Health Minister is mistaken that patients overly consume healthcare services because its free: ex-NTUC insurance CEO


Former NTUC Income CEO Tan Kin Lian has sharply criticised Health Minister Gan Kim Yong for blaming patients for overly consuming healthcare services because it is free.

Gan had said in Parliament this week that co-payment in healthcare is important as it ensures the sustainability of the healthcare system. Noting that some private insurance policies offer zero co-payment coverage the Minister said that such coverage “dilutes the personal responsibility” of patients. He added that this prompts a “buffet syndrome” in patients, in which they overly consume services just because they are free:

“They are called full riders. Such riders encourage a buffet syndrome as patients do not need to pay anything for their treatments. It undermines the co-payment principle and dilutes the personal responsibility to choose appropriate and necessary care.
“This will encourage unnecessary treatment, leading to rising healthcare costs not only for those with such riders, but for all of us.”

That same day, Senior Minister of State for Health Chee Hong Tat announced that patients must bear a 5 per cent minimum co-payment for new Integrated Shield Plan riders with immediate effect. Only new policy holders will be affected by the policy, not those who have already bought zero co-payment insurance policies.

In a thorough explanation on why the government is wrong to blame patients for a “buffet syndrome”, Tan Kin Lian asserted:

“The health minister used the term “buffet syndrome” to describe the unnecessary and over-consumption of health care services. He blamed the patients for this behavior. He thinks that the patients like to consume the services because it is free, i.e. paid by insurance or largely subsidised by the government.
“The minister is mistaken. I am not referring only to the current minister, but to the previous ministers. This mistaken belief had been prevalent for three decades.
“I have not found any evidence of patients who like to consume health care because it is free or largely subsidised.
“The over consumption is largely due to doctors and hospitals. They are running a business. If they can get the patients to consume more, they earn a larger income or profit.
“Some doctors and hospitals will prescribe more treatment to generate the income and profit. I am not suggesting that all doctors and hospitals behave in this manner. But the anecdotal evidence does suggest that this is quite prevalent.
“To overcome the over consumption, attention should be focused on the doctors and hospitals, rather than the patients.
“The patients do not have a choice. They depend on the doctors for advice on what is necessary. Even if they ask for a second opinion, it does not help much in most situations.
“Asking patients to make a co-payment does not solve the problem. Most patients will buy insurance, known as a “rider” to cover the co-payments.
“Restricting the scope fo the rider will also not solve the problem. Most patients are not able to make the sensible choice.
“To stop the over-consumption and explosion of health care cost, the ministry of health has to step in. They have to set system to prevent the over consumption of services and the over charging for these services.
“We can study the system adopted in Japan. Each year, the ministry of health negotiates with the doctors and hospitals on the cost of providing each type of treatment. This negotiation produces charges that are adequate for doctors and hospitals to cover their expenses and earn an adequate income and prevent the over charging for these expenses. It also ensure that the charges are reasonable from the perspective of the patient and the government, which bears 70% of the cost.
“As there is sufficient demand for the services, there is no need for the doctors and hospitals to generate unnecessary demand to increase their income.
“I believe that there is a system for the ministry of health to audit the provision of the services. i do not know if this is the case. It should be possible for this kind of audit to be carried out.”

It is interesting that the Government is only now taking issue with zero co-payment or “as-charged” insurance policies – 13 years after such policies were first introduced in Singapore, back in 2005.

The health minister used the term "buffet syndrome" to describe the unnecessary and over-consumption of health care…

Posted by Tan Kin Lian on Thursday, 8 March 2018



  1. This minister has been sleeping all the while. The shield has been offering as charged basis is good for the policy holders. Why he is against it.

    If you don’t understand insurance product, please take the compulsory exams in SIC and get the FA license from MAS.

    No wonder PAP just take in any TOM, Dick and Harry to be minister without even checking the standard of these ministers.

    Singapore is doom. Doom very soon.

  2. Now Spore too much Hospital already la. please proper arrange the Doctors whose got more responsible to consultation patients la. Patients pay full consultation fees full surgery fees & full hospital bill. After surgery performed by the doctor cause patient permanently unfit for work. Hospital & Dr don’t bear for any responsibility very unfairly and unhealthy to the patient if this kind of thing happened to you or your family member how do you feel.

  3. My rider is only for my children hospitalisation insurance, so i happy happy hospitasize my children just to fully utilised my insurance policy? Is it what the big deal about? What the point of paying few hundred annually? I dont even touch the insurance at some year so does it mean i can claim back my unuse policy?

    • GKY You think the full riders are cheap is it ? What about those who faithfully the full riders over the years and never claim a single cent but for contingency reasons wish to do away with headache of Co payment in the future ??? You think those riders payment are made for fun ??? Would you opt to go for 8 chemotheraphy sessions ( buffet syndrome !’) if you have cancer ? Answer this !

