Phoon also expressed surprised when told the doctors were afraid there was an element of 'fee-splitting' if they agreed to the HSPA.

"My goodness. I don't know where that came from. Discounts are going back to the medical bills of our policy-holders, and it will exhaust their limits slower.

"Basically, I'm stretching the healthcare dollar and limits for policy-holders. When other hospitals also give us discounts, are they suggesting that these hospitals are doing these things?

"It's very unfair to make such sweeping statements about other hospitals who give better value. These are very serious accusations they are putting on ING and the doctors' professionalism that is being questioned.

"Many hospitals have come back (to ING) with good value and they're on the panel for the cash-facility. Is JIHA questioning these doctors' professionalism?" he asked.

"This (HSPA) is on a willing-buyer and willing-seller basis. We are willing to buy (the treatment) on behalf of our policy holders if they offer good value and that's in the form of a discount goes all the way back to our policy-holders," he said.