Asian Firm to Launch Innovative TeleMedical Service in U.S.

An American entrepreneur has spent two years building a telemedicine business in Singapore and is ready to enter the U.S. market. RingMD is a web-based physician referral, telemedicine website and smartphone application. Prospective patients select doctors by viewing physicians’ profiles, locations, insurance acceptance, ratings or specialties. The software draws information from 543 medical conditions to connect patients with physicians from 17 different specialties. Patients just enter their symptoms (and preferences), and the website app will list qualified physicians who meet their criteria.

Participating physicians charge for consultations by the minute, and their prices vary. Some providers only charge $1 per minute, while others charge $5 per minute. It’s a competitive market with dynamic pricing. Patients select a provider and only pay for the time they need. Currently, most of RingMD’s physicians are based in Asia, but the firm is adding doctors from all over the world.

The 22-year-old CEO of the organization reports he is now considering entry into the U.S. market. But the question remains: Why did a Silicon Valley entrepreneur choose to start his Health Tech venture in Singapore? The Singapore government was impressed enough with the idea that it invested $500,000 through its National Research Foundation to help fund the tech startup. But there must be other reasons.

The Singapore health care system is often touted by conservatives as a model for health reform in this country. Singaporeans have been required to set aside a portion of their income into a Medisave account (6.5 percent – 9 percent) to fund their current and future health care needs since 1984.  Medisave accounts are a type of health savings account (HSA), while MediShield is an insurance scheme that functions similar to a major medical or high-deductible plan.

About 5 million Singaporeans control a significant portion of their own health care dollars. Thus, you could expect them to be more cost-conscious and act like consumers because they have an incentive to compare prices and control costs. But engaged consumers also generate spillover benefits. You see, when consumers control their own funds, they stimulate beneficial behaviors in suppliers who compete for those funds. This includes the creation of innovative services that become available as providers look for ways to gain patients’ patronage. By contrast, Americans’ overreliance on third-party payment inhibits the development of innovative service models in health care.

This has profoundly affected the cost, quality and convenience of health care. For instance, long before a patient enters a doctor’s office, third-party bureaucracies determine which medical services they will pay for (and how much) and which ones they will not reimburse. This practice has created a highly artificial market which departs in many ways from how other markets function.

A primary reason physician visits are mostly conducted face-to-face is not because doctors are unaware of the existence of the telephone. Every doctor has a cellphone in his or her pocket; every doctor’s office has a telephone to schedule appointments. So in the Information Age, why is the telephone not more widely used for direct patient care? It’s largely because patients pay only 10 percent of physician services directly. Third-party payers — employer plans, insurers and government — pay the remaining 90 percent, and they are not looking for new ways to spend their money.

As a result, health care payers have been slow to reimburse doctors for talking on the phone. On the other hand, consumers are always on the lookout for added convenience, innovative services and money-saving ideas. When patients control more of their own health care dollars, they act more like consumers. In the process, doctors behave more like competitors and look for innovative ways to attract patients.

Currently, people with HSAs, a few people whose health plans pay for phone consultations and those willing to pay out of pocket have the option to talk to a doctor on the phone or by video. The number of firms that provide telemedicine is growing, including firms like TelaDoc and Doctor on Demand. Insurers are slowly beginning to embrace telemedicine as evidence has emerged that telephone consultations substitute for face-to-face visits, rather than increase total physician visits. Another factor that slowed telemedicine is regulatory uncertainty. Medical societies were initially slow to embrace competition among doctors by providing consultations via the phone. That also is changing. As last week’s Health Alert explained, the funding flowing into digital health has skyrocketed in the past year.

Comments (16)

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  1. Devon Herrick says:

    Over the years I’ve noticed that most innovative medical services initially begin outside the third-party payment system. Retail medicine, convenient telemedicine, cash-pay services. Once they’ve proven themselves, only then are they offered to third-party payers.

    • Stephen Gregg says:

      Agree. The HMO movement took place practically over the dead bodies of third party payers. Game changing, destabilizing innovation tends to be an anathema to the main stream, whether AMA, Insurers, and even employers. The worst can be the public regulatory bureaucracy that has no rules for innovation.

    • Stephen Gregg says:

      Devon, you also plug medical savings accounts. While I certainly favor in concept, it seems to me MSA’s without a stated financial target declared by the govt as desirable is almost a pointless effort. Also the “goodness” of MSAs in the absence of a more complete solution will likely allow MSA adversaries to declare, “see I told you they would not do anything!” In my view all Americans need an MSA and all tax advantaged funding whether from the individual, govt, or employer should be channeled thru individual MSAs…..including Medicare. Universal migration to defined contribution.

      • Devon Herrick says:

        I don’t tend to favor coercive arrangements — especially when they are manipulated by politicians (Social Security, Medicare payroll taxes, individual mandate, etc.)

        However, there is a legitimate public policy need to require people to plan for their own security — or else government will have to. I would not be opposed to mandatory withholding for health or retirement security if the individual owned the account and held it in reserve until retirement or for a health care need.

        I believe Singapore found a better solution that other countries. Its philosophy is:
        o Each generation should pay its own way.
        o Each family should pay its own way.
        o Each individual should pay his own way.

        There is assistance for poor families, but Singapore tends to keep the cross-subsidies low.

