Peace of mind in in­sur­ance has a price

The Straits Times - - OPINION -

The re­cent re­port that a pa­tient could claim only $4.50 for a med­i­cal bill of $4,477 from MediShield Life (MSL) has put the na­tional health in­sur­ance plan’s cov­er­age in the spot­light. The pa­tient’s to­tal bill for a pro­ce­dure at the Sin­ga­pore Na­tional Eye Cen­tre (SNEC) was over $12,000, but came down to $4,477 after gov­ern­ment sub­si­dies. This amount ex­ceeded the MSL limit for the pro­ce­dure, and a claim of only $4.50 was per­mit­ted in the end. Two ques­tions arise: Are MSL claim lim­its too low even for treat­ment at sub­sidised, gov­ern­ment-run fa­cil­i­ties? Or were charges at the SNEC sim­ply out of whack? The SNEC has said it will re­view its charges. And in a sign that un­der­cov­er­age is not con­fined to a few iso­lated pa- tients, the Min­istry of Health re­vealed that eight in 10 sub­sidised bills were within the MediShield Life claim lim­its, and nine in 10 were within $230 of the claim lim­its. For some con­text: When MediShield Life was launched in 2015, one in 10 sub­sidised bills ex­ceeded MSL claim lim­its, but it is now two in 10. In other words, claims ex­ceed­ing cov­er­age lim­its have dou­bled in three years.

Just as MSL has claim lim­its to cap the in­sur­ance sys­tem’s ex­po­sure to big bills, it may be time to cap the amount that pa­tients must pay, health com­men­ta­tors here have sug­gested. One ar­gued that lim­it­ing Sin­ga­pore­ans’ ex­po­sure to big med­i­cal bills that may fi­nan­cially ruin them and their fam­ily is nec­es­sary for gen­uine peace of mind.

That call res­onated with many on so­cial me­dia – not sur­pris­ingly, since peace of mind is de­sired by all. But it comes at a price. Ev­ery treat­ment has to be paid for by some­body. Sin­ga­pore has a mixed fi­nanc­ing model based on gov­ern­ment sub­sides, self-funded Medis­ave, risk-pooled MediShield Life with de­ductibles and co-pay­ment, em­ployer-sup­ported health­care for some work­ers, and Med­i­fund for the in­di­gent.

Any part of the sys­tem that re­duces the bur­den on one party – such as on in­di­vid­u­als – needs to be picked up else­where. In med­i­cal in­sur­ance, some­one some­where picks up the tab. In Canada and Aus­tralia, where med­i­cal care is “free” for pa­tients be­cause the state funds it, taxes are high. So in Sin­ga­pore, those who want MSL to have higher pay­outs, and cover not just 90 per cent of claims but 99.9 per cent, log­i­cally must also sup­port higher pre­mi­ums. Yet pre­mi­ums must re­main af­ford­able for all.

How can a bal­ance be struck in a way that gives gen­uine peace of mind to all? As a gov­ern­ment-ad­min­is­tered but pa­tient-funded health in­sur­ance plan, MSL re­quires buy-in and trust from pa­tients. The lat­est fig­ures on MSL came only after a se­ries of Straits Times re­ports on the is­sue. The au­thor­i­ties must do bet­ter in re­leas­ing in­for­ma­tion on MSL in a timely man­ner. That way, when pre­mi­ums must go up, Sin­ga­pore­ans would be bet­ter placed to know why.

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