Beyond ‘Buffet Syndrome’: Rethinking Riders, Private Care, and Health Coverage in 2025

1. How the “buffet syndrome” narrative took over 2025

The term “buffet syndrome” was first mentioned by Health Minister Ong Ye Kung back in 2024 when he cautioned that overly generous insurance designs, especially full riders that removed nearly all out-of-pocket costs, could unintentionally encourage unnecessary tests or treatments. He described it as the “it’s paid for, so eat more” effect. This term popped up again in 2025 amid public sentiment about rising premiums, the pausing of pre-authorisation, and ongoing changes to policy terms. It immediately shaped public perception. The idea was simple:

If patients don’t have to pay out-of-pocket, they will “consume” more healthcare than they need.

But the problem is this:

It’s an oversimplification and an unfair one.

While many Singaporeans have an Integrated Shield Plan that includes private hospital coverage, utilisation tells a very different story. According to The Straits Times, nearly three million residents have private-hospital-tier IPs, yet more than half still choose public hospitals when admitted. And among those who do seek care in private hospitals, it is hard to reconcile the “buffet syndrome” narrative with what most families actually experience.

For many policyholders, myself included, the choice of a private hospital is driven not by indulgence but by the need for timely diagnosis, faster access, and the ability to choose a specialist best suited to the condition. In our own hospitalisations, not once have we encountered doctors pushing unnecessary investigations. If anything, specialists have often explained why certain tests were not needed, calling them excessive or irrelevant (although I understand this may not be true for the experience of others).

This reflects a reality that does not align with popular assumptions: the vast majority of Singaporeans use healthcare responsibly. To penalise most policyholders for the actions of a small minority, whether consumers or providers, risks creating unfair outcomes for people who simply want clarity, speed, and quality care.

Most Singaporeans:

• Do not overuse healthcare
• Avoid unnecessary specialist visits
• Delay treatment because they are scared of high bills
• Rely on insurance only when medically necessary

To paint the entire population as “overuse” consumers, ignores the lived reality of families who struggle with real illnesses such as chronic conditions, cancer, sudden emergencies, paediatric conditions, and even genetic disorders. And it ignores the fact that the majority of claims come from medically legitimate, often unavoidable conditions, not frivolous visits.

The real issue with the buffet syndrome narrative is that it has shifted focus away from the true drivers of rising healthcare costs and, by extension, insurance premiums:

• Singapore’s ageing population
• Chronic disease burden
• High-cost medications
• Labour shortages
• Medical technology inflation
• Global supply chain pressures
• Increased complexity of cases

These factors, not “consumer behaviour,” are the primary contributors to rising healthcare costs worldwide, not just in Singapore.

2. Riders became the 2025 scapegoat, but they aren’t the villain

Throughout 2025, many public messages emphasised that Integrated Shield Plan riders were unnecessary, too generous, and the reason healthcare costs were rising. But riders were never designed to encourage overuse.

They were created because Singaporeans were becoming more financially literate and health conscious. We want:

✔️ Financial certainty

✔️ Peace of mind

✔️ Predictable healthcare costs

✔️ Faster access to specialists

✔️ Flexibility to choose our doctor

We believe that good healthcare is a right, and if we have the ability to improve our standard of care beyond what is publicly provided, we should. Insurance was never forced on us, and neither were riders. Riders exist for the same reason as paying for comprehensive car insurance, extended dental coverage, maternity plans, and travel insurance.

As we gain more understanding of how risk and safety work, we all choose to err on the side of safety. Have a car? Get comprehensive car insurance. Going on a holiday? Remember to get travel insurance.

The same principle applies to health insurance. While public hospitals provide excellent care, many families also want the option of immediate assessment and treatment for time-sensitive conditions such as cancer, heart disease, or neurological symptoms. Sometimes this means being seen within hours of discovering a lump, or at most the very next day.

This is not to say public healthcare is inadequate. As I’ve shared in earlier articles, my own parents do not have private-hospital Integrated Shield Plans, and they have received care for both cancer and heart-related conditions at public institutions. They are relatively happy with the treatment they received.

But as their child, the waiting was agonising. Knowing that they might have to wait three to seven months for a specialist consult, even when we suspected something serious, created a level of stress that I still remember vividly. And my mother’s breast cancer journey is a clear example of how families sometimes move between public and private care strategically, depending on urgency.

She discovered a lump during a routine self-examination. Her GP advised her to get it checked, but the earliest appointment at a public specialist clinic was several months away. The fear of waiting was simply too much. She decided to see a private breast specialist instead, and managed to secure an appointment the very next day. A biopsy was performed immediately, and she was diagnosed with stage 2 breast cancer.

