Is “buffet syndrome” still relevant in Singapore’s healthcare insurance debate? Dr Tan Yia Swam weighs in on the real problems doctors and patients face today – and why the conversation must shift.
When it comes to the history of healthcare insurance in Singapore, the term “buffet syndrome” is a dominating force.
It was coined to describe a phenomenon where patients with comprehensive insurance policies tend to overconsume medical services, because of a belief that it is heavily subsidised or even “free” – just as how diners at a buffet eat beyond their capacity. Whenever it’s brought up, it’s as a key contributor to escalating healthcare costs.
Depending on the perspective taken, the blame behind this has generally been laid on overly-generous insurance products, and private healthcare providers prescribing excessive procedures.
Since the term first emerged, the healthcare landscape has changed significantly – and today’s challenges often look very different from the buffet metaphor that people still repeat.
To get a better understanding of this, we speak with Dr Tan Yia Swam, Director of Breast Friend Surgery & Wellness, to discuss the current relationship between doctors, insurance companies, and patients, and whether “buffet syndrome” should still be used in today’s healthcare context.
How We Got Here – A Brief History
The introduction of as-charged health insurance plans in 2005 – which allowed insurance to cover all medical expenses – gave rise to buffet syndrome.
The benefit this affords patients – especially us kiasu Singaporeans – means that the desire to bloat ourselves on healthcare can be normal.
“In such a situation, it is human nature on the part of the patient to get ‘the best’ or the most comprehensive tests for their condition,” said Dr Tan.
“When the patients do not have to pay, why would anyone think twice?”
This very notion came to a head in the form of rising costs in the 2010s, highlighting the unsustainability of such a process for healthcare.
It thereafter triggered multiple reforms, such as:
- The Healthcare Insurance Task Force (HIFT), formed in 2016 to propose safeguards such as tighter controls, co-payments, and insurer panels.
- Fee benchmarks, introduced by the Ministry of Health (MOH) in 2018 to guide reasonable charging.
With these healthcare system upgrades in place, can we say the industry has resolved buffet syndrome?
Is Buffet Syndrome Still a Thing?
Medical costs are still on the rise – but buffet syndrome isn’t necessarily the cause.
“In current day, patients have to co-pay, so they are taking more charge of what they feel should be done, in consultation with the doctor,” noted Dr Tan. “For doctors’ fees, there’s a MOH fee benchmark to adhere to, and most of the panel contracts usually have a fixed rate, regardless of the complexity of the condition.”
Thus, buffet syndrome really is “no longer applicable”.
“In fact, strict ala-carte orders, and membership discounts apply! I have patients who tell me they’ve met doctors who ask, ‘Do you have insurance?’, with the intent to order tests and claim. That is also not true nowadays; we now ask, ‘Which insurer are you with?’, so that we can comply with the relevant panel contract, or to advise you that we are not on your panel.”
But if buffet syndrome is no longer plaguing healthcare, what is the real issue?
The New Reality
No one has a simple answer – especially when insurers have filled today’s healthcare system with restrictions, confusion, and opacity.
Doctors: Scrutinised
Doctors and insurers don’t always see eye to eye, with treatment plans requiring negotiation and justification in the quest for insurer approval.
“In general, I think the insurer industry just has a different view of healthcare from doctors,” explained Dr Tan. “Their main interest is still financial, while doctors have sworn a pledge to look after patients. Most of the operations I perform have had smooth reimbursements by insurers, but there are still occasional cases which irk me, because the claims team seems to ask the most fundamental questions which do not make sense to me.”
For example, when she submits pre-authorisation forms for a mandatory surgery, insurers may question the necessity of the procedure and suggest medication instead – a line of inquiry that can feel undermining.
“I find that claims are over-scrutinised and I’m made to feel like I’m doing something wrong.”
Insurance Process: Opaque
Furthermore, there seems to be a lack of standardisation among insurance companies. For instance, doctors often do not know why insurers exclude them from panels or what criteria they use for inclusion.
Insurers also apply the benchmarks and guidelines differently, meaning each can have their own fee limits, and it’s not uncommon for doctors to face clawbacks and fee disputes.
“One time, the patient was an older lady with a heart condition, so the anaesthetist needed more care, more pre-op prep to ready the patient for surgery, to watch out for complications, and after-surgery care. I asked for an extra $200, on top of the usual fee of $1600 (MOH fee benchmark being $1600–2100). This was flagged up as overcharging. I wrote in on behalf of the anaesthetist to appeal, and then finally got approval,” Dr Tan recounted.
“I will never know if I get blacklisted for this, and whether it affects if I stay on the panel – because the terms of inclusion and exclusion are not transparent.”
Patients: Overwhelmed
For the patient, confusion over their coverage and who is on their panel, in addition to reservations over co-payments, has created a discomforting sense of uncertainty when it comes to seeking treatment.
“The types of insurance products being sold are so varied, and I have some patients who realised only after seeing me that (1) I’m not on their panel; (2) their insurance is only for private care (A/B1 class) in a restructured hospital, not for the private sector; and (3) their condition does not fall under critical illness, so there’s no claim possible,” highlighted Dr Tan.
The result is that even a doctor might have to play the role of financial counsellor.
“I have to be able to give them some guidance on how to find out more, and to make a sound financial decision, as well as get their condition treated in a timely fashion. They are also afraid of making any claims for a minor condition, because they might be excluded in future – which is possible; and we have no way to know for sure how the under-writers will proceed when the contract is renewed each year.”
Rather than excess consumption, both doctors and patients are wrestling with limitations and financial stress. With these new concerns in play, what is the best solution moving ahead?
The Solution: Real Alignment
According to Dr Tan, what we need is more open, honest communication amongst all stakeholders.
A few years ago, stakeholders introduced the Multilateral Healthcare Insurance Committee (MHIC) and the Clinical Claims Resolution Process (CCRP) to promote collaborative discourse between doctors, insurers, policyholders, and the government.
However, it’s not enough, with Dr Tan citing a lack of information and mistrust still compounding the issue.
For healthcare to work for everyone, it’s important that the conversation moves past outdated metaphors, and towards solutions rooted in trust, transparency, and balance.
“I have the best conversations with friends in other industries that expand my point of view, and see the problems through their lens. That’s when we can have real heart-to-heart talks about pain-points, and come up with creative solutions. Subsequently, networking, and getting buy-in from industry leaders will help in the system shift,” she asserted.
“To truly enforce certain changes, stricter regulations of healthcare insurance, and may I boldly propose – not just by MAS, but oversight by MOH may be the real impactful change.”
Meaningful progress happens only when all parties accept each other’s circumstances and move forward together.
“Ultimately, the healthcare system affects all of us, because all of us will need medical care one day – whether it’s for a minor condition, or major one like cancer, or even palliative and end-of-life care. We should all be working together to be responsible users, so that it is sustainable and accessible for everyone – regardless of financial status.”
External References
- Cai, C. (2025, July 1). ‘Tied up in a knot’: Ong Ye Kung concerned over state of private insurance and private healthcare. AsiaOne. Retrieved from: https://www.asiaone.com/singapore/tied-knot-ong-ye-kung-concerned-over-state-private-insurance-and-private-healthcare
- Khalik, S. (2024, July 13). Breaking health insurance vicious circle a top MOH priority, says Ong Ye Kung. The Straits Times. Retrieved from: https://www.straitstimes.com/singapore/ip-insurers-risk-a-race-to-the-bottom-as-they-compete-to-win-market-share-says-ong-ye-kung