        Your idea that all subsidies should pass through a MSA/HSA is interesting. I’ve always thought that health benefits should be similar to the lifecycle theory of investing for retirement security. When you are young, you deposit funds into an account for use when you are older. A 22 year old needs a high deductible plan, which should be cheap considering the extremely low risk. Most of their health care premiums should be funding an account; not an insurance plan. When the 22-year old become 52 or 62, they could spend down the accumulated balance when the insurance premiums are much higher.

        • Stephen Gregg says:

          i don’t have any disagreement with the intent of your views. Probably need to confront the obvious view that the politics of this does not want individuals to save money for future health care expenditures. In the old days, I testified before an Oregon State legislative committee explaining MSAs. Never forget one crusty old legislator declaring “why would we want to do that!”….(and lose all that revenue). Govt can’t bring itself to declaring “All Americans should have $200,000 in a personal medical savings account at retirement if they want to mitigate the trauma of end of life health care expenses”. With that declaration, tax policy, credits, employer contributions could all be designed to achieve those ends. Without that unifying target, it is a waste of time in my view. Doctors, Insurers, the public bureaucracy at the heart of it, do not want individuals to have control over their own cash. Self determination v.s dependency agenda. My 40 year old daughter lost her catastrophic insurance policy and when she checked with the Exchange, she was refused any consideration of a subsidized private insurance policy (that I would have subsidized) and told she must join Medicaid as her only option. Result…she just does not have any insurance which I support as a form of civil protest. Why would any young, health adult join up with a program that overtly says “join this, so we can screw you over to help us subsidize someone else”!

  2. James R Chaillet, Jr MD says:

    If the level of deductibles and co-payment or co-insurance could continue to rise(Obamacare sets limits based on the 9.5% rule), health insurance devolves toward catastrophic coverage. Patients, even now, are paying for many services out-of-pocket-most notably early in the coverage year. Some or many have HSAs which are savings accounts to help cover these expenses.

    So even now the health care industry is a fertile field of health care delivery innovations. Some of it will occur through non physician entrepreneurs as described in the article. I suspect that much more will happen when physicians and other providers see the opportunity such as Advanced Patient Imaging, just outside Cincinnati, offering MRIs including interpretations for $395. (Note: I have no financial or other interest in this company) Because physicians are involved as owners and/or providers of the services, the services will be more credible to the public. They may also pressure other providers, such as hospitals, to get their costs and prices more in line with the new reality of consumers being price sensative.

    • John R. Graham says:

      That is a very good case. Government policy tries to suppress physician entrepreneurs (Stark laws). However, physician ownership of a facility is a good signal of quality, because the physician’s capital is at risk.

      • Stephen Gregg says:

        I don’t know about these assumptions as most physicians and their management are “gamers” of the system, thus the ultimate public push back on physician owned hospitals. Never ceases to amaze me how many docs are fed up with the practice of medicine and seek greener grass in some aspect of the business side.

    • Stephen Gregg says:

      I am not comfortable with physician owned enterprises connected to that physician’s ability to refer to the business. Had a friend with a son who was an Orthopedic Fellow looking for a job…It was explained to him by one practice that he would have a quota obligation to the group’s MRI.

      • John R. Graham says:

        MRI scans? Well, that is one problem with 3rd-party payer: No incentive to limit too many MRI scans.

  3. Don Levit says:

    I was glad to hear that John Goodman contacted Elliott, our marketing director, regarding our Health Matching Reimbursement Account for self funded plans and Health Matching Account for fully insured plans.
    We are taking our super-sized HRA/HSA on the road, first in Las Vegas on Feb. 9th.
    To view our touring schedule, go to
    Don Levit

  4. Big Truck Joe says:

    Regarding physician ownership showing quality of services, how any doctors want to run afoul of Stark Anti-kickback laws and potentially be facing a govt funded Fraud lawsuit? Losing that is a felony and millions in fines in damages. Remember, HHS has an uimited amount of legal resources to chase down those evil doctos who are “gaming the system” for personal benefit; doctors don’t. You would essentially force the doctor out of practicing medicine to run the new entrepreneurial venture which is the only way to 100% not be implicated in a Stark violation.

    • John R. Graham says:

      The Stark laws are harmful. So, my statement will be more executable when they will have been repealed.

  5. Stephen Gregg says:

    The State of Florida is crawling with physicians trying to manipulate an extra buck out of the system. Check the history of CEO leadership of United Health Care, U.S. Health Care and you will find excessive gaming in my view. I really don’t think there is anything particularly special about the innovation of doctors. General Surgeons can be particularly unusual. We used to host droves of them at Kaiser trying to mimic something back home. Embarrassing.

  6. Don Levit says:

    Devon and Stephen
    I agree that the most secure form of accumulating health care reserves would be in one’s own separate account
    However if one does so through a separate notional account in an insurance company one could earn 8-12 percent per month
    Through pooling a large group instead of each person accumulating for himself much greater returns on the contributions are available
    We will be in Las Vegas Feb 9-11
    Come visit our booth
    To learn more go to
    Don Levit

    • Stephen Gregg says:

      I would be amenable to a pooling of funds similar to the Section 129 College Savings Accounts, where my grandkids have their own separate savings account pooled and overseen at the State level. I can even pick my preferred State without consideration of my State of residency. If we had a public policy target of $200,000 at retirement, pretty easy to get there with a combination of contributions from parents, grand parents, tax credits, future employers and the individual. Unfortunately the mentality of most is “$200,000 ! Are you kidding me? I can’t even save for my retirement and college education for my kids”!