  4. Ya right. I got a 50% artery blockage. Diet, exercise n medication will do. Since I got Zero co-payment insurance policy- I might as well go for stent implant. Wait a minute. Am I nuts. Better make full use since its free. Buffet syndrome-I’m going 4 open heart sugery as suggested by our health minister. Absolute stupidity from our million dollar minister.

  5. The PAP is still trapped in the LKY time warp of “ the buffet syndrome “ they cannot think out of the box. I an saying they have not learn anything but only parroting the old PAP cliche.

    If patients are paying for riders they are actually paying in advance for medical services they may or may not be using. Yhe insurance companies do not lise anything and neither will the hospitals unless they want to be greedy. Examples are dentists who insist that patients must be x-rayed before getting treatments. They just want the patients to pay for their expensive equipment. What is the government doing about this?

  6. Now Spore Government Hospital terrible la. Patient pay full consultation fees. Dr ask patients to do the test only ask you to sign up agreement letter. Never asked the Patient condition clearly. Before doing any test for the patient. Any happened to the patient hospital & the doctor don’t care the patient live or die very unhealthy. No mercy to cure patient shift to other job.

  7. Idiot@ u think we want to be sick?? And wad buffet or free, we fucking pay premiums to cover us.. u need money u say loudly, not accuse citizens of taking medicall care for advantage.. we paid for it in advance!!!! U huys are the ones benefiting. I dunno which minister did a bypass for dunno wad miser amt..ya u elites deserve a cheap medical care. While we citizens are eating buffet.. f off la

  8. Dunno how they can think people wanna go through a buffet syndrome just so we could abuse things for free? That means it’s as good as saying we’re purposefully looking to screw up our body just to get free medical services? Gosh… the stupidity… really hope the fella jump down and do everyone a favor.

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  10. What I do not like is Mr Gan allegation that people is misusing the healthcare services. On one hand G allows market demand to determine the healthcare pricing and not putting the needed pricing control mechanism. On the other hand, healthcare treatment in singapore is so high that foreign patients are going to alternative places to seek treatment. So when income is affected, doctor will over prescribe treatment. All this happen and the end result is the people become scapegoat and blamed for the healthcare cost issue. Who is more able to manage healthcare cost? The people or G? Well, pointing the finger at population at large is a serious allegation while I do agreed that there may be a small pocket of people (esp the rich) might abuse the system. After all they can afford the small difference in premium but not the majority of us.

  11. Yes.. this is what I’ve been also saying. It’s the hospitals and the doctors who put us through unnecessary procedures and charge exorbitantly for it.

    I was once made to go through two MRI scans one day after another at a well-known private hospital. Don’t know what they can’t find in the Day 1 MRI, they found in Day 2. Best still… I was assigned 3 specialists, one for pain, one for therapy and one neuro but none were not able to diagnose my problem accurately. One specialist wrongly diagnosed it as a ‘mini-stroke’.

    Until I went to consult another specialist who rubbished the ‘mini-stroke’ diagnosis. He confirmed it was a vertigo. Now… that’s a lot of difference between a mini-stroke and vertigo.

  12. They always assume the worst of Singaporeans. How about making Khaw co-pay a lot more for his heart procedure a few years ago?

    $8 seems very little. Maybe he was overconsuming medical services then. He must be charged more to teach him personal responsibility.

  13. Mr Tan you are totally right. I had numerous encounters for my parents and myself when admitted to hospital and for medical appointment. Some of these doctors will “recommended” a series of tests and even operation with little or no regard to the risk to the patient life. The only thing on their mind is can you afford to pay? I you tell the doctor that i cannot afford he will say is ok then. I you can afford, the doctor will say then let proceed since payment is covered by insurance.

  14. When u have a minister who have that kind of perception about its people, always thinking about negative things and looking down on their citizens. Do u think they can do a lot for them? Stop voting people who look down on you. Don’t be stupid anymore.

  15. I fully agreed with Mr.Tan’s observation and explanation. I was a heart patient with Heart Centre and despite having bought the co-payment rider, I still choose the loweat available ward even I could go for Grade A knowing the cost of any future follow up would depend on the Grade of service we chose.
    Once in the ward, the decision is not up to us to decide what is best for us but according to what the doctor “advise”.
    However, we have to accept there might be a small group of patient who abuse the use of insurance coverage. Nonetheless, hospital as what Mr.Tan mentioned here, needs to be controlled to prevent overcharging.

  16. F by GKY.
    PAP has one trick. Always accuses Singaporeans or Patient.
    But will never mention, under current PAP ruling, Medical Consultation Fees SPIRAL OUT OF control.
    PAP GKY is great at accumulating wealth but not for you.!