Because we had the means, she could access that urgent consult and confirm the diagnosis without delay. After that, her treatment and cancer care continued in the public system, at the National Cancer Centre, where she received excellent, comprehensive care.

Her experience reflects what many Singaporean families feel: the desire for timely clarity when something might be wrong, and the reassurance of knowing they can act quickly when every day matters.

To blame riders for medical inflation is like blaming umbrellas for rain. Most people aren’t trying to “consume more”; they’re simply trying to protect their health, their dignity, and the people they love.

3. The pre-authorisation pause: A shock that shook trust

One of the most defining events of 2025 was the Great Eastern announcement that it was pausing pre-authorisation for major private hospitals.

This pause:

• Caused confusion
• Created fear, anger, and distrust among policyholders
• Disrupted patient care
• Left many families unsure if they could proceed with treatment
• Put pressure on specialists who were trying to manage patient expectations

What this episode exposed

Singaporeans do not fear illness as much as they fear the uncertainty of paying for it. Pre-authorisation is not a luxury; it is a crucial safeguard that assures us our treatment is medically necessary, helps ensure claims can be approved, reduces out-of-pocket surprises, and protects both insurer and policyholder.

Removing it, even temporarily, is not the way forward. In fact, removing it caused distrust to grow among policyholders, especially policyholders who had been paying their premiums obediently, believing that the product they bought for the sole purpose of providing reassurance in the event of a medical situation would fulfil its role.

Great Eastern policyholders who had paid for coverage that allowed treatment at any private hospital naturally expected a certain level of assurance. Instead, many suddenly found themselves being told, in effect, “Your coverage still exists, but pre-authorisation will not be issued for these two hospitals. If you want full peace of mind, please seek treatment elsewhere.”

For policyholders, this abrupt shift felt like a break in trust, a disconnect between what they believed they had paid for and the reality presented to them. The resulting confusion and anxiety were both unnecessary and deeply unsettling, especially for individuals already navigating health concerns.

4. Private healthcare is not the enemy, it’s a partner

Not only were Integrated Shield Plan riders the talk of the town, but 2025 also saw a spike in narratives portraying private healthcare as:

• Too expensive
• Unregulated
• Unnecessary

But this view misses a key point: Private healthcare exists because public healthcare alone cannot carry the entire national load.

Let’s think back to the COVID-era days: Singapore relied on a coordinated response involving both public and private healthcare providers. The Ministry of Health worked with private hospitals, COVID-19 Treatment Facilities, and community partners to manage system-wide capacity, divert some non-COVID patients away from public hospitals, and support the broader care infrastructure when public institutions were under intense pressure. Private providers formed part of a wider network that helped maintain care continuity and prevented bottlenecks during critical periods.

That same dynamic holds true today. Public hospitals shoulder the bulk of subsidised care, emergency services, and chronic disease management, a load that continues to grow as Singapore’s population ages and medical needs become more complex. Private hospitals help ease this pressure by providing timely access to specialists, performing more advanced or personalised interventions, and offering care plans that can be tailored more closely to an individual patient’s circumstances. Their clinicians often have the flexibility to explore different treatment approaches with the patient, focusing on what will deliver the best possible outcome.

This dual structure is intentional. Singapore’s healthcare system is designed around a public–private partnership, in which each sector fulfils different yet complementary roles. Public hospitals ensure accessible, subsidised care for the broad population, while private hospitals provide additional capacity, speed, and choice, helping distribute demand more evenly across the system.

Private healthcare isn’t a luxury add-on.

It is part of the architecture that keeps the entire ecosystem resilient, responsive and sustainable, especially during periods of strain. Private care does not replace public care.

It complements it.

5. The part people missed in 2025

While many believed private hospital bills were “unpredictable” or “uncontrolled,” a key fact was often missing in public conversations:

Panel doctors and approved hospitals must follow strict fee structures aligned with MOH benchmarks and insurer-agreed schedules.

This means that their charges are not arbitrary, their fees have ceilings, insurers already control costs through panels, patients who choose panel specialists receive predictable pricing, and hospitals adhere to transparent frameworks. Did you know you can even ask the hospital for an interim bill throughout your hospital stay if you, like me, are a natural worrier (despite having the assurance of pre-authorisation, Letter of Guarantee, and great knowledge of your insurance coverage), and still anxious about keeping your finances in check?

Far from the “Wild West,” private healthcare is actually highly structured.

Most people don’t realise that:

• MOH publishes fee benchmarks
• Insurers negotiate panel rates
• Specialists must comply to remain approved and, on the panel list
• Claims processes have built-in oversight

This is the part of the story that didn’t get enough airtime in 2025.