  17. No matter what anyone says, in Singapore, if I find I contracted terminal illness, I rather pull the plug and die rather than to seek treatment and cause my family to suffer whole life of poverty, cos I know in Sg, unless i deplete all resources and let my family suffer, there will be no help, so I rather die!

  18. Maybe my friends are all different from your friends….

    Sad to say, many of them abused their 0% co-pymt insurance policy. AND the ‘buffet’ syndrome was a spot-on description of their attitude. I remember in the group chat “eh u go stay mt E Novena, there like hotel!”. True enough, my friend chose there, and we even brought snacks, drinks AND poker chips to play poker there. Exaggerating? No, it’s the truth.

    0% co-pymt stripes off total responsibility of the user AND encourages abuse.

    Just stating my opinion. As for EVERYTHING in life, some people do, some people don’t. Don’t not happy, di di KPKB here. Thanks.

  19. TKL is right. Docs nowadays, with the slightest doubt, will recommend more checks, procedures, etc. When my son injured his knee some years ago, the young doctor at KK, an Assoc Prof, insisted on a CT Scan, that costs $1600 then to see if ligaments are torn. I said no. 40 years ago, the same happened to my brother. The doctor was able to diagnose as torn ligaments, with an x-ray. Later, my son told me that a more elderly doctor had told him, before the younger doctor took over, that he had most likely just dislocated his knee and a CT scan is not necessary. Not sure if the doctor is not experienced enough to tell, or KK wants to make more money, or both!!

  20. Finally a real elite stand out and he is NOT sprouting nonsense. The situation he said is true. It can be spoted by your neighbourhood clinics. One can be a normal medical bills est. $40 below for common flu sickness while the other clinic charges up to $100 + or -.. it that scary. It always the same mistake repeatedly by our MP. They issues goodies or policy but they always either never create the awareness or regulate that market which result in abuse or wrong statistic then end up make wrong decision and everyone hated them. Than they ask why ? Lol

  21. Hello! It is not free ok?? I paid EXTRA $$$ for rider so that in case anything happens and I am hospitalized, I don’t have to sell an arm or leg to save my heart or my head! Isn’t that what insurance is all about? Pay money when you don’t need so that IN CASE SHIT HAPPENS, you are not left hanging and there is help?!!!
    Why is this now an issue? Shouldn’t you have thought about it when you offered people option of riders?
    Happy to take people’s money when they are well but when people fall sick and you have to cover their fees by way of insurance, you buay song to pay because it is supposed to be your profit/revenue and best if you keep it all??!!! Makes me angry.

  22. There is one core issue that is being overlooked by almost everyone.
    The insurance-based model for healthcare provision that we have adopted in Singapore is Wall Street’s invention. It is meant to turn healthcare into a business. A business that would be overall run or managed by insurance companies for the profit of all providers, vendors and intermediaries. Patients are turned into customers from whom money is to be extracted in the form of insurance premiums, deductibles, co-payments and more.
    Going by the logic of risk management, the larger the risk pool the lower the burden of risk to be shared.
    If so, why is the national risk pool being fragmented purely for allowing the six private insurance companies to compete for the business profits to be derived from the insurance premiums they collect from the insured. There are now six insurance companies permitted to offer private healthcare insurance in Singapore. Now, they are turning around to cry for premium increases year after year. This is what is happening in the US, to the detriment of the healthcare of common Americans. How can we expect anything different to happen here in Singapore.
    Why not have a single risk pool at the national level managed by a statutory authority (to be known as, say, the National Healthcare Insurance Authority) which could offer universal healthcare cover for all Singaporeans for life. It would be essentially an enhancement of Medishield Life, which could offer two or three different plans for people to choose from. That would leave private insurers to cater to foreigners, and also serve as servicing outlets for Singaporeans covered by the national (government-run) Medishield Life Plus, which is actually a kind of Group Health Insurance for all Singaporeans.
    Unless we revert to a single national risk pool, we would be forced to pay higher and higher insurance premiums as the years go by.
    On the other hand, the government must be called upon to improve the quality of healthcare at government hospitals so that people are not forced to seek treatment in private hospitals. The government has failed the people very seriously in this respect and this has to stop asap.
    It is time to revert back to healthcare as a service, not as a business for insurance companies and others (hospital operators, etc.) to profiteer from.

  23. The problem with the local doctors here is the “money-making mentality” that has been long ingrained since they were kids.

    Typical parent-child conversation.

    P: “What do you want to be when you grow up?”.
    C: “Doctor.”
    P: “Why?”
    C: “To help (heal) sick people.”
    P: “No… so that you can make LOTSA money!!!”

    Wonder how many doctors here actually know their true purpose of their medical profession (& not just pay lip service) when they take their Hippocrates Oath.

    “I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism.”

  24. Healthcare where got free we also pay for the insurance premiums till the very last days, best is still look after your own health, eat healthy, stay health. If ready major illness soon or later we will leave and back to the Mother Earth.