6. The real drivers of healthcare cost, without the politics

But let’s cut through the noise and look again at what actually pushes costs up.

A. Ageing population

We start with one of the biggest indicators, our ageing population. Singapore is one of the fastest-ageing countries globally.

And the unavoidable fact is that older adults tend to need more scans, specialist visits, medications, procedures, and long-term management.

B. Chronic disease burden

Diabetes, hypertension, kidney disease, and obesity are all on the rise. In fact, the rates of chronic disease in Singapore have increased significantly over the past decade, driven by an ageing population, lifestyle factors, and earlier, more accurate detection. More Singaporeans are living longer with complex health conditions that require ongoing monitoring, specialist input, long-term medication and periodic hospital care. This growing chronic disease burden places sustained pressure on the healthcare system, not because individuals are “over-consuming” care, but because they genuinely need it.

C. Medical technology

Advances in medical technology have transformed outcomes, allowing earlier detection, minimally invasive surgeries, and more precise interventions. Another reason why the population in Singapore is getting older, is that they’re living longer!

But innovation comes with a price. New machines, specialised equipment, and digital systems are costly to purchase, maintain, and staff. As hospitals upgrade to provide better, safer, and more effective care, these improvements naturally contribute to rising healthcare costs.

D. Labour and manpower

Healthcare is one of the most labour-intensive sectors in the world. Singapore faces a tight labour market, rising wage expectations, and global competition for skilled nurses, allied health professionals, and specialists. To retain talent and ensure safe staffing levels, salaries and manpower costs must rise, and these are significant contributors to overall healthcare inflation.

E. New medications & targeted therapies

Breakthrough drugs and targeted therapies are extending life expectancy and improving quality of life for cancer, autoimmune conditions, metabolic diseases, and rare disorders. But these medications are often complex to develop and costly to produce. While life-saving, they can dramatically increase treatment costs, not because people are using more care, but because the care itself has become more advanced.

F. Public hospital load

Public hospitals carry a heavy caseload, from emergency admissions and subsidised patients to chronic disease management and complex multisystem conditions. As demand grows faster than capacity, wait times naturally lengthen. Faced with delays of weeks or months, many patients with urgent concerns turn to private hospitals for faster access to diagnostics and specialists. This shift is driven by necessity, not indulgence.

These are real, systemic pressures, not consumer behaviour. Rising healthcare costs reflect the complexity of modern medicine, demographic shifts, and structural realities. They are not the result of Singaporeans casually “using too much care,” but of a system responding to genuine medical needs.

7. Singapore needs a fairer narrative, not a blame game

We need to recognise that ultimately, the majority of us just want everyone to get the care they need and want. Doctors want to provide the best care possible. Insurers want to keep premiums sustainable. Patients want clarity and peace of mind. Hospitals must manage rising costs and staffing challenges.

The story is not one of “abuse” or “overuse.”

It’s a story of rising complexity, higher expectations, global inflation, medical advancements, ageing populations, and real people doing their best within the system.

8. Beyond fear: A more balanced way forward

2025 taught us something important:

When the conversation becomes negative, extreme, or one-sided… Everyone loses.

Families become anxious. Doctors become cautious. Insurers become defensive. Hospitals become reactive.

But when the conversation is transparent, compassionate, factual, and collaborative, everyone wins.

No organisation is perfect in a system this complex, so the only meaningful way forward is to move together, acknowledging challenges, sharing responsibility, and working towards solutions that genuinely serve people. Solutions that recognise different needs, preferences, and financial circumstances, while ensuring that both public and private hospitals can operate sustainably and fairly, side by side.

A sustainable system also means ensuring that insurers remain financially stable, because without viable insurers, there is no long-term protection for policyholders. Profitability is not the goal in itself, but a necessary condition for insurers to continue offering coverage, paying claims promptly, and supporting patients through life’s biggest health moments.

At the same time, policyholders must remain at the centre of every decision. Any redesign of insurance products, fee structures, or care pathways should ultimately benefit the people who rely on them by keeping coverage accessible, predictable, and fair.

Singapore has one of the strongest healthcare systems in the world because we work together. Public and private. Patients and providers. Regulators and insurers.

2026 can be the year we:

• Rebuild trust
• Communicate better
• Reduce uncertainty
• Make insurance simpler
• Champion fairness
• Empower people with knowledge

And most importantly, put patients back at the centre.

As 2025 ends, one call to action: Know your coverage

If there is one lesson from this year, it’s this:

Singaporeans want clarity. Not fear. Not surprises. Not finger-pointing.

Clarity begins with understanding your own plan, what it covers, what it doesn’t, and what options you have.

Before 2026 begins, take a moment to review your health insurance coverage.

A little clarity goes a long way when life happens.